Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
jl Permit#: ELR2020-00091
COMMUNITY DEVELOPMENT
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 7/16/2020
Parcel: 1 S 135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 570
Project: Maxim Subdivision: METZGER,TOWN OF Lot: 9
Project Description: HVAC system.
Contractor: AMERICAN HEATING INC Owner: LINCOLN CENTER LLC
5035 SE 24TH AVE BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97202-4765 235 MONTGOMERY ST, 16TH FLOOR
SAN FRANCISCO, CA 94104
PHONE: 503-239-4600 PHONE:
FAX: 503-239-7038
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/16/2020 $75.00
12%State Surcharge-Electrical 07/16/2020 $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: 0
HVAC: 1 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. 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 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or
1.800.332.2344.
Issued By: //7 / /l�i�aL o-� Permlttee Signature: a�1 '/87 2`",z,f -s
/
v 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 1' FOR OFFICE USE ONLY
City of Tigard 3ECEl y eived ,7/`l� Permit No _ wq(
't 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
%7 �fV
Phone: 503.718.2439 Fax: 503.598.1960 JUL 13 2020 Date/By: Other Permit:
T t G A R D inspection Line: 503.639.4175 Date Ready/By: Saris: ® See Page 2 for
Internet: www.tigard-or.gov CITY OF TIG Notified/Method: Supplemental Information
Please check all that apply(submit 2 sets of plans w/items checked below):
❑New construction ®Addition/alteration/replacement
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition ❑Other:
where the available fault current ❑Marinas and boatyards.
t _ _ �` , Y 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 to Commercial/industrial ❑Accessory building amps for all other installations. buildings.
0 Multi-family ❑Master builder ❑Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION 45D LOCATION ❑Emergency system. larger separately derived system.
0 Addition of new motor load of ❑"A","E","1-2","I 3",
Job no.: Job site address: 10220 SW Greenburg Rd 1001-IP m more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,OR 97223 0 Health-care facilities. 0 Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.:570 Project name:Maxim TI ❑Service or feeder 600 amps or more.
r r L
Cross street/directions to job site: Description
I Qty. Fee _.:.I Total
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'l 500 sq.It.or portion 33.92 1
Tax map/parcel no.:
„ Limited energy,residential
. $ 6„xw � :6 ,.. � : , . (with above sq.ft.) 75.00 2
itaiiiiiia Limited energy,multi-family 75.00 2
low voltage wiring and T-stats residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
m _ t`? ,�. :; Cam. gyp. � 200 amps or less 10070 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
200 amps or less 59.36 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 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
.�W ® CON' ..a �' ... )
above service or feeder fee, 7.42 2
Business name:American Heating Inc. each branch circuit
B.Fee for branch circuits without
Contact name:Amanda Bostic service or feeder fee,first 56.18 2
branch circuit
Address:5035 SE 24`h Ave. Each add'l branch circuit 7.42 2
City/State/ZIP:Portland,OR.,97202 Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:(971)678-2094 Fax: :( ) dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail: a.bostic@americanheating.net Pump or irrigation circle 67.84 2
_. �.-._ •,;y; Sign or outline lighting 67.84 2
Business name:American Heating Inc. Signal circuit(s)or limited-energy I See I
panel,alteration,or extension. Page 2 2
Address:Amanda Bostic Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Portland,OIL,97202 Investigation(1 hr min) 66.25f h
r
Phone:(971)678-2094 Fax:( ) Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 33135 Electrical Lic.: 26993CRE Suprv.Lic.: 2640LEB s.-cificall listed %,hr min
Suprv.Electrician signature,required:� tigNealiEEMMENMTITEMEENAME
) Subtotal: x `
Print name: T Steve Young Date: i_1_Z6� Plan review(25%of permit fee): ",
aynti/ncialy)
State surcharge(12%of permit fee):Authorized signature: JTOTAL PERMIT FEE: ' aa'
/` This permit application expires if a permit is not obtained within 180
Print name: Amanda Bostic Date: / 3 1 0I-6 days after it has been accepted as complete.
Number of inspections allowed per permit.
1:\Suilding\Perrnits\ELC PrnnitApp_ELR_ERE.doe Rev 05/21/2013 440-4615T(11/05/COM/WES