Permit n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I! - COMMUNITY DEVELOPMENT Permit #: ELR2010 00291
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/30/2010
Parcel: 1 S 135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 360
Project: Ameriprise Subdivision: LINCOLN CENTER /FIVE LINCOLN Lot: 0
Project Description: Low voltage for HVAC
Contractor: AMERICAN HEATING INC Owner: LINCOLN CENTER LLC
1339 SE GIDEON ST BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97202 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 239 -4600 PHONE:
FAX: 503 - 239 -7038
FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/30/2010 $75.00
12% State Surcharge - Electrical 12/30/2010 $9.00
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
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued - ct 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 ac .ance with a••roved 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. ATTE' ION: Oregon law re• • es you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -00 0 through OAR 952 -00 1090. Y. may obtain a copy of the rules or direct questions to OUNC by calling 503.23 7 or 1.800.332.2344
Ai �R M AAG {-
Issued =y: e 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 the next available inspection date.
This permit card shall be kept In a conspicuous place on the job she until completion of the project
Approved plans are required on the Job site at the time of each inspection.
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received , A
DatelB : /... ,._-, r ifillIP71 , 112MIIMM
II • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review .--
l l Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: Ms: la See Page 2 for
Internet: www.tigard Notified/Method: Supplemental Information
! Ifigair,.• 3 . 1414,4:55,Tfil3- 1 W la ; .',. .... ; .4 6 gloaflakkaigt*AMIMI
0 New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of pans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition El Other: where the available fault current 0 Marinas and boatyards.
or 0 Floating buildings.
less to ground, or exceeds 14,000 0 Commercial-use agricultural
12 1- and 2-family dwelling Commercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
larger separately derived system.
AISIN : . :14,0*IW I NCRICWIT,01*,VOPIN::'. : :: - ....)- :: --' ; :::-:-: 0 Addition of new motor load of
Job no.: I Job site address: /)2 00 5 W 6r 0 )7. ei 100HP or more. occupancy.
0 Six or more residential units. 0 Recreational vehicle parks.
.....--•"--,
City/State/ZIP: / / c. A 0 El Health facilities.
0 Hazardous locations. 0 Supply voltage for more than
600 volts nominal.
.
Suite/bldg./apt. no.: 36,0 I Project name:4 ni er / pc's e 0 Service or feeder 600 amps or more.
:'•:.'if44tC,iiiiikiii4;;A10:4- ;2•Ak
Cross street/directions to job site: Description -"' I QtY..1 Fee. I Total ' I •--
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq. ft. or less 168.54 .
Ea. addi 500 sq. ft. or portion 33.92 . 1
Tax map/parcel no.: _
Limited energy, residential
.4,1002A)::110t-t0.W'Ai'-.:41;t41).: (with above sq. a.) 67.84
2
Limited energy, multi-family
/ a in/ V o I - / - 013 e VI / l r" I '1 C r esidential (with above sq. ft.) 67.84 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
201 amps to 400 amps
133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: • Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 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
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date:
A. Fee for branch circuits with
)tTAF;*;13.0;304.000;50ii.,_,1::::,"'.':' above service or feeder fee,
742 2
each branch circuit
Business name: A ire r 1 ca r) H Col f I ell B. Fee for branch circuits
without service or feeder fee,
Contact name: 8 ,,,,j A404chester. first branch circuit 56.18 2
Address: /331 5 E i d eon S -i- Each add'l branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City/State/ZIP: PC) r ÷ jar cl 0 R 4=772 to 2 Each manufactured or modular
67.84 2
dwelling, service and/or feeder
Phone: (503 )231— /-/el 0 C2 I Fax: : (5 8 Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
t5 in .0.i141101a Sign or outline lighting 67.84 2
Signal circuit(s) or limited-
Business name:A rn er - y c ,-...? He.? r/f7:7 energy panel, alteration, or i
Address: /33' SE 6 21cl c 0.-1 5 --f extension. Describe: Page 2 2
City/State/ZIP: PO r - -t- 1,2 d OR c172 02- Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone: (503 ) 2 3/- 116,00 I Fax: (co 3 ) 2:3 '7-70'3 8 Investigation per hour (1 hr ruin) 66.25
CCB Lic.: 3S / 5 1 Electrical Lic.:20 .173 (ATI Suprv. Lic.: 2 wio LE Industrial plant per hour _. .. 78.18
'-:: ,.*1E:OBTOWPWIMIVFXM:4,:V.'
Suprv. Electrician signature, requiretr\ ..... ----- Subtotal:
k
Plan review (25 of permit fee):
Print name: T stc v e y c 1 u Date: 12, 2$ 1
1 - Star % te surcharge (1 of permit
i .
Authorized signature: € / i.... ---- / / TOTAL PERMIT FEE:
Print name:gra(/ 444n 4e.5 --te.),- D ate: /2 0 / This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
0 0
. /
* Number of inspections allowed per permit.
t:\Buildiog\Permiis\.ELC.PermitApP.dOC 10/01/09 440-4615TO 1/05/COM/WEB