Permit ilali#! Fit~� CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
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COMMUNITY DEVELOPMENT Permit#: ELR2015 00286
t"19; Date Issued: 12/07/2015
T1Gr RIS13125 SW Hall Blvd ,Tigard OR 97223 503.718.2439
y,. i Parcel: 1S135AB03400
Jurisdiction: TIGARD
Site address: 10260 SW GREENBURG RD 700
Project: Axiom Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Fire alarm.
Contractor: SAFE TECHNOLOGY GROUP INC Owner: LINCOLN CENTER LLC
6400 NE HWY 99 STE G375 BY SHORENSTEIN PROPERTIES LLC
VANCOUVER,WA 98665 235 MONTGOMERY ST, 16TH FLOOR
SAN FRANCISCO, CA 94104
PHONE: 360-699-2130 PHONE
FAX: 360-719-1527
FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/07/2015 $75.00
12%State Surcharge-Electrical 12/07/2015 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 0 Fire Alarm: 1
HVAC: 0 Instrumentation: 0
Intercom/Paging: 0 Landscape/Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 0 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 A • •1: . -.on law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952-Or -0010 through OA- S52-1.' -9•90. You may obtain a copy of the rules or dire ct questions to OUNC by calling 503.232.1987 or
1 800.30J32.2344.
Is ued By: ' / , it) Permittee Signature: \C' �v'Wr.. ..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.
T
electrical Permit Application
ciVt � roli orrlc:F, lsr,oNLY
City of Tigard Received Permit No.: /
III13125 SW Hall Blvd.,Tigard,OR 23 ^ 15 Plan Review
`• Phone: 503.718.2439 Fax: 503.598.1960 4. Date/B : Other Permit: —/ • ,f 7
TIGARD
Inspection Line: 503.639.4175 '0 g p Date Ready/By: 0 See Page 2 for
Internet: www.tigard-or.gov d� y����q�1Y @� Notified/Method: ��� Supplemental Information
TYPE OF 1 ��v������laaltl�,a���1". ' PLAN REVIEW
•
❑New construction ®Addition/alt-, �l w e)cYWe'fnent Please check all that apply(submit 2 sets of plans w/items checked below):
0 Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where the available fault current
0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION , •" , , • exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 75 KVA or
JOB SITE INFORMATION LOCATION . . , 0 Emergency system. larger separately derived system.
0 Addition of new motor load of ❑"A","E","1-2","1-3",
Job no.: Job site address: 0 SW GREENBURG RD 100HP or more. occupancy.
0 Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP:TIGARD OR 97223 100 0 Health-care facilities. 0 Supply voltage for more than
/
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.:700 Project name:AXIOM 0 Service or feeder 600 amps or more.
' FEE SCHEDULE
Cross street/directions to job site:LINCOLN TOWER Description I Qty. I Fee, I Total 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.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 75.00 2
FIRE ALRM residential(with above sq.ft.)
Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
0 PROPERTY•OWNER_ , . ' 0 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
Temporary services or feeders installation,alteration,and/or
City/State/ZIP: relocation
Phone:( ) 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 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.Fee for branch circuits with
APPLICANT above service or feeder fee,
, '® . ., - ,'❑:CONTACT PERSON , - . : 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'l branch circuit 7.42 2
Address:6400 NE IIWY 99 SUITE G375 Miscellaneous(service or feeder not included)
Each manufactured or modular
City/State/ZIP:VANCOUVER WA 98665dwelling,service and/or feeder 67.84 2
Phone:(360)699-2130 Fax::(360)719-1527 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:SALES@SAFETECHNOLOGY.NET Sign or outline lighting 67.84 2
.- CONTRACTOR - ' Signal circuit(s)or limited-energy
Business name:SAFE TECHNOLOGY GROUP INC. panel,alteration,or extension. I Page 2 75.00 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(1 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(A hr min)
CCB Lic.: 173731 Electrical Lic.: CLE79 Suprv.Lic.: 4272LEA - , _ ELECTRICAL.FPERMIT.-FEES' .' , - .. •
Subtotal:
Suprv.Electrician signature,required: 9a.d.9 '
s 'v t (25% 75.00
e
Plan review of permitt fee):
Print name: JASON SWEET Date: 11/30/15 State surcharge(12%of permit fee): 9,t
TOTAL PERMIT FEE: if
Authorized signature: -
/
9a-e-eifi This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: JASON SWEET Date: 11/30/15 • Number of inspections allowed per permit.
1.\Building\Permits\ELC-PermttApp.doc 07/01/10 440-4615T(11/05/COM/WEB A.?
,g6 / , F3
1
'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*
nBurglar Alarm
❑ Garage Door Opener*
❑ Heating,Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
nData Telecommunication Installation
® Fire Alarm Installation
❑ HVAC
❑ Instrumentation
n Intercom and Paging Systems
•
❑ Landscape Irrigation Control*
❑ Medical
E Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial syste : 1
*No licenses are required. Licens e required
for all other installations
(.\Building\Permits\ELC-PermitApp.doc 07/01/10