Permit • CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
!I COMMUNITY DEVELOPMENT Permit #: ELR2012 -00054
Date Issued: 03/27/2012
T1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 parcel: 1S135AB01002
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 601
Project: Matrix Absence Management Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Security system.
Contractor: PIXEL LLC Owner: LINCOLN CENTER LLC
4647 SW HUBER ST BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97219 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 208 -7248 PHONE:
FAX: 971 - 223 -4730
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/27/2012 $75.00
• 12% State Surcharge - Electrical 03/27/2012 $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: N
HVAC: N Instrumentation: N
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: Y 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 0 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /
Issued By: Permittee Signature: /7i /eW - 7SO N
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.
To: 15035981960@maxema @ 503- 598 -1960 From: Pixel LLC v,0 Pg 1/ 3 03/27/12 11:03 am
a
Electrical Permit Application e - 0 , , \ _ I 11 1 III t I 1. I !..I II .1. \
City of Tigard � ,lt , Q �_ , ,_. .: i DO Permit No.:EZA,2 9 /2 — a
13125 SW Halt Blvd., Tigard, OR 9 ?tb
• i Phone: 503.718.2439 Fax: 503.598. 1 . '1 QQ` • r?: �°T ' a /..2 —Q` •
i i Inspection Line: 503.639,4175 �� ( Date Ready/By:
Internet: www.tigerd or.gov � Nodfetlimathoe: IIM WEER!"
TYPE OF WORK V\ �ti� :. PLAN REVIEW
•
❑ New construction ® Addition/alteration/replace Please choir all that apply (submit 3 sets of plans w /items checked below):
❑ Demolition ❑ Other; O where the l ce� t M ❑ Building over throe ds Marius and boatyard.
m44,1,10.000 amps at 150 volts or 0 Floating building.
.. last to pound, or exceeds 14.000 0 Commercial -use agricultural
El 1 -and 2- family dwelling g ® Commercial/industrial 0 Accessory building amps for all other installations. buildings.
❑ Multl•fbtnily 0 Master builder ❑ Other: O Fire pump. 0 Installation of 75 KVA or
JOB SITE INFORINA'1'ION AND LOCATION. Emergency system. larger fly derived system.
• . O Addition of new motor load of CPA", "E". "1.2 ", "1.3 ",
Job no.: J1075 1 Job site address: 10220 SW Greenburg Road 1°OHPormore. occupancy.
0 six or more residential unite. 0 Recreational vehicle parka.
City /State /ZIP: Tigard, OR 97223 ❑ Heahh.care thcihties. 0 Supply voltage far more than
O Hazardous locations. 400 volts nominal.
Suite/bldgJapt no.: 601 I Project name: Matrix Absence Management O Service or fbeder too amps or more.
:: FEE. SCHEDULE
Cross street/directions to job site: o. I 0tr. i Pe. 1 Total l •
New residential single. or multi dwelling unit.
Includes attached garage.
Subdivision: I Lot 4.: 1,000 sq. ft. or less 168.54 4
Tax map/pareel no.: Se. edd'i 500 sq. ft. or portion 33 l
Limited energy, residential 75.00 2
DESCRIPTION OF. WORK .. , . . • (with above sq. IL)
Limited energy, multi.falnily 75.00 2
Installation of security system residential (with above s ft.)
Services or feeders Instaltatfon and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ' ® TENANT :.:.. • 201 amps to 400 amps 133.56 2
Name: Matrix Absence Management 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 10220 SW Greenburg Road Over 1,000 amps or volts 552.26 2
City/State/ZIP: Tigard, OR 97223 Temporary services or feeders Installation, alteration, and/or
relocation
Phone: (503)977,3635 Fax: ( ) 200 amps or less 59.36 1
I 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 to 599 amps 168,54 2
la nth etreulte - new , alttrat121 or mention, per Hanel
Owner signature: Date: A. Foe for branch c with • ® APPLICANT . I CONTACT PE above service or feeder fec, 742 2
'° ^.': each branch circuit
Business name: Pixel LLC D. Fee for branch circuits without
service or feeder foe. fast 56.18 2
Contact name: Steven Nguyen branch circuit
Each add'! branch circuit 7.42 2
Address: 4641 SW Huber St Miscellaneous (service or feeder not Included)
Each manufactured or modular
City/State/ZIP: Portland, OR 97219 dweWna, service and/or fender 67.84 2
Phone: (503) 208-7248 1 Fax: : (971) 223 -4730 Reconnect only 67.84 2
E-mail: snguyenQpiYelllc.com -
Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR.,.•, ... . ... ' °'. '-`" ' Signal eirtistt(s) or llm(ted- ener6
Business name: Pixel LLC panel, alteration, or cx,tension. I Page 2 75 2
Each additioaai inspection over allowable in any of the above
Address: 4647 SW Huber St. Additional inspection (I hr min) 66.25/ hr
City /Stale/ZIP: Portland, OR 97219 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 208-7248 I Fax: (971) 2234730 Inspections for which no fee is vo.00/ hr
specifically listed ('h hr min)
d CB Lie.: 166289 8I3d/1 Lie.: CLE24 1 Suprv. Lie.: 3936E /
/ . • ..£LE(TRICAL•PER IIT FEES
Suprv. Electrician signature, required /0/ � Subtotal: 75
Plan review (25% of permit fec): 0
Print name: Rick Baker Date: 03126112 State surcharge (12% of permit fee): 9
Authorized signature: , TOTAL PERMIT FEE: 84 v
. This permit applicetion expires If ■ permit m oot obtained within L80
Print name: �, . r I Date: 03016/12 a ins after It has been accepted as complete.
Numbs of inspections allowed per permit.
Iauilding .PereatslELC- PKmIIApp.doc no /,o 440-4615T(IMu/COSINES
To: 15035981 axema @ 503- 598 -1960 From: Pixel (IC Pg 2/ 3 03/27/12 11:03 an
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL woR> ONLY ; :; • ° .
•
Fee for in 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 ONLY: .
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
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
cleWw;ng tats- renmaApp.ax 07ro1/10