Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2013 00068
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/21/2013
Parcel: 1 S135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 465
Project: Doral Healthcare Finance Subdivision: METZGER, TOWN OF Lot: 9
Project Description: (1) low voltage for voice /data cabling
Contractor: TECHNOCOM INC Owner: LINCOLN CENTER LLC
7929 SW BURNS WAY SUITE F BY SHORENSTEIN PROPERTIES LLC
WILSONVILLE, OR 97070 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 682 -4195 PHONE: 503 - 619 -3200
FAX: 503 - 682 -2781
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/21/2013 $75.00
12% State Surcharge - Electrical 03/21/2013 $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 O • R •52- 001 -0'90. You ma obtain a copy of the rules or direct questions to OUNC by calling 503.232,1987 or 1.800.332.2344.
y
Issued By: ■��..� E Permittee Signature: ‘2,0. �} ?Pt CA Ioki
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.
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Electrical Permit Application RECEIVE --- - r„,,..- ict: iis, oNi.,.
City of Tigard . •, 1 20r Dateli3v: 3/a--1 i 1 3 .4 Permit No.e...R ?Of 37(p
7 I 4 13125 SW Hall Blvd., Tigard, OR 9'7223 u Plan Review
''. Phone: 503.7182439 Fax: 503.598.1960 Datc/By: °therPcrmit 6 X1—.00x31
Inspection Line: 503.639.4175 CITY OF TIGAREFtute:cadYLY: , iidis,,. Page Stor
TIGARD i 11(0 Supplemental Information
Internet: wwwtigard-or.gov BUILDING DNISION" .,.. . ..............
•:,.:,•••,:•• ;i:ti•;,;:d.!:;; Nogitt!: m,:i:i:i.,:tni..,:tiL.,•i,t0.#0.,#xEF:P.:•i5(.1•:
Please checkiall that Oppl es7 a sets of ohms Winans cheeked below):
U New construction CE Addition/altcration/replacement
0 Service ot feeder 4, 00 amps or mom ['Building over three stories.
CI Demolition 0 Other: where th4 available fault current 1:1Marinas and boatyards.
tikTRODittitettliftitIetibt4.0:Fi,:i;:illinTEt';;:;;;j`!:;:.:;:;":;:;t exceeds 19 at t' s at I" volts or 0 °wiling buildings'
less to ground, or exceeds 14,000 I:1 Commercial-use agricultural
0 1- and 2-family dwelling El commerciatAndustrial 0 Accessory building amps for WI °dual installation% buildings.
0 Multi-family 0 Master builder 0 Other: El nrC PUI 0 installation of 75 KVA or
larger separately derived system.
of 0 ".A". "r. "1-2 , -14-.
Job no.: 134029 I Job site address: 10300 SW GREENBERG RD 100I4P ce,mare. I occupancy.
I:1 Six or mdre residential units I:I Recreational vehicle pats.
0 Health-alre lheililies, CI Supply voltage for than
City/State/ZIP: PORTLAND, OR 97223 more tha
13 Hazardmis locatirins, 600 volts nominal,
Suite/bldg./apt no.: iiie I Project name: DORAL HEALTHCARE FINANCE DScrviec 4 foodcrOo amps or more.:,t.P.-.:.4.::::::::Efgf!ii::SPIOPYLV:4,:j9P:t1:-:;:::#:t,".j,;I:
Cross street/directions to job site: ....ticto i ! A t ' il ' et: -.1"-- jot 1 •
. . . ___________ --
Ncw rcsIdtntlat link or intild dwelling unit.
Includes *ached garage.
Subdivision: I Lot no.: 1,000 sq. Ill or less' 168.54 4
. Ea. midi 500 sq. ttl or portion 33.92 1
Tax map/parcel no.: Limited cndrgy, reSidential
. . . . . ...... ... . . ............................ ..... ........„ ..,. ,,,,,,, ........,.....,..........,..,........,
j. (with °have st l' Ill 75.00 2
Limited endrgy, multi-family
75,00 2
VOICE/DATA CABLING residendel (with above sq. ft.)
