Permit TIGARD
CITY O 1 a ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00044
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/3/2009
PARCEL: 1 S 135AB -01004
SITE ADDRESS: 10220 SW GREENBURG RD 570 ZONING: C -
SUBDIVISION: LINCOLN CENTER /TWO LINCOLN LOT: JURISDICTION: TIG
PROJECT: SPEC SPACE
Project Description: Low voltage for HVAC.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
SHORENSTEIN REALTY SERVICES AMERICAN HEATING
ONE SW COLUMBIA #300 1339 SW GIDEON ST
PORTLAND, OR 97258 PORTLAND, OR 97202
Phone: 503- 412 -4800 Contact #: PRI 503- 239 -4600
FAX 503- 239 -7038
FEES Reg #: ELE 26- 993CRE
LIC 33135
Description Date Amount SUP 2640LEB
[ELPRMT] ELR Permit 2/3/2009 $75.00
[TAX] 12% State Surch 2/3/2009 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or dir ct questions to OUNC at 503.246.6699 or 1.800.332.2344. M l
Issued B • 4 ♦ / e I/ 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'N: 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.
,
d , ''
Electrical Permit Application _ • n FOR oFFIICE USE 'ONLY _
City of Tigard Date Received o2 — • TO PermitNo.: ,� /r ... Q
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 / ' v""'li '\ DateB : Other Permit:
df �a` � �
Inspection Line: 503.639.4175 •_' I Date Ready/By: H See Page t for
Internet: ww.ci.tigard.or.us . Notified/Method: - SupplemeotalInformation
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.vas �w+>u s - _ s,v`c `. r '& 9 "° ma y` ` a A' t}Yt - 4 4: �st yl==AC':- t'i
: ;'t" z' 3 " IMF e - zt tWtl i'f�' e - " :ti* 1" i +as sl€ .,! e.`3. ..:: IV: ts. .! -;% 41 '1 +`'.,
❑ New construction C Addition/alteration /replacement Please check all that apply:
['Service over 225 amps, comm'I 0 Hazardous location
❑ Demolition ❑ Other: ['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
}
W � P y e ti 2 r 0 °` 0 ' ' `-4 of 1- and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling C Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ['Feeders, 400 amps or more
❑ Multi family 0 Master builder
❑ Other: 0 Occupant load over 99 persons El Manufactured structures or
W 47 2 2 G4 1M AVVO ® €S t 0 = 0 a^ "� §` " x : ❑ RV park
�� Y ,�; Egress /lightingp1an
Job no.: Job site address: / 02 20 S W ' �p ✓t L' U R d ❑ Health -care facility ['Other: / Submit 2 sets of plans with any of the above.
City/State/ZIP: 779 4 ,_c 0 R ? 72.2 3 The above are not applicable to temporary construction service.
- o :'`"'., a�im.. � �;
,, ,?r�t..J ulr gfi:'= ii,
Suite/bldg. /apt. no.: • j 7 7 I Project name: VS P
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 leis 145.15 4
Subdivision: I Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 • 1
Limited energy, residential 75.00. 2
Tax map /parcel no
Limited energy, non - residential 75.00 2
, �4 4 4 c4` g 4 g ' ` ' MA e . ti Each manufactured or modular
dwelling, service and /or feeder 90.90 2
re /7C 4 7 e.. � e/7.7o..s = 7 Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
.: E ti ` r -f t� t. P'4 4 `11441 # r ". &i fi 401 amps to 00 amps 160:60 2
Name: 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: ( ) I F ax: ( ) relocation
• 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
{T x r � 1"- 4 I �- " ""°A " �' A. Fee for branch circuits with
..ar/a�. � ..•.- s.+,,,. :��i".. "' ..:e � S.ds: � "�'�.n��.s Y�' - 'r' -�. `;?
/ service or feeder fee, each 6.65 2
/ r
Business name: p Cc a 1--1 t° 4.4 / -, .n C branch circuit •
/' J B. Fee for branch circuits •
Contact name: D, / /7giki n f t without service or feeder fee,
46.85 2
/ each branch circuit
Address: /3 s 6,, C l e O S Each add'I branch circuit 6.65 2
City/State/ZIP: P r — f /Gind OR g720Z Miscellaneous (service or feeder not included)
X5-03) 23 5 � 0 I ( 3) 5 703 ¢• Sump or irrigation lighting t ine 53.40 2
Phone: �- GO Fax: $O 23 v Sign or outline lighting g 53.40 2
E Signal circuit(s) or limited -
r :. MFR". - 0r € ®# `r' - energy panel, alteration, or
> , �� > . � Fa 75' 2
� extension. Describe: Page 2
Business name: Ark1e,./Coin gC4 - 1147 Z G
Address: X33' 5 6, /c1 e 0, S 1` Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: / C? rt / / /_I/ 9/'?' , t7 2 Investigation per hour (I hr min) - 62.50
Phone: ( 23 /' 9,00 Fax: (S63) z 7 -7O ?.53' Industrial plant per hour 73.75 j
s 2(0 773 Suprv. 2&i I0 ••
CCB Lic.: /3 Electrical Lic.: CX ,E Su rv. Lic.: L, EB S ubtotal 75 •
Suprv. Electrician signature, required: Plan review (25% of permit fee) .
12.'6 State surcharge-IOC permit fee) 9 _GC),
name:7 5 -fete, /o i) n Date: 2-3- 0 9 "�
TOTAL PERMIT FEE 5, Qf/
Authorized signatur� This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: g,„. i n 4 5---1,0,- Date: 2 -3 - d 9 . Fee methodology set by Tri- County Building Industry Service Board
** Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PermitApp.doc 17/03 440- 4615T(10 /02/COM/WEB
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: ELR2009.00044
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/3/2009
Phone: (503) 639-4171 J11 j
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 2/18/2009 TIME: 7:OOAM PAGE: 22
SITE ADDRESS: 10270 SW GREFNBURG RD 670 CLASS OF WORK:
SUBDIVISION: LINCOLN CENTER/TWO LINCOLN LOT #: TYPE OF USE:
PROJECT NAME: ',.;PFC. SPACE ED
DESCRIPTION: Low voltage lor HVAC.
OWNER: SHORENSTEIN REALTY SERVICES, PHONE #: 503-4124800
CONTRACTOR: AMERICAN HEATING PHONE #: 503239-4500
Inspection Request Scheduled For: Date: 2/18/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical find 000594-01 503-597-9557
Corrections/Comments/ Instructions:
4Z4 PAS 7 PARTIAL APPROVAL 7 CANCEL NO ACCESS
El CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: N (?) Date: 1--1 Phone #: (503) 718-