Permit §x r QTY lS
� � q CITE( OF TiGAR® ELECTRICAL RESTRICTED ENERGY PERMIT
m COMMUNITY DEVELOPMENT Permit #: ELR2010 -00084
Date Issued: 05/18/2010
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 710
Subdivision: LINCOLN TOWER Lot: 0
Project: Axiom EPM
Project Description: Low voltage for HVAC
Owner: FEES
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 05/18/2010 $67.84
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 05/18/2010 $8.14
PHONE:
Contractor:
AMERICAN HEATING INC
1339 SE GIDEON ST
PORTLAND, OR 97202
PHONE: 503 - 239 -4600
FAX: 503 - 239 -7038
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: N Fire Alarm: N
HVAC: Y Instrumentation: N Total $75.98
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATT ION: •n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001- 010 through OAR • -001 -• ; .. Yo may obtain a copy of the rules or direct questions to OUNC by calling 503 24&.6699 or 1.800.332.2344.
Issue y: 6 �� • Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application " " * , "" [ ' 1 ' g ''' "
PA 4 'TM1 1 OR OFFICE-USE � *Y'''^ ''* T �' � ,!
City of Tigard ;a, IV PennitNo STdOR 97 r 3 ', EC E VE D Plan Review
Phone: 503.639.4171 Fax: 503.598. 9.0 kfri,$ ti o , � ,\ , DateIB
M AY Other Permit
Inspection Line: 503.639.4175 18 201 , r I � w Date Ready/By: mric H See Page 2 for
Internet: www.ci.tigard.or.us .Notified/Method: Supplemental Information
F F , J kl s !" - r y r „ :, • .s"`r.." w wr 4 c 1.. ; *T 9 V irk - 5 s t - ri ry [ y_
.t`r_, c Y Ft r s .. , u "'x '� . 1� 'f ? r A° � fl �` } r 4 f -- ., y ,, , i, i4 H
.. ;r.. > .. :.. µ J'.: -.: o. ._. ,<L_ i > ... d:,l �...._._ s�� : s + z �t4 _.� '..r:.e� -.;1
T , —.��� :� -s7 ,�,,... � ix �.. fi.., „�f:�' e,.4.
_ r t ql* 1 I ? i '
❑ New construction a' A.4 , [ � , : . 'Prep acement Please check all that apply:
❑ Demolition O�� ['Service over 225 amps, comm'I ['Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
', V, -5_. t °, .. > of 1- and 2-family dwellings 4 or more new residential
❑ 1 and 2 family dwelling ; Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi- family ❑Master builder ❑ Other: ❑Building over three stories ['Feeders, 400 amps or more
., ['Occupant load over 99 persons ['Manufactured structures or
5' ,F F -.A ` 1�5 ) if t 7 1r I : 9 1 ti Z " $ 3kfE N 6 x t e. f i ,s - 'g j 1 g g P RV park
�. ❑E s/li h tin p P
.K.s -+azi.-: { _ r _.. _- �_.:..:r , ,._, .._. �_. �.__.r� ._ _ 3 �.. _ _.�_� .�_._ — ❑Other.
// ❑Health -care facility
Job no.: Job site address: /026 5W & /cenv Submit 2 sets of plans with any of the above.
City/State/ZIP: 77/ -d+ , - G 0 r ' The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: 7/0 Project name: i4 x / 0 Yfr i ,�`2 � rs r. � �r ! - ,- f ` 'ti . ` - .--A....!........,..1
Description Qty . -Fee. Total
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea- add'I 500 sq. ft. or portion 33.40. 1
Tax map /parcel no Limited energy, residential 75.00. 2
Limited . energy, non - residential 75.00 2
xN� a z .tip alt 'E!' in' , 8 �� 1' � � Yh
�.�.�_.,...�;._...�__�..� 4'r'..� b � l�s�_6� ��` .� " _� �__ Each manufactured or modular
ti Y V 4 dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
�s ` Y 3 '�i �� ,. ["yy i; `i i ' l '''.7.,--,':-.'f- > 4 j 4�t i d :< rt f . ' s , 201 amps- to400 amps 106.85 2
.�. •-.St_'_...., ... _- ,_.L.._.._._.. t..-,... . X . .: F u . — i.._. . _. .....,2. ?_...- ...... 401 amps to 600 amps 160.60 2
Nance: 601 amps to 1,000 amps 240.60 2
Address: . Over 1,000 amps or volts 454.65 2
'Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) Fax: ( ) relocstlon
'200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: - Date: Branch circuits — new, alteration, or extension, per panel
1 `ldTiZl . « ,i -�I 1 r i r' Viii a"t la1't}ilS ` ,t . r A. Fee for branch circuits with
'- _ 1,. ,. _ , ._C.
3. ., ... _., y + " _.. >: , service or feeder fee, each
Business name: A me Y i c a n . y branch circuit ' 6.65 2
/ B. Fee for branch circuits
Contact name: 8rai J � Gr n c h e s ' f - e ( without service or feeder fee,
each branch circuit 46.85 2
Address: /33 4 S E ai con 5 1 —
Each add brarich circuit 6.65 2
City/State/ZIP: Po r' f - G, d 0 f 97 o2 Miscellaneous (service or feeder not included)
Phone: (SO3 )23 yG o 0 Fax: : (5o3 ) 23 J -7038 Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E Signal circuit(s) or limited-
;A : ss =. --� L 1 . ... m c -- -. — I �f2i .. ` .6 a..' - `' < ;, fi n r ; ,� i � energy panel, alteration, or
`�` J extension. Describe: Page 2 2
Business name: 4 ryj et /64/7 I PJ e 9 74 M t -
Address: W ' Se �I s 7
Each additional inspection over allo in any of the above
6 t U
q Per inspection 62.50
City/State/ZIP: i Grit OR / 7202, Investigation per hour (i hr min) 62.50
Phone: (503 �� 3 ) 9 — (f Go a Fax: (5'03 ) 23 ° f - - 70.3 S Industrial plant per hour 73.75 .1<_ Yr L i t { �t4f�y i 2J rfd 1 `a 3[a i0 n y ma x, :z
CCB Lic.: 33 135 Electrical Lic.:2 � l93t;/ Suprv. Lic.: LE B Subtotal
Suprv. Electrician signature, requi - e : ` _ Plan review (25% of permit fee)
T Si e y o State surcharge (8% of permit fee)
Print name: - Q Da S — fl — Q
n TOTAL PERMIT FEE � .
Authorized signatur :1�,l�e r _ This permit appltcadon expires If a permit is not obtained within 180
�'
days it has been accepted as Industry anG , e r' Date:,5— / — • • Fee methodology set ct by Tri- County Building Industry See
rvice Board
•• Number of inspections per permit allowed.
i: \Building\Permi[s\ELC -P « mitApp.doc 12/03 • 440- 4615T(10/02/COM/VEB