Permit C ITY O F TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00101
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/23/2008
PARCEL: 1 S135AB -03400
SITE ADDRESS: 10260 SW GREENBURG RD 200 ZONING: C -
SUBDIVISION: LINCOLN CENTER /LINCOLN TOWER LOT: 014 JURISDICTION: TIG
PROJECT: ASCENTIUM
Project Description: Installing (1) low voltage data system.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
SHORENSTEIN REALTY SERVICES CAPITOL DATA & COMMUNICATIONS
ONE SW COLUMBIA ST #300 11401 NE MARX ST.
PORTLAND, OR 97258 PORTLAND, OR 97220
Phone: 503- 412 -4800 Contact #: PRI 503- 255 -9488
FAX 503- 257 -7121
Reg #: ELE 26- 1054CLE
FEES LIC 142457
Description Date Amount SUP 2834LEA
[ELPRMT] ELR Permit 4/23/2008 $75.00
[TAX] 12% State Surch 4/23/2008 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: %������� . ermittee Signature: i �� /
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
t 04/23/2008 13:36 5032551966 CAPITOL ELECTRIC PAGE 02
''' Ilectrica[ Permit Ap licatioII Ftl1 { 'oh► rc'P ltyr Q� Ll'
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ity of Pr &A Plan Review �
4 1 13125 SW J-ieI1 Blvd., Tigard, O 9722 0 °$ 2o rm O$ Date /t3v, Other Permit:
i9 . Phone: 503,639,4171 Fax: 503,59'0060 503,59'0060 Date Ready /fly: Juris: re Nee 2 Per
Ti A. ii T? CnspectienLine: 503.639 -4175 0, �� °�� A V I Oti
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• Intl rnet: www.tigard-or.gov CI T or SIGN
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TYPE OF WORK I�UILLil' ' PLAN REVIEW
New construction - Addition /altcration /replacement Please check all that apply:
❑ Demolition ❑ Other: _ ❑ Service over 225 amps, comma ❑ Hazardous location
CATEGORY OF CONSTRUCTION ❑ Service over 320 amps - rating Li Building Over 10.000 sq.ft.
L 1- and 2 fancily dwelling Li Commercial /industrial I_I Accessory building of 1 and 2 - family dwellings 4 or more new residential
❑ Multi - family ❑ Master Builder - L-i Other ❑ System over 600 volts nominal units in one structure
10B SITE INFORMATION AND LOCATION n Building over three stories ❑ Feeders, 400 amps or more
Job no,: 080170 .fob silo address: 10260 SW Greenhurg ❑Occupant load over 99 parsons El Manufactured structures or
❑ Egress /lighting plan RV park
City /Slalcl7,iP; Portland OR 87223 n Health -care facility L Other:
r Submit g sets of plans with any of the above.
Suite /bldgJapt, no.: Suite 200 Project sonic: a GIN urnitu 1 r i The above are not applicable to lempora construction service.
G- FEE SCHEDULE
Cross Street /Directions to job site: Description 1 Qty. J re Total
New residential - single or multi- family dwelling unit,
Subdivision Lot no.: Includes attached garage.
T 1000 sq. R, of less $ 145.15 4
Tax map/parcel no.: En, Adel 500 so. It orportion 5 33.40 I
DESCRIPTION OF WORK Limited energy residential S 75,00 2
Network cabling Limited energy, non - residential $ 75,00 2
Each manufactured home or modular
L PROPERTY OWNER I - 11 TENANT dwelling, Service and /or feeder 5 90,90 _ 2
Namur Service nr feeders installation, alteration, and /or relocation
200 wpm!: Iess s 10,30 2
Address: 201 amps to 400 amps $ 1 06.85 2
401 amps to 000 l0 amps s 16n.6n 2
il
City /Slate /ZIP: 601 amps 1000 amps . . s 240.60 2
Ovcr 1000 amps nr votes S 454.05 2
Phone: Fax: Reconnect only $ 00,95 1 I 2
503. 295.5355 Temporary services or feeders Installation. alteration, and /or
Owner installation: This installation is being made on properly that I own which is not relocation
intended for sale, lease, rent or exchange, according to ORS 447, 449. 070, and 7131 200 amps of 1033 S 66.15 1
Owner signature: r>alc: - 201 an ps to 400 amps R 101,30 2
401 amps to 600 snips 5 133,75 2
• APPLICANT I CONTACT PERSON Branch circuits - new, alteration, or extension, per easel
Business Name: A, Fee liar branch circuits with
service or feeder fee, each
Contact name: branch circuit. 5 6.65 2
B. Pee for branch circuits
Address;
without service or feeder fcc,
each branch circuit 0 46.55 2
Ci tylStatc/7_IP: Each additional branch circuit: S 6.65 2
Miscellaneous (service or feeder not included)
Phone; Fax:
Pump or irrigation circle $ 5340 2
Sign or outline lighting $ 53.40 2
E - mail: Signal circuits(s) or limited -
CONTRACTOR - energy panel, alteration, or
ilusines Nantc: Capitol Data & Communications, Inc.
