Permit t CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° • COMMUNITY DEVELOPMENT Permit#: ELR2013-00018
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503 718.2439 Date Issued: 01/23/2013
Parcel: 1 S 135AB01002
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 417
' Project: Cypress Subdivision: METZGER,TOWN OF Lot: 9
Project Description: (1)low voltage for data/telecommunications
Contractor: AZIMUTH COMMUNICATIONS INC Owner: LINCOLN CENTER LLC
PO BOX 508 BY SHORENSTEIN PROPERTIES LLC
WILSONVILLE,OR 97070 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE 503-639-0110 PHONE•
FAX. 503-639-0115
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 01/23/2013 $75 00
Type of Use: COM 12%State Surcharge-Electncal 01/23/2013 $9 00
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 2 01-009 You may nobtain/a copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344
Issued By: `'r ,LCit Permittee Signature: 6 4O PU 17 O/1
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.
88888
To: 5035981960 From Lindsey Schmitt 1-22-13 1:21pm p. 3 of 4
RECEIVED
Electrical Permit Application irm(ii IA( 1. t •I.ON II
City of Tigard JAN 2 2 7013 R ( 1.3 (5 1 Permit No.:e -aoi3-09015
111 • 13125 SW Hall Blvd.,Tigard,OR 97223 A Plan Review
8 Phone: 503.718.2439 Fax: 50310}: 11pp TIGARD Date/By: Other Fatale
-r-1 G,1 R 1,
Inspection Line: 503.639.417`B UILDING DIVISION �``Ready/By. h�o H See Page 2 for
Internet: www.eigard-or.gov Notified/Mothod: Supplemental information
TYPE OF WORK PLAN REVIEW
i ❑New construction ®Addition/alteration/replacement Please check all that apply(submit sets of plans wit ems checked below):
❑Demolition Other: ❑Service or feeder 400 amps er more ❑Building over three stories.
where the available fault tuners ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to grmnd,or exceeds 14,000 ❑Commercial-use agriculttiral
❑1-and 2-family dwelling ®Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: 0 Fare pump. ❑installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION DEmergencysystem. larger separately derived system
❑Addition of new motor load of ❑
Job no.: Job site address:10220 SW Greenburg Rd. 100HP or more occupancy
_ .._. ❑Six or nmre residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,OR 97223 ❑Health-are facilities. ❑Supply voltage for more than
..._ ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt no.:417/445 Project name:Cypress ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Desertet(oo 1 Ow- 1 Fm. I Tom i •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft or less 168.54 4
Tax map/pair-el no.: Ea.add'I 500 sq.ft.or portion 33.97 1
Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family 75.00 2
Voice/Data residential(with above sq.ft)
Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER 0 TENANT 201 amps to 400 amps 13156 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,007 amps 301.04 2 j
Address: Over 1,000 amps or volts 552.20 2
Temporary services or feeders iastallation,alteration,and/or
City/State/ZIP: , I relocation
Phone:( ) I Fax:( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation:This installation is being made on property that I own which is not 401 amps to 599 amps 168 54 2
intended for sate,lease,rent,or exchange,according to ORS 447,449,670,and 701.
Branch circuits—ocw,alteration,or extension,per_panel _
Owner Signature: Date:. A.Fee for branch circuits with
❑ APPLICANT ' El CONTACT PERSON above service or feeder tax, 7 42 2
each branch circuit
Business name:Azimuth Communications D.Fee for branch circuits whew
service or feeder fee,first 56.18 2
Contact name:Jerry branch circuit
Each add'I branch circuit 7.421 12
Address:9540 SW Tualatin-Sherwood Rd. Miscellaneous(service or feeder not inciuded)
Each modular State/ZIP:Tualatin,OR 97062 dwellin&sa v i poi feeder 67.84 2
Phone:(503)639-0110 Fax::(503)639-0110 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:lindsey @azimuthcoeamunications.com Sign or outlinclighting 67.84 2
CONTRACTOR Signal circuit(s)or limited-energy
Business name:Azimuth Communications panel alteration,or extension Page 2 2
Each additional inspection over allowable in any of the above
Address:9540 SW Tualatin-Sherwood Rd. Additional inspection(1 hr min) 66.25/hr
Investigation(1 ht rein) 66.25/hr
CityiState/ZIP:Tualatin,OR 97062 Tndtstnal plant(1 hr min) 78.18/hr
Phone:(503)639-0110 i Fax:(503)639-0115 , Inspections for which no fee is i
t — specifically listed(Si hr min)
{
CCB Lie.: 145828 .-A7./. Electrical Lie.: 36-94CLE Supprrv�.�Lic.: f ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: •i_____ ° _r/ (�1 t`t� Subtotal:
d Plan review(25%ofpermit fcc):
Print name: sie.„,?-6,„,„t1Date: 1/22/2013 Stale surcharge(12%of pe mit fee):
Authorized signature:
Maw. TOTAL PERMIT FEE:
This permitapplialioo expires if a permit is not obtained within 180
Print name: 1114114014- evt Date: 1/22/2013 + Number of inspect oensrallowed per iced as complete.
1.18u14d40Pan,it:\ELC.PennitApp.doe 0701/10 440-4615i(t U0S/COMAYEFI
To: 5035981960 From: Lindsey Schmitt 1-22-13 1:21pm p. 4 of 4
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:
,❑ 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
❑ Instnimentatioa
❑ 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
IuuUUAmpermiif\ELC-PeamiiApp ax 07/01/10
To: 5035981960 From: Lindsey Schmitt 1-22-13 1:21pm p. 1 of 4
Fax
FACSIMILE
Date: 1/22/2013
To: 5035981960
From: Lindsey Schmitt
Subject: Attn: Shirley
Lindsey Schmitt I Administrative Assistant I Azimuth Communications, Inc.
Physical Address: 9540 SW Tualatin-Sherwood Rd. Tualatin, OR 97062
Mailing Address: PO Box 508 Wilsonville, OR 97070 I Ph: 503-639-0110 I Fax: 503-639-0115
From: konica @azimuthcommunications.com [mailto:konica0azimuthcommunications.com]
Sent: Tuesday, January 22, 2013 2:16 PM
To: Lindsey Schmitt
Subject: Message from KMBT C360
1
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10220 SW GREENBURG RD 417, TIGARD, OR,
97223
Commercial - Electricial Limited Energy
199 Electrical final
02/21/2013
ELR2013-00018
PASS - No C of O
Violation Summary:
Inspector Contractor