Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
11 I : COMMUNITY DEVELOPMENT Permit#: ELR2020-00081
T I G rtL1 R 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 7/21/2020
Parcel: 1S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 410
Project: CR Mining Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Low voltage wiring and T-stats.
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 07/18/2020 $75.00
12%State Surcharge-Electrical 07/18/2020 S9.00
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 18D
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 0 952-001- 90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or,1.800.332.2344..8
Issued By: �' dc�--� Permittee Signature: t 5V/ (/ /� "/-32 e—rt
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.
a'
Electrical Permit Application FOR OFFICE USE ONLY �,t q p
City of Tigard R E C E I V may: f zo/zi p Permit No.0 � W-'U'Oil 0 I
Ili 11 • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 JUN 16 2020 Date/By: Other Permit:
TI GA RD Inspection Line: 503.639.4175 Date Ready/By: orris: El See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIE 6i
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plansw/items checked below):
O Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition ❑ Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCI'ION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ 1-and 2-family dwelling ® Commercial/industrial ❑Accessory building amps for all other installations. buildings.
D Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
30B SITE INFORMAT ❑Emergency system. larger separately derived system.
['Addition of new motor load of ❑"A","E","1-2",`•1-3",
IOOIIP or more. occupancy.
Job no.: Job site address: 10220 SW Greenburg Rd
❑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.:410 Project name:CR Mining TI 0 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 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'l 500 sq.ft.or portion 33.92 1
fax map/parcel no.: Limited energy,residential
41 DESCRIPTION OF WORK (with above sq.R.) 75.00 2
"T= 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
❑ PROPERTY OWNER I TENANT 200 amps or less 100.70 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
® APPLICANT ® CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
Business name: American Heating Inc. each branch circuit 7.42 2
B.Fee for branch circuits without
Contact name:Amanda Bostic service or feeder fee,first 56.18 2
branch circuit
Address:5035 SE 24th 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
CONTRACTOR 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,OR.,97202 Investigation(1 hr min) 66.25/hr
Phone:(971)678-2094 Fax:( ) Industrial plant(1 lir thin) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 33135 Electrical Lic.: 26993CRE Suprv.Lic.: 2640LEB specifically listed(Vs hrmin)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:
Subtotal: 75, U-61
Plan review(25%of permit fee):
Print name: T Steve Youngr. ' Date: (i_15-20 State surcharge(12%of permit fee): 9 get
Authorized signature. j TOTAL PERMIT FEE: tq, et
This permit application expires if a permit is not obtained within 180
Print name: Amanda Bostic Date: 65/28 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I'.1EuddingWerosits\ELC PennitApp_ELR_FRF.doc Rev 05/21/2013 4404615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONL 'i '_7 •I77•
Fee for all residential systems combined ... $75.00 Description I en. I Fee j Total I*
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
501to15kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
nBurglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 552.26 2
❑ Heating, Ventilation and Air Conditioning OAR 918-309 0040)
* Solar generation systems in excess of 25 kva:
System
Each additional kva over 25 7 42 3
❑ Vacuum Systems* >100 kva—no additional charge 00 3
❑ Each additional inspection over allowable in any of the above:
Other: Each additional inspection is
charged at an hourly(1 hr min) 66.25/hr 1
Inspections for which no fee is 90.001 hr
specifically listed(V7 hr min)
COMMERCIAL WOR ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within ISO
❑ Audio and Stereo Systems days after it has been accepted as complete.
* Number of inspections allowed per permit.
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
KVHVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
IT Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: (
*No licenses are required. Licenses are required
for all other installations
I:1Building\Permits\ELC_PermitApp_ELR_ERE,dor Rev 05/21/2013
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