extension, Describe: / Page 2 2
z n a 6 � Rticls additional inspection o ver Allowable in any of the a bove
Contact name: rte- /-t
Y - Per inspection S 02,50
Adncess 11401 NE Marx Street Investigation per hour (1 hr min)__ $ 02,50 L.
Industrial plant per hour $ 73.75
City /Stale /ZiP: Portland, Oregon 97220 . - ELECTRICAL PERMIT FEES"
- r- Subtotal 75,00
Phone: 503 - 255.9488 Fax: 503 - 257.7121 Plan review (2g3 of permit ice)
State surcharge ( 12% of permit fee) 9.00
CCB Lie,: 14257 lElcctrical Lie,; Z6- 1015CLE I Suprv. Lie,: 2934 LEA TOTAL PERMIT FEE 64.00
Suprv. Electrician signature. required: Or ^-� MO pernnlrnppllentbn aspires Ito permit a not pnrntncn within ran
/ . "~-•' tray, nnv tr hen been tempted no complete
_ Print Name: Ray vein .. Fate: 0412 :/08 ^' Fee methodology set by Tri•County 0cildirg Industry Service Rom'
• Authorized signature: "Nuntbcr ofinspcetions por pormit allowed. •
Print Name: Ray Younger
•
CITY OFTIGARD
BUILDING DIVISION -' PERMIT #: ELR200B -001Q1 ,
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/23/2009
Phone: (503) 639 -4171 im��
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/20/2008 TIME: 6 :59AM PAGE: 45
SITE ADDRESS: 10260 SW GREENBURG RD 200 CLASS OF WORK:
SUBDIVISION: LINCOLN CENTER /LINCOLN TOWER LOT #: 014 TYPE OF USE:
PROJECT NAME: ASCENTIUM
DESCRIPTION: Installing (1) low voltage data system.
OWNER: SHORENSTEIN REALTY SERVICES, PHONE #: 503 - 412 -4800
CONTRACTOR: CAPITOL DATA & COMMUNICATIONS PHONE #: 503-255.9488
Inspection Request Scheduled For: Date: 5/20/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 07011302 971 - 508.3714 N
Corrections /Comments /Instructions:
t
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•
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. Vy i y\
V'
:2 PASS) Ti PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: G me u / Date: to 614 Phone #: (503) 718- lifitle
CITY OF.TIGARD
BUILDING DIVISION PERMIT #: ELR }00I3 -00101
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/23 /2009
Phone: (503) 639 -4171 moo, Nl�l�iWi�l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/20/2008 TIME: 6:59AM PAGE: 46
SITE ADDRESS: 10260 SW GREENBURC RD 200 CLASS OF WORK:
SUBDIVISION: LINCOLN CENTER /LINCOLN'IOWER LOT #: 014 TYPE OF USE:
PROJECT NAME: ASCENTIUM
DESCRIPTION: Installing (1) low voltage data system.
OWNER: SHORENSTEIN REALTY SERVICES, PHONE #: 503.412 -4800
CONTRACTOR: CAPITOL DATA & COMMUNICATIONS PHONE #: 503- 255 -9488
Inspection Request Scheduled For: Date: 5120/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
M! c M'on 070113 -01 971- 506 -3714 Y
Corrections/Comments/Instruction �
PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED •
Inspector: 6-1 N4Qa Date: 6f 29I(51 Phone #: (503) 718- 11.1A