Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
n il& DEVELOPMENT SERVICES PERMIT #: ELR2006 -00052
1 1 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 2/13/2006
PARCEL: 1S135AB-01004
SITE ADDRESS: 10220 SW GREENBURG RD 130 ZONING: C -P
SUBDIVISION: LINCOLN CENTER /TWO LINCOLN LOT: JURISDICTION: TIG
Project Description: Feeder cables.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA /TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
EQUITY OFFICE PROPERTIES TRUST CSHARK NETWORKS
ONE SW COLUMBIA #300 5111 FIRWOOD DR.
PORTLAND, OR 97258 WEST LINE, OR 97068
Phone: Contact #: FAX 503 697 - 1818
PRI 503- 697 -1818
FEES Reg #: ELE CLE23
LIC 164236
Description Date Amount
[ELPRMT] ELR Permit 2/13/2006 $75.00
[TAX] 8% State Surcharl 2/13/2006 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set f• th in OAR 952 - 001 -0010
through OAR 952 -901 -0100. You may obtain copies of these rules or direct questi• • • Ui
. : - 503- 246 -6699.
By: AO v � / / /I;�� /./
Issued B % Permittee Signature: 'AP" ' -
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'N DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
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.
111
Al Per 1` r l
Etc = ;ti i r' o I rol "_U o \`Ll
City of Tigard t i m s Received ^ I e i Permit No.., 41, ! '049 5-*
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503 96e 2�U6 ' 3 14 . i0 F I'' Date/B .
Inspection Line: 503.639.417 1 'I' Date Ready/By: lisiG El See Page 2 for
Internet: www.ci.tigard.or.p � ru _ Notified/Method: Supplemental Information
• . E�4� PLAN REVIEW
❑ New construction • a�tio e
B rY/alI' (b>Pacement Please check all that apply:
1:3 Demolition ❑ Other: ❑Service over 225 amps, comm'l ❑ Hazardous location
['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of l- and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi family 1=1 Master builder ❑ Other: ❑Building over three stories 0 Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
.. JOB SITE INFORMATION AND LOCATION DE plan RV park
Job no.: I Job site address: /6) Z ,�,r� / i 96 i^ ❑Health - care facility ❑Other:
Submit 2 sets of plans with any of the above.
City /State /ZIP: oS✓ / - f - 1Z / Z) . The above are not a to temporary construction service.
Suite/bldg. /apt no.: j zQ 4
�� Project name: t S FEE* SCHEDULE , _ .
l�� 1 Des ion I Qty. I Fee. I Total
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2 a ' DESCRIPTION OF WORK Each manufactured or modular,�1M .4,/S dwelling, service and/or feeder 90.90 2
,Lt— / /A=t) ���s Services or feeders installation, alteration, and/or relocation
( �� 200 amps or less I I 80.30 I 2
0 PROPERTY OWNER I . ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) I Fax: ( ) relocation
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signatur Date: Branch circuits — new, alteration, or extension, per panel
.. : APPLICANT I ❑CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each
Business name: �"*"/„. � /yrGC,e 1�� branch circuit 6.65 2
Contact name: ( — , ^ c+`6\ B. without for service circuits
i I T�`Y� I without service or feeder fee, 46.85 2
Address: first branch circuit
Each add'I branch circuit 6.65 2
City /State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) I Fax :: ( ) Pump or irrigation circle 1 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
.
CONTRACTOR energy panel, alteration, or
Business name: extension. Describe: a Page 2 2
Address: ` <'// A � K:/l� Each additional inspection over allowable in any of the above
o/ �j Per inspection 62.50
City /State/ZIP: td;: j /1/414/, 4 r J 8 , Investigation per hour (I hr min) 62.50
Phone: 503 / �, / / I Fax 3 ) G _ /67/A Industrial plant per hour 73.75
_ ELECTRICAL PERMIT FEES *,
CCB Lic.:`".( ' , Electrical Lice 2,2) I Suprv. Lic.: Subtotal
Suprv. Electrician signature, required: 7 — / —o Plan review (25% of permit fee)
)e. V ""/ State surcharge (8 %ofpermit fee) Date:
TOTAL PERMIT FEE —c(
ic Authorized signatu ?� This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: + Date: i * Fee methodology set by Tri- County Building Industry Service Board
V r ���`
•• Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PernitApp.doc 12/03 441 .. 15T(10/02/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:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK
Fee for each commercial system $75.00
(SEE OAR 91 8- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
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