Permit q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' COMMUNITY DEVELOPMENT Permit #: ELR2010 -00286
T1 GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/28/2010
Parcel: 1 S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 500
Project: Concero Subdivision: LINCOLN CENTER/TWO LINCOLN Lot: 0
Project Description: HVAC system.
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 12/28/2010 $75.00
12% State Surcharge - Electrical 12/28/2010 $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 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. 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 OA: 952 - 001 -0090. You m.. = - .- • • • of - •r direct questions to OUNC by calling 50387 or 1.800. 32.2344.
_ .232.19 8
gc M4■-,
Issued :4 • � — = Permittee Signature: C
'� 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.
Electrical Permit Application RECEIVED FOR OFFICE USE ONLY - •
1111 City of Tigard RCCG1 ' d �. Permit Na.: y (�- f. • 13125 SW Hall Blvd., Tigard, OR 97223 DEC 2 8 rt i ' Plan Review l t I X11 1
Phone: 503.639.4171 Fax: 503.598.1960 Date/13 ; Other Permit:
T I G A It D Inspection Line: 503.639 CITY OF TIE ARD Date Ready/By: ®See Page 2 for
Internet: www.tigard- or.gov plvISIO
Notified/Method: r Supplemental Information
. ;c- .; ;,' -� :�;- r`= m - - _ - - n � : . ;�,: :- r.`.•. F, -. - -:': '�p %'- •`'•' %�'aY "y':
1,i + �r: 7z..`* }i, "o- -i"�:: : { , x '�<• - �'i:. �: 'i4?r�� � "'Y`
:'o- .:ro,.R 'a.;a - , : t st '� '' .•r = �; J�r. r � - ^ ,, :r: •5145• : 4 1:6: 't x 44 . 4 40. " v mu. • " 1 A .- J,s`.i', . ,<��Y
���- :�i"`{�,...i�r -; n.� F. � d.- � 3u._: �� c: 7b.�• . - . .: « ti:�< .:t.;i� - : „ r; r, ^; :7 . :, r � �, Y _. .t::.:.- �i.sr7 r -3:� -� .s`: ro . r ' _w,� -
❑ New construct ion Er Addition/alteration/replacement Please check all that apply (submit 1 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
''z s•�:r s' -1 I/ y i;,y:; y,- _ - a_ v r, .,<, •; : -:; _- exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
-i4,+ ..=t: %:_ _ >b .- 1ST #1.70 O. _ -
' ``'�•.x s.; �s,.. 4+ : %�: • ..... ,r. �� ,c.oa -_r a,., -... � " � � less to ground, or exceeds 14,000 ❑ Commercial-use agricultural ❑ ^ and 2- family dwelling Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
: . t , � T , z• �.... K S j} - ❑ Emergency m. larger separately derived system.
�u: , 4QB S' O FC o` Vitily d ' °_` < Addition of n ew syste motor load of ❑ "A" ••E "1.2 ••1 -3
,.- r.: :•; rt -i,d <y .P Z: :.et`..7�tr:y,..s. :.7., . - • ..,.. ❑
Job no.: Job site address: 10220 $ � / �or ee n 6u l R� 100HP or more. occupancy.
0 or more residential units. ❑ Recreational vehicle parks.
City/ State/ZIP: 7 Ar / a p g •z Z '3 ❑ Health-care facilities.
❑ Supply voltage for more than
rJ /� ['Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 560 Project name: Con C e r'o Ex / ' ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: Description I - Qty. I Fee. ( 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'I 500 sq. ft. or portion 33.92 . l
Tax map /parcel no.: Limited energy, residential
r�. -'.r F.> :.3 •�. •..� {; :; 67.84 2
:yu - `ar' 60#104t4g1F ;:; ,r,�_':.';- " `>~i..ls``: i (with above sq. ft.)
"�;i :�.. y'r`�ix •:: �a c : s'.,�%a «`,"` uw �,''f:��..,,.x.., �a «,. �,- 1,- �<,.;� , .... , , ;3`�;'- �::'-; �,' . , r �, ,,..r � -
Limited energy, multi - family 67.84 2
/o v / V a / i �t e • w I Y I el q residential (with above sq. ft.)
J J Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
e'- .,. y'.li{o)PERfYl '�+U lx>✓'R. : . : s �3 ' %= _ f N .NT° ; : .-: , 201 amps to 400 amps 133.56 2
- .'t`; .:�:- e.bt j-'- �..q,.ar .n �:1. f.-` r ��:"�i:e i "1'� < - . . v ... r- c-... . _
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: ( ) 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
:4: ;yi `. ." „s;F iik.; . :y g ': •< - - .I above service or feeder fee
,�''� +._ -. �;� r <i- •°.;` l�^ �. �L``^' s-': ��t4 °.�s�:�9'., }s -:-_ .;.�__ a.,_..- `,R:!:tS3...r_ -i�:;: ,.. - _ -. x .. 7.42 2
Hem f each branch circuit
r Business name: Arne 'can el B. Fee for branch circuits
r✓ I r A c i M // r
without branch nch circuit
or feeder fee, 56.18 2
Contact name:
MR /1C G �7 es e first branch circuit
Address: /33q 5 E , J e o n S I Each add'l branch circuit 7.42 2
q Miscellaneous (service or feeder not included)
City/State /ZIP: Po r -f 1 / Gn d 0 / 72 Q 2 Each manufactured or modular
67.84 2
/_ dwelling, service and/or feeder
Phone: (503 )231- L/(. d 0 Fax:: (SO3)z3 'O3 S Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
'A.Z; �y„ _ !, z - A C' M - : rA - ' f, . ';S: °:' {�. �' ;:;''S;i:• - `u. Sign or outline lighting 67.84 2
; ;;OT.,` ti.' - 4 , :c ;.- =.:f: �';:i ;; e.?4 .-. .-�i- _bid s :•l
Business name:A er' / C,---7 H e'.4 7 /J ' / Signal circuit(s) or alteration, d-
r energy panel, alteration, or
Address: /331 5E U ( d O/l s extension. Describe: Page 2 - ]5. 2
City/State/ZIP: Po r'- f- /.s , i Og 9 7 .o2 Each additional inspection over allowable in any of the above
$03) 23 '1 -/ OO (co 3 ) 23 - 7 o3 8 Investigation 66.25
Phone:
( Fa Inve per hour (1 hr min) 66.25 _
' CCB Lic.: 33135 Electrical Lic.:2 CRE Suprv. Lic.: 2 ( 'l0 L.EQ Industrial plant per hour 78.18
rE,CI FtCV. pFrR ' , :,'
Suprv. Electrician signature, required' \ Subtotal: - 75 -- W
Print name:T S'C V e. y 0 ill Date: ) 2 12 t 1 Plan review (25 % of permit fee):
State surcharge (12% of permit fee): /; QO
Authorized signature: i 7/7,.f.,c- /4.S / 7 TOTAL PERMIT FEE: Inf try
�?�j��/ �nG eS �- I Dat 2 27 This permit application expires if a permit is not obtained within 180
Print name: u' J e� � 2 / / � days after it t has been accepted as complete.
• Number of inspections allowed per permit.
1:\ Building \Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(I1 /05/COM/WEB