Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a COMMUNITY DEVELOPMENT Permit #: ELR2012 -00123
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/14/2012
T t; . \. R O g Parcel: 1S135AB01006
Jurisdiction: Tigard
Site address: 10500 SW GREENBURG RD 200
Project: Mutual Fund Store Subdivision: ASHBROOK FARM Lot: 6
Project Description: Data Telecommunications
Contractor: TICE ELECTRIC Owner: LINCOLN CENTER LLC
5405 N. LAGOON AVE. BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97217 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 233 -8801 PHONE:
FAX: 503 - 872 -8290
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/14/2012 $75.00
12% State Surcharge - Electrical 06/14/2012 $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 OAR 52 01 -009 . You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332 /,
Issued By: Permittee Signature: ' L APP L4 `.- 6�L/k L
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.
06/1412012 09:41 Tice Electric Company (FA 728275 P.002/004
Electrical Per Application ECEIVED t,,,; i,rn t(, , 1 „.t.
Ph ....- City of Tigard Received J Pamtnit �,� _ b b /�, j •
e 13125 SW Hall Blvd., Tigard, OR 97223 J U N 1 4 2012 Plan Review B(� jj ( 411 - . oat O�
Phone: 503.718.2439 Fax: 503.598.196600 Date/Br Other Ptamit;
t Inspection Li ne: 503 CITY a OF TIGARD Dee y/aY rurb; 5d See Page 2 for
Internet: www.tigard- or.gov BI JIi D1NO DIVISION Netieed/Met '[t(p Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 2, seta of plans cams checked below):
Other: ❑ SaMoe ar feeder 100 snaps or more ❑ Braiding over Onto stories.
❑ Demolition
❑ where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
lass ❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amva t br au installation ❑ l t-us agricultural
❑ Multi - family ❑ Master builder ❑ Other: O Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emerg�y�m• larger separately derived system_
pAddition of new motor load of D'". "E"."1-2", - I.3 ^,
Job no.: 22.5381 Job site address: 10500 SW Greenberg Rd 100NP Of mare. OCcu '
❑ Six or more residential units. ❑ Recreational vehicle parka.
City /State /ZIP: Tigard/OR/97223 ❑ Health -care facilities. ❑ Supply voltage far more than
O Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: 200 I Project name: Mutual Fund Store ID Service or feeder 600 amps or more.
job site: FEB 9C DULE
Cross street/directions to
J Description I Q. I Fee. I zeal 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. edd'1500 sq. ft. or portion 33.92 l
Tax map/parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - timely 75.00 2
Installing Low Voltage Data Cables residential (with above sq. ft)
Services or feeders installation alteration, and/or relocation _
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ 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
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 5936 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 snipe to 599 amps 16864 2
Branch circuits- new, alteration, or extension, per panel
Owner signature: Date: A Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.A2 2
each branch circuit
Business name: B. Aux for branch circuits without
service or feeder the, first 56.18 2
Contact name: branch circuit
Each add'1 branch circuit 7.42 2
Address: Miscellaneous (service or iteder not included)
City/State/ZIP:
Each =endured or modular 67 2
dwelling, service and/or feeder
• Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal eircult(a) or limited-energy
Business name: TICE ELECTRIC COMPANY panel, alteration, or extension. 1 Page 2 75.00 2
Each additional Inspection over allowable in any of the above
Address: 5405 N LAGOON AVE Additional inspection (1 lu min) 66.25/ hr
City /State/ZIP: PORTLAND/OR/97217 Investigation (1 hr min) 66 25/ hr
1 Industrial plant (1 hr min) 78.18/ hr
'�
Phone: (503) 872 -8230 �e� Fax: (971) 230-3330 l4) Inspections for which no the is 90,00/ hr
11
CCB Lic.: 166 4 I , Electrical Lic.: 12- 6C Suprv. Lic.: 33045 specifically listed ('h hr min)
ELECTRICAL PERMiT FEES
Subtotal:
Suprv. Electrician signature, required: Plan review (25% of permit fee): 75.00
Print name: LOWELL ARNO ( Date: 6/14/2012 State surcharge (12% of permit tee): 9.00
Authorized signature: TOTAL PERMIT FEE: 84
This permit eppuranoa aspires if a permit Is not obtained within 180
days after it has been accepted as complete,
Print name: Date: • Number of inspections allowed per permit.
06114/2012 09:41 Tice Electric Company (FA 728275 P.0031004
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for 211 residential systems combined........ $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
LI Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systeme*
❑ Other:
COMMERCIAL WORK ONLY;
Fee for each commercial $75.00
system
(SFR 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: 1
*No licenses ate required. Licenses ate required
for all other installations
06/14/2012 09:40 Tice Electric Company TA)05038728275 P.0011004
1 \•-• Y-
ELECTRIC COMPANY
5405 N Lagoon Ave Portland, Or 97217
Phone: 503/233/8801
Fax: 971/230/3330
Fax
To; City of Tigard From: Theresa Hollan
Fax: 503 -598 -1960 Pages: 4
phone: pate: 6/14/2012
Re: Low Voltaee Permit CC:
Urgent ❑ For Review ❑ Please Comment Please Reply 0 Please Recycle
Thanks
Theresa
5034724230
1