Permit � f
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
S COMMUNITY DEVELOPMENT Permit #: ELR2011 -00217
Tigard OR 97223 503.718.2439
13125 SW Hall Blvd., Ti Date Issued: 10/06/2011
TIGARD 9
Parcel: 1 S135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 1180
Project: NSKB, LLC Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Data telecommunications system.
Contractor: ADVANCED COMMUNICATIONS SERVICES IN Owner: LINCOLN CENTER LLC
PO BOX 231196 BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97281 -1196 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE 503 - 598 -7082 PHONE.
FAX. 503 - 598 - 7320
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/06/2011 $75.00
12% State Surcharge - Electrical 10/06/2011 $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 $84.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law All work will
be done in accordance with approved plans This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952- 001 -0010 through OAR 952 -001 -0090. You may obtain a copy of the_ = =�ect questions to OUNC by calling 503 232 1987 or 1 800 332 2344.
_
Issued By. �_. - �; / ' Permittee Signature: d
'� i OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application FOR 0 -EFICE USE' ONIA ' "
11‘ City of Tigard Received Permit No.
- q 13125 SW Hall Blvd., Tigard, OR 972 Plan Review `
Phone: 503.718.2439 Fax: 503.598.1 6 � Date/By: Other Permit- / /J� ii ._�
T7 G A R D Inspection Line: 503.639 OC � Q , Date Ready/By .runs RI See Page 2 for
Internet: www.tigard- or.gov v r ? I =onfied/Method: Supplemental Information
\\
H YPE OF WORK ON AN 1 O � GQ - PLAN REVIEW
El N ew construction ❑� ` Addition /alteration /r®tal$�elit Please check all that apply (submit 2 sets of plans w /items checked below):
''C3`"' ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards
CATEGO � OF' CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agncultural
❑ 1 and 2 family dwelling 0/Commercial/industrial ❑ Accessory building amps for all other mstallations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately denved system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: I D _(9 a S U reej� 2- e(( 100H e occupancy.
❑ more residential or more residential units. ❑ Recreational vehicle parks
❑ Health -care facilities ❑ Supply voltage for more than
Cit /ZIP j r� l( , Imo- 7 Z 23
�'
0 Hazardous locations. 600 volts nominal.
� k) t. no.: Project ./a Pro ect name: S� � (
❑ Service or feeder 600 amps or more.
Suite/bldg./apt.
I " ' FEE SCHEDULE
Cross street/directions to job site: („�/ to h r . ) Uv-- l2 r' Description I Qty. I Fee. I Total I *
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75 00 2
DESCRIPTION OF WORK - (with above sq. ft.)
Limited energy, multi- family
75.00 2
L. 0 ( V C cj,(- 06Lb 110_3_ I residential (with above sq. ft )
Services or feeders installation, alteration, and /or relocation
— VO I (e _ r D t.( G-- 200 amps or less 100.70 2
❑ .PROPERTY 'OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: y\f 1 , ) 401 amps to 600 amps 200.34 2
S C 1 601 amps to 1,000 amps 301 04 2
Address: / 0 2 S(A.,) (,./ r r) Yom( . S'7 _ / / 0O Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: / 11 col G , ( 6 Q ( ! 7 ZZ .3 relocation
Phone: (5c, 9 ) 5 35 -�(J 0 33 Fax: ( ) 200 amps or less 59 36 1
J 201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A Fee for branch circuits with
above service or feeder fee,
❑ APPLICANT • ONTACT PERSON each branch circuit 7 42 2
Business name: /, S
W - 9 B Fee for branch circuits without
/ vayLei, I (owl 04 ur / (��I 1.S , l/ 1 U service or feeder fee, first 56 18 2
Contact name: ,, oe ) -�i branch circui
Each add'l branch circuit 7 42 2
Address: Po box 7,_/ /9 Co Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City/State /ZIP: ��� —( 0( ( ) j/2 77 / dwelling, service and/or feeder
Phone: (5 0 7 ) 5 07 - C 7 c(c CJ �F a.x :: (5 5 j g _ -7 2c) Reconnect only 67.84 2
Pump or irrigation circle 67 84 2
E - mail: ^, LI ��6 V C . C e . ( ii71 Sign or outline lighting 67 84 2
CONTRACTOR Signal circuit(s) or limited -energy
Business name: AZl uG ,{ 4 ( C n panel, alteration, or extension. I Page 2 7 2
��{ � C 7 Y w -S Each additional inspection over allowable in any of the above
Address: Co Sox -2:3 (( 9 (' p Additional inspection (1 hr min) 66.25/ hr
1 Investigation (1 hr min) 66 25/ hr
City/State /ZIP: en z c y c( , G '2- 2 7 2-s I Industrial plant (1 hr min) 78.18/ hr
Phone: Op 3) )7 / 7t4 C_i Fax: ( 3) F > G I g - 3 2 a Inspections for which no fee is 90.00 / hr
specifically list (%3 hr min)
CCB Lie.: ' 1 Electrical Lic.: �V Suprv. Lie.: / ELECTRICAL PERMIT FEES
J s f 0 1 h i ' l Subtotal:
Suprv. Elect r a re, requirer Electric' Plan review (25% of permit fee):
Print name )(lax) vYl ,.. _, Date: 1 0 C9 I I State surcharge (12% of permit fee): " . .' d
� �
TOTAL PERMIT FEE: ' c/ c r
Authorized signatur
This permit application expires if a permit is not obtained within 180
Print name: Date: U Ir
l Q ' 1 days after it has been accepted as complete ` Number of inspections allowed per permit.
IABuildingWennitsmLC- PennitApp doe 07/01/10 440 -4615 (11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
•
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
H Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n I • nstrumentation
❑ Intercom and Paging Systems
❑ L andscape Irrigation Control*
❑ Medical
n N • urse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Budding\Permns\ELC- PennitApp doc 07/01/10