Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' o COMMUNITY DEVELOPMENT Permit #: ELR2010 00208
TIGARD 13125 SW HaII Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/07/2010
Parcel: 1S135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 600
Subdivision: LINCOLN CENTER/FIVE LINCOLN Lot: 0
Project: Axium
Project Description: Low voltage for HVAC
FEES
Owner:
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 10/07/2010 $75.00
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 10/07/2010 $9.00
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 $84.00
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 pe • sue. • • -- to the re, lations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be d• e in accordance with alp. •vs.• pl= s. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
day.. ATTENTION: Oregon law - quir -s y••. to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 •- 001 -0010 through OAR 952 -0• -01 • -. Y. • may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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sued By: / 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 Fo OFFICE USE ONLY - - - -
City of Tigard Didwa Receivcd , A , 7 ,,, It an Permit No.: e4R.,940/i0 af)ad. :
Ili ---'• 13 125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax 503.598.1960 Date/B : Other Permit:
1 RiAito Inspection Line: 503.639.4175 Date ReadyMy... Inns: f s p for
Internet: www.tigard Notified/Method: Supplement' Information
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'±7•, . f ''' ..1 •S`s-;`,Tai,7,54,:. t.Nti....'.:;th.-'1:-..1:-.F■-:.t...-`.ki'l: -' 2. ,z A , .-
0 New construction • II Addition/alteration/replacement Please check all that apply (submit a sets of plans writestehecked below):
0 Service or feeder 400 amps or more 0 Building oar three stories.
, 12 Demolition 0 Other: where the available fault current 0 Marinas anneanYards.
filV;ir.I.1,V , giro c exceeds 10000 amps at ISO volts or 0 Floating bidding&
•--',;`.=.t --..:-..',?..A.P.,r,}1,4.1.g.-2s-g.-.•,,A,_,,,,,,,v-,,: . ,--..: ...,: less to groun °rum poop 0 c agr
El 1- and 2-family dwelling C Commercial/industrial 0 Accessory building amps for all other installations. buildings.
12 Multi-family 0 Master builder 0 Other: CI Fire pump. 0 Installati000f 75 KVA or
..,.., .„ . ,., „ ....c CI Emergency system. larger sepately derived system.
T r..-....;:-...:.....,„:. 0 Addition of new motor load of 0"A", "E",1-2'', "1-3",
Job no.: Job site address: /0200 .5W 61 Rd 100HP or more.
0 Six or more residential waits. occupancy.
0 Recreatioml vehicle parks.
City/State/ZIP: T
/yard 0 R a Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts minima.
Suite/bldg./apt. no.: 67(9 0 I Project name: A x 1 0 nn 0 Service or feeder 600 amps or more.
'_. : .F.-ffq34-t i t.A 3 .V.Riff.P;ta i....":..'
Cross street/directions to job site: tamenntion Q. Fee. Total •
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: 1 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 6714 2
1 ;?i .:1.---;-t.,'%:M-$.5l.irt7:1161A.V.Wailnii*:$1:05.11EKRM (with above sq. ft.)
. Limited energy, multi-family 0.84 2
ia tell VO i 4 5 e wiriel, residenti (with above sq. ft.)
Services or feeders Inatallation and/or relocation
200 amps or less 10020 2
201 amps to 400 amps 133.56 2
',. ',' + v -=:.-- "C.10110.4:01. '..402,Vi2-..:414 ' . ,-*.''' -.' ' . --+. ...jilt • ''' ' '," ' . t
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: • Over 1,000 tunps or volts 55226 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) I 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
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
-;.1, above service or feeder fee,
742 2
each branch circuit
Business name: A mer Ica ,..) H e a -1- i t1.1 B. Fee for branch circuits
without service or feeder fee, 56.18 2
Contact name: a , c /4,„7,4e,-Ter first branch circuit
Address: /33'1 5 F , d eon S.* Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Pp (--- + jail d 0 R "70 so 2 Each manufactured or modular 6784 2
dwelling, service and/or feeder
Phone: (503 )231— 1.-/e9 0 0 I Fax: : (.5 $ Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
woh--,, 'ler itN,1 Sign or outline lighting 67 84
Signal circuit(s) or limited- , e l 2
Business name:A rn e r v c --, e:P e'r 1 t'? 1 energy panel, alteration, or i 7b
Address: 1331 SE 62 (dcon 5 --t extension. Describe: Page 2
_
City/State/ZIP: 1:::b r-rt. 4 0 g 772 02_ Each additional inspection over allowable in an of the above
_Per inspection 66.25
Phone: (503 ) 23 110.0 I Fax: (So 3 ) 2.3i -7o3 '8 Investigation per hour (1 hr mirk) 66.25
CCB Lic.: 33 135 1 Electrical Lic.:2 0 4 1/3 (Re I Suprv. Lic.: 2 41/01..E6 Industrial plant per hour 78.18
. .
-'77-::";*-::::1/4:.:`;::,.----.2.4.3iltillir.allgkiiMr.; ..i1...
Suprv. Electrician signature, requirc____ .....2.--- Subtotal: ''
Print name:T 5-1- y Date: / 0 -- 1\ I 0 Plan review (25% of permit fee): .-- j ---- 1 - 1 ) "
State surcharge (12% of permit fee):
-
Authorized signature: -- "Ar7,..„‘„ 1....c -11-- TOTAL PERMIT FEE: .°
Print name: "P di; es et-- Date: 10 7/0 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
440-4615TO I/05/COMAVEB