Permit I ll CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
:''' - COMMUNITY DEVELOPMENT Permit #: ELR2011 -00166
Date Issued: 07/12/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1S135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 400
Project: Kforce Subdivision: ASHBROOK FARM Lot: PTS 1, 2
Project Description: Data /telecommunications.
Contractor: REIGNCOM, INC Owner: LINCOLN CENTER LLC
4134 N VANCOUVER AVE SUITE 303B BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97217 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 262 -9335 PHONE:
FAX: 503 - 256 -7813
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/12/2011 $75.00
12% State Surcharge - Electrical 07/12/2011 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: Y Fire Alarm: N
HVAC: N Instrumentation: N
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR + -• • - 090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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Issued By: Permittee Signature: (74/ A/ , L/ C -/Y
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the Job site at the time of each inspection.
FROM : FAX NO. :503 256 7813 Jul. 07 2011 11:37AM P1
• • • • • • • .
Electrical Permit Application REcErvpn fok 0 1:1.
City of Tigard. " ,
. . L c e t r e r 7 A g re PrA Famit N° " Adik
• . .
Ill • 13125 SW Hall Blvd., Tigard, OR 97223 1 A Pla R
• 1 Phone: 503.7182439 Fax: • 503.598.1960v U I -• 7
-- U 2011 Beyv7 Other Pcsmit
Tic A ,, ,, Inspection Line: 503.639.4175 Date Ready/By. .
Jostr:_,...-/ r,,„.. HI See Page 2 for
Internet www.tigard CITY OF TIGARD NatifiedThAethcid' " i t bill' Supplemental Information
..... .:.':',:;,./ ....J '.. . !.'..2..' ' ,f-''-'7 : •'::: ... f,-... . ,: •q i. "04 . ;:0 . ; : .4 1 0 16 .P.#fg .. .PlY0.;.VP4 -: : .. : : . '''..:: g
.... . . . ,.. .._
13 New construction El Addition/alteraticm/replacement • please check all that apply (submit 1 sets of plans w/items checked below):
°Service or fheder 400 arum or more Ei Building over Mtn* Stories.
El Demolition 0 Other: whero Me available fault carnmt 0 marinas and boatyards.
. .
•
' ' r: ',*;.....', ::•'' ' 7 ' '6ilit L. n, ,,,,: ''..'•;'.,:',,':',.: C,.',1'. exceeds 10000 amps at 15e volts or CI Ficathig headings.
let to yond, or exceeds 14,000
El CI COtrimereial agricultural
1 - and 2-family dwelling i2 Commercial/industrial 0 Accessory building sanps for all other installations. building& •
0 Mai-family 0 Master builder 0 other 0 Fire pump. 0 Installation of 75 ICVA or
- 013merpney system. larger separately derived system.
#1*:,'*.i* ****00K*:040.04110$ 0 Addition °film motor toad or El - A''. "F'. "1-2". "1-3".
Job no.: 1 Job site address: 10300 SW Greenburg 100HP or more. occupancy.
0 Six grim= residential units 0 Recteational vohicie parks.
City/State/ZIP: Portland, OR, 97223 CI Ileattb-corc halite& ' LI Supply voltage for most than
0 Nazardous locations. 600 volts nominal.
Suite/bIdgJapt. no.: 400 « Project name: KFOrCe Voice & Data 0 Service or *oda 600 amps or more.
'. ...... 4. q . ' .. . ' 'J.. !. .4 1 0.0 .. $#* 1 0..tag';': - ',;:: : /(:;...i.;* .. CW
Cross street/directions to job site: rincri;:10 Loh ( vet. i Tom i •
New residential single- or multi-family dwelling unit.
Includes attached garage. . .
Subdivision: •
I Lot no.: 1,000 sq. ft. or less , 168,54 4
E.a, addl 500 sq. ft. arportica 3392 1
Tax map/parcel no.: .
Limited energy, residenti 75.00 2
al ' .
' . •
• 1 '.., ,.'... ',: . : .• .,.:1::::1,.;‘:......: .:: .... .; , (vnth abwi sq " fk ' ..
Limited energy, multi-famtly
75.00 2
Voice/Data wire installation for thirty Jacks in Suite 400 residential (with above sq_ ft) _
Services or feeders instillation. alteration, and/or relocation
200 amps or leas • 100.70 • 2
:).'. : 0* 1 .0 1.: : ./ :. ' .; . ? ' : • .?(MW,C... , .. , ;. : : : . 1112. ;.) + 0 . : **; - '' • : • .:• :: ' . *: ......:.....!, 201 amps to 400 amps • 133..56_ 2
401 amps to 600 amps 200.34 2
Name:
• . 601 amps to 1,000 amps ' 301.04 2
Address: Over 1,000 amps or volts 552.26 _ 2
Tetapontry services orfeeders installation, alteration, and/or
City/State/ZIP•
relocation
Phone: ( ) [ Fax: ( ) 200 amps or less . 5936 1
ps
Owner installation: This installation is being made on property that I own which is not 201 am to 400 amps 125.08 2
intended for sale, !case, rent, or exchange, according to ORS 447, 449, 670, and 701_ 401 MIPS TO $99 amps 168.54 2
Branch circuits - new, alteration, or extension. per panel
.
