Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
2 COMMUNITY DEVELOPMENT Permit #: ELR2012 -00172
T I GA . R O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/02/2012
Parcel: 1 S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 210
Project: Advanced Wealth Management Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Install low voltage controls to a fan powered box and mount (1) new thermostat. Relocate (1) existing low voltage
thermostat
Contractor: MCKINSTRY COMPANY LLC Owner: LINCOLN CENTER LLC
16790 NE MASON ST., STE. 100 BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97230 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 331 -0234 PHONE:
FAX: 503 - 331 -6907
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/02/2012 $75.00
12% State Surcharge - Electrical 08/02/2012 $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 0 R 952- 001 -0090. You may obtain a copy t of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. •
Issued By: W(.c.lci �1 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 site until completion of the project.
Approved plans are required on the job she at the time of each Inspection.
70s65
Electrical Permit Application REctivED holz order uSI ()NIA'
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City of Tigard Received 2 4q , I ly PermitNo ,0�
1 S W Hall Blvd., Ti ard, OR 97223 A U G 0 ! Q' L Date /By: } �-vr
11111111 , g Date/By: Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:8U P O(�- tow I �S
r Date /By:
I" I c:1 RI) Inspection Line: 503.639.4175 C � ® El ICA Date Ready /By: Juris: El See Page 2 for
Internet: www.ti and -or. ov V�++�RZ�,,�$$ Notified/Method: � , (p Supplemental Information
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TYPE OF WORK 'PLAN REVIEW •
Please check all that apply (submit 2 sets of plans w /items checked below):
El 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.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
• " less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling Z Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I - ", "1 - ",
Job no.: 70865 Job site address: 10220 SW Greenburg Road
1 00HP or more. occupancy.
❑ Six or more residential units. 0 Recreational vehicle parks.
City/State /ZiP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
l ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 210 Project name: Advanced Wealth Managemen ❑ Service or feeder 600 amps or more.
FEE SCHEDULE •
Cross street/directions to job site: Description 1 Qty. I Fee. I 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 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
install low voltage controls to a fan powered box and mount (1) new thermostat. residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
Relocate (1) existing low voltage thermostat. 200 amps or less 100.70 2
'0 PROPERTY OWNER ® TENANT 201 amps to 400 amps 133.56 2
Name: Advanced Wealth Management 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
Ci /State /ZIP: Temporary services or feeders installation, alteration, and/or
ty 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 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: McKinstry Company, LLC B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Janel Lipe branch circuit
Each add'I branch circuit 7.42 2
Address: 16790 NE Mason Street Suite 100 Miscellaneous (service or feeder not included)
Each
Ci /State /ZIP: Portland, Oregon 97230 l manufactured or modular 67.84 2
dwe
dwelling, service and/or feeder
Phone: (503) 278.3954 Fax:: (00 ) 331_ ( 0'p Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: janell @mckinstry.com
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited -energy
Business name: Same as above panel, alteration, or extension. ( Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (I hr min) 66.25/ hr
City/State /ZIP: Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
specifically listed ('/2 hr min) 90.00 / hr
CCB Lic.: 172811 Electrical Lic.:37_930La Suprv. Lie.: 51 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 4.7, Subtotal:
wn Plan review (25% of permit fee):
Print name: 744,`& C, -• .(( Date: 00,- oz,... 1 y State surcharge (12% of permit fee):
e TOTAL PERMIT FEE: g L/.O1)
Authorized signat This permit application expires if a permit is not obtained within ISO
Date: Q days after it has been accepted as complete.
Print name:
` 7 - A„, . r LI D� Op . o f_ 12.. ` Number of inspections allowed per permit.
\ E rm
I: \Building \Permits LC- PeitApp.doc 07/01/10 / 440- 4615T( II /05 /COM /WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
I RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: 7 •
*No licenses are required. Licenses are required
for all other installations
l: \Building \Permits \ELC- PennitApp.doc 07/01/10