Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
114
s.: COMMUNITY DEVELOPMENT Permit #: ELR2013 -00122
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/19/2013
Parcel: 1 S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 570
Project: Wave Connex Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Low voltage for fire alarm
Contractor: SAFE TECHNOLOGY GROUP INC Owner: LINCOLN CENTER LLC
6400 NE HWY 99 SUITE G375 BY SHORENSTEIN PROPERTIES LLC
VANCOUVER, WA 98665 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 360 - 699 -2130 PHONE:
FAX: 360 - 719 -1527
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/19/2013 $75.00
12% State Surcharge - Electrical 06/19/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: Boiler Controls:
CCTV: Clock Systems:
Data & Telecommunications: Fire Alarm: Y
HVAC: Instrumentation:
Intercom/Paging: Landscape /Irrigation:
Landscape Lighting: Medical:
Nurse Calls: Protective Signal:
Security Alarm: Other: Total $84.00
Other Desc: Required Items and Reports (Conditions)
This permit is ' • ubject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done ' accordance wi 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 =w re• ' -s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- thr• gh OAR 952-011 •090. • may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.8
I sued By: d Permittee Signature: , �
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.
Electrical Permit Application R ECE I )R (11..F ICE t'st: ()NI.)
City of Tigard ,Q �3 Q �IA � --
t • �j /3 I Perm No.:
• 13125 SW Hall Blvd., Tigard, OR 97223 1
C Phone: 503.718.2439 Fax: 503.598.1960 JUN ° 4 L e/By. Other Permit: 04Sp.0/3 ^000
T I G A R D Inspection Line: 503.639.4175 CITY Date Ready/By: /
C � / iu� ®
s: See Page 2 for
Internet: www.ti 8 ardor. ov V OF r'(� A "Meth . Supplemental Information
TYPE OF WORK c7U1 , V AI ISION PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
dwelling Commercial/industrial less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I - and 2 g ® ❑ A ccessory building amps for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: I Job site address: 10220 SW GREENBURG RD Six 100HP more more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: TIGARD OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 570 I Project name: WAVECONNEX ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: LINCOLN 2 Description
Qty. I Fee. I Total
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family
FIRE ALARM residential (with above sq. ft.) 75.00 2
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
Name: 401 amps to 600 amps 200.34 2
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 59.36 I
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 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: SAFE TECHNOLOGY GROUP INC. B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: JASON SWEET branch circuit
Each add'I branch circuit 7.42 2
Address: 6400 NE HWY 99 SUITE G375 Miscellaneous (service or feeder not included)
City/State /ZIP: VANCOUVER WA 98665 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (360) 699 -2130 Fax: : (360) 719 -1527 Reconnect only 67.84 2
E - mail: SALES@SAFETECHNOLOGY.NET Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: SAFE TECHNOLOGY GROUP INC. panel, alteration, or extension. _ 1 Page 2 2
Each additional inspection over allowable in any of the above
Address: 6400 NE HWY 99 SUITE G375 Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: VANCOUVER WA 98665 Investigation (I hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (360) 699 - 2130 Fax: (360) 719 - 1527 Inspections for which no fee is 90.00/ hr
specifically listed (Y2 hr min)
CCB Lic.: 173731 Electrical Lic.: CLE79 Suprv. Lic.: 4272LEA ELECTRICAL PERMIT FEES
/J /)/
Subtotal:
Suprv. Electrician signature, required: / "/ 74 —
Plan review (25% of permit fee):
Print name: JASON SWEET Date: 6 - 3 - State surcharge (12% of permit fee):
/)^ TOTAL PERMIT FEE:
Authorized signature: /�✓
This permit application expires if a permit is not obtained within 180
Print name: JASON SWEET Date: 6 -3 -13 • days after it has been accepted as complete.
• Number of inspections allowed per permit.
I :\ Building \Permits\ELC- PermitApp.doc 07/01 /10 440- 4615T(11/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
V:RESIDENTIAL WORE ONLY:7 - '4` , 1
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
COM,MERCIA ::.WORICONLY ;;.,::,. <.<
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
❑ IIVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
El Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
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