Owner sigrraturcr Date; A, Fee for branclicircuitiwith
.. ..**,.... ,: ,.::..•....' : .:•: :: •:::':Aa . .*** *- .W, - ...• •: :"V::.'::7il';•' : ':g• ip:s.3;00rAMt • a wndce fee 742 2
' Business name: B. Fee for branch circuits W/ihOW
service or feeder fee, first
56.18 2
Contact name: branch circuit
Each add'I branch circuit 7 .42 2
Address:
Miscellaneous . . Modul
(service or feeder not included) _
,Ench manufactured Of
City/State/ZIP:
dwelling. service and/or feeder 67.84 2
-
Phone: ( ) Fax,: : ( ) Reconnect only ' 67.84 2
E-mail: Pump or irrigation circle • , 67.84 2
Sign oi outline lighting 67.84 2
•'. •"-: •.::::•:. :. :•:' •••:' •• ':•:. •:::::". ::•', ':, ,,: : ;• '• . : :- :.. , ". i .•• 1 O 5 NTRA:CIIN: .. .N ., 4 . :1':; , :ez ..:.;•.:::':::,::4.::K.'i;'...:...::::'.:!'... signal' circuit(s) or tinutcd-cnctgy
Business name: Reigncom, Inc. panel. alteration, or extension. I page 2 $75.00 2
1
1 i I Each additional inspection over allowable in any of the above
Address: 4132 N. Vancouver Ave, Suite 303B q1, Additional inspection (1 hr min) - 1 • 6625/ hr . ..
_ ttwesiiption (i in- min) 6625/hr
City/State/ZIP: Portbnd, OR, 97217
0' _ Industrial:dant (I hr min)
Fax: (503) 256-78 /4 // Thauccoons 9
for which no fee is . _ 78.18J hr
Phone: (503) 262-9335 I 040/10
e'„," I„, , specific...5.4 OS hr min)
(
. , . . . . . ..,
CB Lie.: 129318 9 ( "" Electrical LiC.: 26 &Try. Lic.: 31671.,EA signature, ;,27',..g#:'•,••':::.:";(1•:•:: • • " " ' ' "•"" ""'• """- • ' • - ••••
%
Suprv. Electrician requi ;;-.. _ ..... .411 0P 1.„ &A , .... ... . .
ELECTIuciwnitmrr, :TEEs...,!....
Subtotal: S75.00 • Plan review (25% of permit fce):
- ..-
Print name: Richard A. Minich • Date: 7/7/11 State surcharge (120.4 of permit fcc): $9.00
•
TOTAL. PERMIT FEE: $84.00
Authorized signature: - '• •
Thl Permit application cspinss if a permit It not obtained within tau
Print name: Richard A. Minich •
Date: • 7/7/11 data after it fuss been accepted as complete.
• " Number of bispeclions allowed per lximit.
. : •
r AR / 6 # J - - 5 0 e / /4e.• 77ff:4 e 8ez • • 7 f ... /..
ee 9 Al .- efle- -7 • ro C 761-7- -- 4 Ai 7/ - td / 77 - 4-41 74t
& I ES 7 Gc)/1-t-• E Afo/s/A4V 1 /,/ 771447- /61/7 14/24 le2-1-S*6-4 4. gEC0146
FROM : FAX NO. :503 256 7813 Jul. 07 2011 11 : 38AM P2
Electrical Permit Application - City of Tigard
Page 2- Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL'WORX ONLY
Fee for all residential systems combined $75.00
Check Type of Work Involved:
0 Audio and Stereo Systems*
• Burglar Alarm
Garage Door Opener*
0 Heating, Ventilation and Air Conditioning System*
O Vacuum Systems*
1171 Other
COMMERCIAL WORK ONLY
•
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Fee for tach commercial $15.00
system •
(SEE OAR 918-309-0000)
Check Type of Work Involved:
•
Audio and Stereo Systems
0 Boiler Controls
0 Clock Systems
Data Telecommunication Installation
D Fire Alarm Installation
•
HVAC
0 Instrumentation •
LI Intercom and Paging Systems •
El Landscape Irrigation Control*
O Medical
•
O Nurse Calls
El Outdoor Landscape Lighting*
0 Protective Signaling
El Other
Total number of commercial systems:
. •
*No licenses are required. Licenses are required
for all other installations
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