Permit N CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
°' 1 : . COMMUNITY DEVELOPMENT Permit #: ELR2011 -00245
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/16/2011
Parcel: 1S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 150
Project: Sleep Medicine Network Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Fire alarm.
Contractor: SAFE TECHNOLOGY GROUP INC Owner: LINCOLN CENTER LLC
6400 NE HWY 99 SUITE G375 BY SHORENSTEIN PROPERTIES LLC
VANCOUVER, WA 98665 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 360- 699 -2130 PHONE:
FAX: 360 - 719 -1527
FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/16/2011 $75.00
12% State Surcharge - Electrical 12/16/2011 $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: N Fire Alarm: Y
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 accord - • - 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. ATTE ' ON: Oreg• • law re• • es you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -00 0 through OAR 9 •-00 .190. • may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1. .332.2344.
i f
Issued , Permittee Signature: X ,'C
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 OFFICE USE ONLY
City of Tigard Date /B . �� , ) Permit No.: i� , • it —�
" 13125 SW Ha Blvd., Tigard, 91.11:1V r t �'\ Plan Review
I
Phone: 503.718.2439 Fax: 50 t.� ` +:'. " .0 {.O Date/B : Other Permit: i
I . ' G.
TIGARD Inspection Line: 503.639.4175 GC Date Ready/By: H See Page 2 for
Internet: www.tigard- or.gov Ov �\(`��'lti ® w //' . Notified/Method: / / /l - i Supplemental Information
TYPE OF WO OF ���� PLAN REVIEW
VV�` 1
E] New construction ® Addition/altcra t - • :cement
Please check all that apply (submit 2 sets of plans w /items checked below)'
n
• ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ■ Commercial /industrial ❑ Accessory building amps for all other installations buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB' SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "l - ", 'l -
Job no.: Job site address: 10220 SW GREENBURG RD IOOHP or more . occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: TIGARD OR 97223 ❑ Health -care facilities. ❑ Supply voltage for mote than
❑ Hazardous locations. 600 volts nominal
Suite /bldg. /apt. no.: 150 Project name: SLEEP MEDICINE ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street /directions to job site: LINCOLN 2 Description I Qty. 1 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'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
sq. 7.5.00 2
DESCRIPTION OF WORK ( with above q )
ft
Limited energy, multi- family
FIRE ALARM residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 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
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
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
® APPLICANT El CONTACT 'PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: SAFE TECHNOLOGY GROUP INC. B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: JASON SWEET branch circuit
Each add'I branch circuit 7.42 2
Address: 6400 NE HWY 99 SUITE G375 Miscellaneous (service or feeder not included)
City/State/ZIP: VANCOUVER WA 98665 Each manufactured or modular 67.84 2
n' dwelling, service and/or feeder
Phone: (360) 699 - 2130 Fax: : (360) 719 - 1527 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: SALES @SAFETECHNOLOGY.NET Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy •
Business name: SAFE TECHNOLOGY GROUP INC. panel, alteration, or extension. 1 Page 2 7500 . 2
Each additional inspection over allowable in any of the above
Address: 6400 NE HWY 99 SUITE G375 Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: VANCOUVER WA 98665 Investigation (1 hr mm) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (360) 699 - 2130 Fax: (360) 719 - 1527 Inspections for which no fee is 90.00/ hr
specifically listed (%3 hr min)
CCB Lie.: 173731 Electrical Lie.: CLE79 Suprv. Lie.: 4272LEA ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: / .* Subtotal: 7 j r Q9
/ Plan review (25% of p fee): ,_---
Print name: JASON SWEET Date: 12 -8 -11 State surcharge (12% of permit fee): 9 go
Authorized signature:
TOTAL PERMIT FEE: X 'i,DU
7 11 /i/ jr--
,
T his permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: JASON SWEET Date: 12 -8 -11 * Number of inspections allowed per permit
P\ Building \Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(1 1/05 /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*
n Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
n 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
n Clock Systems
n Data Telecommunication Installation
Fire Alarm Installation
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems: _
*No licenses are required. Licenses are required
for all other installations
I:\ Buildin ■ELC- PermitApp.doc 07/01/10