Services or feeders Installation, alteration, and/or relocation
2nn *rept ni. lent ! inn 7n 2
tie ,, . ;::; . ,:;:! •.: !l!i 201 amps t6 400 aMps 133.56 2
401 amps to 600 athps 200.34 2
Name: _ 601 turqrs 14 1,000 l iiiips 301.04 2
Address: Over 1,000*nps or volts 552.26 2
Temporaey servies or feeders Installallon, alteration, and/or
City/StateJ2IP: relocation] :
Phone: ( ) I Fax: ( ) 200 amps of less I 59.36 - 1
201 amps tO 400 arhps 125.08 2
Owner installation: This installation is being made on property that I own which is not
40i amps tt) 599 arbps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits 4 new, alteratio Per panel
Owner signature: Date: A. Fee for branch Circuits with
APPLICANT RI i:titjki*Op.::/!Elito]■4::: ahun 7A2 2
Business name: TECHNOCOM INC B. Fee for branch Circuits withold
service Ar feedel. &A, firer
Contact name: LESLIE PARSONS branch c 50.18 2
ircuit i -
._. Each odd'I brmtch Circuit 7,42 2
Address: 7929 SW BURNS WAY, STE F Miscellaneous (service or fcdcr not iRcluded) -
Each manufactured or moduLar
City/State/ZIP: WILSONVILLE, OR 97070 dwelling, stirviee and/or fbeder 67.84 2
Phone: (503) 682-4195 I Fax: : (503) 682-2781 Reconnect Only I 67,84 2
Pump or irrigation circle ' 67,134 2
E LparSens@gotechnocom.com
Sign or outline lighting 67.84 2
1 : .. ! . : . .::.!: , :: !: '1 signal circat(s) or ilimited-energY
Business name: TECHNOCOM, INC _pit_n ..cl, alteration, orl, extension. - PaRe 2j 75
2
.. , Each additional inspection over allowable in any of the above
Address: 7929 SW BURNS WAY, STE F Additional inspection (1 hr min) 66.25/ hr
-
City/State/ZIP: WILSONVILLE, OR 97070 invanigatitia(1 hr lnin) 66.25/ hr
Industrial plant (1 OT min) 78.18/hr
Phone: (503) 682 [Fax: (503) 682 . ittspectionslfor which no fee is
90.00/ hr
specificalbjilisted ( 4 hr min)
CCB Lie.: 73872 J Electrical Lic.: 34-269CIt I Suprv. Lie.: 286ILEA :L':1
1 ,
; i Subtotal: 75
uprv. Electrician signature, required; # 1 #
I P10 review (25% of perrnit fee): 9
Print name: SCOTT BERKEY Ja Date: 03/20/13 :State stircharge (12% of permit fee):
yAutbori TOTAL PERMIT PEE: 84
Authorized signature: 11 r ,
, 1
The permit application expirra If a permit is not obtained within ISO
, days after It bits been accepted as complete.
4 NitmllertkillarwtOinne slimmed, pet gorrnit.
■
Print name: SCOTT BERKEY Date: 03/20/13
1:113141dingTennits\BLC-PerrnitApp.doc 07/01/10 440.4615T(11/05/COM/WES
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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*
0 Burglar .Alarm
P Garage Door Opener*
1:1 Heating, Ventilation and Air Conditioning System*
fl Vacuum Systems*
O Other:
Fee for each commercial $75.00
system
(SEE OAR 918-309-0000)
Check Type of Work Involved:
▪ Audio and Stereo Systems
El Boiler Controls
El Clock Systems
ICI. Data Telecommunication Installation
El Fire Alarm Installation
I-IVAC
El Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
• Medical
El Nurse Calls
El Outdoor Landscape Lighting*
p Protective Signaling
El Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
fot all other installations
INauitclINAPermItAELC-PemlitApp,doc 07/01/10