Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
II II
= COMMUNITY DEVELOPMENT Permit #: ELR2012 -00076
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/24/2012
Parcel: 1 S135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 300
Project: Spec Space Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Data /telecommunication system.
Contractor: PAVELCOMM INC Owner: LINCOLN CENTER LLC
1640 NW 14TH AVE BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97209 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 223 -5008 PHONE:
FAX: 503 - 223 -0104
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04/24/2012 $75.00
12% State Surcharge - Electrical 04/24/2012 $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: 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 0 95 - 01 -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: o/v e.09-//0",/
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.
04/23/2012 12:46 5032230104 PAVELCOMM PAGE 01
Electrical Permit Application
RECE
rent OFFICE I -1r. ()isi,)
City of Tigard APR 2 3 20 g ccc ivcd yff41 .1� Permit No a , /a .. 7‘,
7 q 13125 SW Hall Blvd., Tigard. OR 97223 GINIMIE Permit:
Phone: 503.718,2439 Fax: 503.598.196(1 j =
CITY OF TIGA ,,,tint: gj see Pa 2 for
1. I c. r I+ I 1
Inspection l.inc: 503.639.4175 , • a c c. dyBy: � Snpp informotion
Internet www.tigard or.gov BUILDING DIVI I ied/Mctltod: // _
;Ta ':f` -:. . -,- �, • i . ^ .. Tp I
'�, F . t ' i:" .Yi >,T:`�raa-' casrh . y i
':� ' °�.i _ '' ?E`� . •1�"1f�..; :.. .. ;"`= W' � oleMY•+ 'xn...x.: ,c -:.. �'�,sn��'U
,rr• r '1` ° Picnic check all that apply (submit a sets of plans w /items checked below):
❑ New construction ®Addition/alteration /replacement ❑ Service or feeder 400 amps or mora ❑ Building over once Dories.
❑ Demolition ❑ Other: where the available Ault current ❑ Marinas and boatyards.
y�� r 'i' �' : ;;:: : ::..f. : .:1 exceeds 10.0(10 amps at 150 volts er ID Floating brtildings.
l �'i ., ,: A'> 'A : -`. • > -- a p +.. i, "�: a . _ - �G. t ' : I : ;,r,� ' ,. :: . . . a
' ..z,�� � M1'�•` ••' �,:._._'. •- �: •.`, k:.: , sa _ a. .. .. . � teas to ground, or clrc 14.000 ❑ Commcrcial.use agricultarnl
❑ 1- and 2 - family dwelling N Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi family [] Master builder _ em gi• p system ❑ Im separately g V ve system
Pig § 1 .i c ' r - ❑ Other: ❑ }•. i �` "•': a + 0 n or loud of CI ,.A. , t „ 1 - " - 3..
., ' ' i .rt'a s !
., 'f •c . . i1 . - •: � ... - >•' Additio f new motor 0
100HP or more. occupancy.
Job no.: Job site address: 10300 SW Grcenbur g Road in Siv or more mirk/11W units. ❑ Rcereational vehicle parks.
❑ Hcakh•ays facilities. 0 Supply voltage for more than
City/State /7.TP: Tigard, OR 97223 ❑ Hazardous locations, 600 volts nominal.
/
y Suitc/bld / t no.: 300 I Project name: ❑ Service or fonder 600 amps or more.
Cross street/dircctions to job site: , . .tans '„' Elliall Total -
New residential single- or multi - family dwelling unit.
includes attached garage-
Subdivision:
J 1,0[ no.: I,ODO ft. unless 168,54 4
_ Ea. add'1500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential above 2
1a iR %�'1 'iii$ .i (with J
..,',',' . �, :. . � ,.,, --- , T „V- ., J; '.i ti' ':. .•. t '{ ? T� -
aeu ^�' '� Limited energy, multi-family
Low voltage voice and data wiring residential (with above sq. ft.) 75 2
Services nr feeders installation, alteration, and /or relocation _
200 amps or less I 100.70 2
=:rc 7 ;, ,.z; hr _ l 201 amps to 400 amps 133.56 2
-. r..,.
401 amps to 600 amps 200.34 2
Name: 601 amps tot • 000 amps 301,04 2
Address: Over 1.000 amps or volts I 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State/ZIP: relocation
Phone: ( ) I Fax: ( )
200 amps OT less 59.36 I 1
• 201 amps to 400 amps 1 25.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amt's 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449. 670, and 701. Branch circuits- new, alteration, or extension, per panel
Owner signature: Date: A. Fec for branch circuits with
- .. I ,'%c si, - - x :, each branch Servi a or feeder fee.
, ' r l4f ' 4 : a h bran h circuit 7.42 2
�� B. fee for branch circuits without
Business name: : service or feeder fcc, first
56,18 2
Contact name:
brunch circuit
Each edd'l branch circuit I [ 7.42 12
Address: Miscellaneous (service or feeder not included)
Each manufbaaucd or modular
67.84 2
City /State/ZIP: dwelling, service and /Or (coder •
Phone: ( ) l Fax: ( ) Reconnect only 67.84 2
— Pump or irrigation circle 67.84 2
E-mail: - '
Sign or outline lighting 6714 2
GrA V.451i1CAV' '-W;. - signal dreUll(9)orlimttcd- energy -
Business Warne: Pavelcomm, Inc panel, alteration, or extension. 1 ,. Page 2 2
— Each additional inspection over allowable in any of the above
Address: 1640 NW 14 Ave Additional inspection (1 hr min) 66.25/ hr
Tnveatigetion (1 hr min) 66.251 hr
City /Statc/7iP: Portland, OR 97209 , Industrial plant (1 hr mm) 78.1 8/ hr
Phone: (503) 223 -5008 I I Fax: (503) 223 -0104 Inspections for which no fke is 90,00 / hr
a. i listed % hr min
-
CCii Lie.: 63963 (I Electrical Lic 7/i1�1 2 S 9 P } Suprv. Lit.: .. 699 -LE 10 1. i i ' J ' ,;,fi 'L h -w : a `~ 't5i + _ 1 k • is •, 4'0 :' i �, r a' `•r
Suprv. Electrician signature, requir• • : r Subtotal: 75.00
Plan review (2S%ofpermit fee):
—
Print name: James Pavel 4 r-= - State surcharge (12 %of permit fee): 9.00
TOTAT. PERMIT rnP: 84.00 ✓
Authorized signature; This permit applieanon expire if a permit is not obtained within 180
days after it has been accepted ne complete.
Print name: Date: • Number of inspections allowed per penna.
•;\ nulldlrtp \PermiulELC- PpmltApp.doc 01/01/10 440.4615T(I I ,0S/COMiWDD
04/23/2012 12:46 5032230104 PAVELCOMM PAGE 02
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
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_
Fee for gash commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
IZ Data Telecommunticarion Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
LI 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
Muaa irOru+a PermitApp.daa 07/91/10