Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1111 COMMUNITY DEVELOPMENT Permit #: ELR2011 -00192
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/10/2011
Parcel: 1 S 135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 610
Project: New York Life Subdivision: METZGER, TOWN OF Lot: PTS 7 -8
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 08/10/2011 $75.00
12% State Surcharge - Electrical 08/10/2011 $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 i issued subject to the r-. lations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done i accordance with approved pl- 1 This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. AT ENTION: Oregon law re.. es yo . t . •flow the rules adopted by the Oregon U tility N otification Center. Those rules are set forth in OAR
952 -001- 010 throu h OAR 952- 001 -.090. o in a copy of the rules or direct questions to OUNC by calling 503.232.1987 r 1. .332.23
.. , / ���
Issue By: ' / '/ Permittee Signature: Y
// 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 1 FOR OFFICE usE oNLI 1,, '' -. ."
City of Tigard 1 ECEIVED Received �„ /O !, y-
_ Permit No.: � Q�/ �� �9� x '
'� 13125 SW Hall Blvd., Tigard, OR 97223 Plan R By: eview
Phone: 503.718.2439 Fax: 503.598.1960 All 1 0 2011 DateBv: Other Permit:
TIGA Inspection Line: 503.639.4175 Date Ready/By• Suns: ® See Page 2 for
- Internet: www.tigard- or.gov e rare Notified/Method: Supplemental information
°, ��" � :TYPE OF� SI i '..PLA I2EVIE,W„
,DING .....:...;, ,: .:.. . � , � -
s »8�,�. � -i, � -� ,�v_�?�� �_ _< _, ..�` ,. �, . _= � «.., �,.��> '��= .
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Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction ❑ Addition /alteration/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ['Marinas and boatyards.
,..x -. ,. .. s;g >: - -. rya - --�,,, y ,., .
�:s ;t3 „ ^ ;F< : :,, " - exceeds , amps at 150 volts or ❑ Floating building s
;; CATEGORY= OF;: �CONSI'1ZUCTIONsu "::aa d 10000 l
` " ' `` ' less to ound or exceeds 14 0 0 Commercial -use
gr 0 ❑ agric ultural
❑ 1- 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
w,xi hra s •. ;• . , , .- ❑ Emergency system. larger separately derived system.
' % �,,,; F� ; ' a : M illi SITE IIVFNRMTIO ;,ANl LOC770N ; ` <` "iti
. iii. �a�,.�.�:.�s:����� ,:.max -- , .. ,. A ,,:.:, .. -, .,.:•, . . A
' .. ... .. . . . .. " N A.��.••,:�5 El of new motor load of ❑ ., .. .. :, ,
Job no.: Job site address: 10260 SW Greenburg Road 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard OR ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: fOrk/j Project name: New York Life ❑ Service or feeder 600 amps or more.
_: <1 ' FEE SCHEDULE;, ' <. --,:::
Cross street/directions to job site: Description p I Qtv. 1 Fee. I Total I 1 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 1
Tax map /parcel no.: Limited energy, residential
75.00 2
1'wDESCRIP IION �OF W O R K.`° ry °. , ' . - : v
ene
' (with abo e sq. ft.)
" - _ �� L energy, multi family
75.00 2
low voltage wiring (t residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
? Y ' "g ' . ® PROPERTY OWNER: < :; TENANTn'' e11 %' e ' ,: 201 amps to 400 amps 133.56 2
s,;z
4' et5.x.`,. ✓.,, .:j3�:. >_.,.., ; r, :.;..r.,;, cs4 °'4fitu'xmp5� +; x�,Eti� „ -, ';,3, � ,- 2, .. - -. � a �' °a,.%'...
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: relocation
Phone: ( ) 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
�..' -., above service or feeder fee
74
APPtiICANT - -:� � �' ••T, ,PERSON < °`', - 2 2
, , �._. � ,� .-- _...._. _ . .. . ", .;,,,,��<•• ='s��;� -: °� each branch circuit
Business name: American Heating Inc B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Brad Manchester branch circuit .
Each add'I branch circuit 7.42 2
Address: 1339 SE Gideon St Miscellaneous (service or feeder not included)
City/State /ZIP: Portland OR 97202 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 239 - 4600 Fax: : (503) 239 - 7038 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: •
Sign or outline lighting 67.84 2
�� 1VTRA' 2 T.OR:
` > C
„ .... , .. ,..w , . _ x�; +`y ;;<°'�A � • , � _ Signal circuit(s) or limited-energy 1
�
Business name: ` American Heating Inc panel, alteration, or extension. Page 2 7� 2
Each additional inspection over allowable in any of the above
Address: 1339 SE Gideon Street Additional inspection (1 hr min) 66 25/ hr
City/State /ZIP: Portland OR 97202 Investigation (I hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 239 - 4600 Fax: (503) 239 - 7038 Inspections for which no fee is 90.00/ hr
specifically listed (' /a hr min)
CCB Lic.: 33135 Electrical Lic.: 26993CRE Su rv. Lic.: 2640LEB �" -
P :, ... ;< •`:` ::;,.. F ,ELECTRiCAL PERMIT FEES ° `'s;• ;�:l-
Subtotal: 75
Suprv. Electrician signature, requir a" Plan review (25% of permit fee): — ----
Print name: T Steve Young Date: 7/15/2011 State surcharge (12% of permit fee): i ,00
...--e/ TOTAL PERMIT FEE: 7t�,0O
Authorized signatu
This permit application expires if a permit is not obtained within 180
Print name: Brad Manchester Date: 7/15/2011 days after it has been accepted as complete.
L * Number of inspections allowed per permit.
I: �Building�Permits�ELC- PermitApp.doe 07/01/10 440- 46t5T(11 /05 /COM/wEB