Permit CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2006 - 00228
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/21/2006
PARCEL: 1 S135AB -01004
SITE ADDRESS: 10220 SW GREENBURG RD ZONING: C - P
SUBDIVISION: LINCOLN CENTER/TWO LINCOLN LOT: JURISDICTION: TIG
Project Description: LV for T stats.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
EQUITY OFFICE PROPERTIES TRUST AMERICAN HEATING
ONE SW COLUMBIA #300 1339 SW GIDEON ST
PORTLAND, OR 97258 PORTLAND, OR 97202
Phone: Contact #: PRI 503- 239 -4600
FAX 503- 239 -7038
FEES Reg #: ELE 26- 993CRE
LIC 33135
Description Date Amount
[ELPRMT] ELR Permit 9/21/2006 $75.00
[TAX] 8% State Surcha 9/21/2006 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: ,Za 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'N: 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.
OCT. 11. 2006 11:58AM 5032397038 _ NO. 9854 P. 1 ° F
Building Division
'" 4 ``' ''A I Request for Permit Action or Refund
City of Tigard
TO: CITY O1' TIGARD ' C) Co -.(oC-
Permit System Administrator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503,598.1960
PROM: ❑ Owner ® Applicant ❑ Contractor ❑ City Staff
(cheek one)
Name: American Heating, Inc.
(Business or Individual)
4 " 1 0 Mailing Address: 1339 SE Gideon Street o \T 2 ' 0
/6 / 2 3/c 6 /State /Zip: Portland, Oregon 97202
OCT 1Q 6
Phone No.: 503-239-4600 - v^ AD
smarm 3 DOM CIO h
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (V):
CANCEL PERMIT APPLICATION.
REFUND PERMIT FEES.
REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: $006-00228
Site Address or Parcel #: 10220 SW Greenburg Rd
Project Name:
— _
Subdivision Name: Lincoln Center Two Lot #;
EXPLANATION: Low Voltage permit not required - pnematic controls
Signature: � ' Date: 10 -11 -06
� �����
I G� /
o Project Coordinator
Emma n, l
Print Name:
Refund Policy
1. The Building Official may authorize the refund of
a) any fee which was erroneously paid or collected.
b) not more than 80 percent of the pconit fbe for issued permits prior to soy inspection requests.
c) not more them 80 percent of plan review fee what an application is canceled before 2. Refunds will returned the original Payer in the same method in which payment was received.
review effort has been expended.
1 OIZ OI• F1(1. l •l: O\ I,)
Rte to a Admen: Date i0ZEMI B ' " Rte to B ' • : , f. • , • Date 4 . EM
Refund Processed: Date D ,.3 06 Er ��a Invoice Processed: Date E
Permit Canceled: Date a m B f Parcel T. • Added: Date
. Date % Method ? MIN= Amount $
1 ;\Buildingllronos\RegPermitActi -BI' _ doe Rev 10/17/05
RECEfiVED
Electrical Permit Applicltio n 1 44 '& FOR OFFICE USE ONLY
City g of Ti and RaCG1VOa °`"'
: l_ il� ' � / EW „22
p -
13125 SW Hall Blvd., Tigard, OR 97223 UILDING DIVISI • , Pin R Other Permit:
Phone: 503.639.4171 Fax: 503.598.19 CITY OF TIGARD i nc !' DateBy:
Inspection Line: 503.639.4175
• A I' Date Ready/By: Jut: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: �J 1. •upplementalInformation
NY r� .1' 1 X �.' ry � �5`p�T� i• � a U il�� � -. >,a4 7 Sf t ,� r '� L .'� r 7 j J. S y s �' � e � - �Ti�uJ w ��LPJ , N f/� st�rif �u%:'11 �..
t�.�.'tc_a . F_ _ - - . '._v, Wes_•' psf...' br'. Il?�",' is��**-._ r �mf 'iYt3., -�'sj.;l�ita"S t.t a'y -i o ..�' 1
❑ New construction G • ddition/alteration/replacement Please check all that apply:
El Demolition ❑Other: ['Service over 225 amps, comm'I ['Hazardous location
r a X , � R _ ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
`� � �,a, ? tf C q `, :. 9: l 4 0 t h, __ _ i , ., "�."s„/'? of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling pvCommercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
['Building over three stories ['Feeders, 400 amps or more
❑ Multi -family ❑Master builder ❑Other Occupant load over 99 persons ['Manufactured structures or
'-¢'w �: , t T,7 -. x h r•' S ` vA t{� .� _ rF , r1, RV park
gi p - , .% , _ t � ` " r '_ ,, , , r L,, '�'t ,, ,,,,1 ❑E l plan P
�. J ❑Health -care facility ['Other:
Job no.: Job site address:
i a20 I�n bu Submit 2 sets of plans with any of the above.
City/ State/ZIP: . a . d 0 ( 11,,,- The above are not applicable to temporary construction service
Suite/bldg. /apt no.: Project name: b b 1 , ••
t I 1 _� 1 Description Qty. F ee. Total
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no [� �{ Limited energy, non - residential 75.00 2
f 4 ' i 4 '
. y " - ''' ' . �� 3 .. s b - , t;,.-, - . u t . 1`° C ,� l 1 ,= ; ; fi ,ii �
; T 7 ,4t r Wz' V=T -, d am _ Each manufactured or modular
dwelling, service and /or feeder 90.90 2
v c
11a6 'A,. T 54 Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
p s r v� /3 .,f 4 7 . 7 z r u c�� 201 amps to 400 amps 106.85 2
:-._1.j- v r_t �t `7 0 't4-- l f � ` � r 2 vEI ` ' . 7 . u 12j141,,14'5g,, v
1 _,_� ��a a: �> _�� ,�. s._� i.- 401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 1 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
4'I r'` i i �5 r W ttiW'4i�W {? ':-: :' ::- r 1 - ' (fi t; .:; : . T/I� (d ffi Cd1 r ° a .1 - 7x F 'P'
A. for branch circuits with
" �r a.._. _� , 't ' 2' _ '' 'r !' 2
2 L 7 t`,'','W_ ; "r' - 1 service or feeder fee, each
branch circuit 6.65 2
EMEZ WIIIINIMEMNINII B . Fee for branch circuits
Contact name: t, 'l._. without service or feeder fee, 46.85 2
Address: i33 5 e -ia each branch circuit
\ • Each add'I branch circuit 6.65 2
City/State/ZIP: �0 yi l ( Q rZ (1-) 0 Miscellaneous (service or feeder not included)
a(� Pump or irrigation circle 53.40 2
Phone: • ) D 30 1 _ ( � U Fax: ( ) a J_I 6-6% Sign or outline lighting 53.40 2
E -mail: yy Signal circuit(s) or limited -
J� ` . a '�'� '' �wdtC >� /� N`�' !3I r 0 ;: 4 � ♦ J ih F���U ,,, s %y!' Y panel, alteration, or
are z ae e z � , .r z.�YaS�t!.�'�z�,r �_ n energy
extension. Describe: Page 2 2
Business name: f- l 1 (1 1 MIKTIONIMMIIIII
Address: ` Each additional inspection over allowable in any of the above
I 1 Per inspection 62.50 -
City/State/ZIP: C) 4 I "1'30? Investigation per hour (1 hr min) 62.50 _
(Ph ) P n O v ( - Industrial plant per hour 73.75
one: `"1- Fax: D -
CCB Lie.: 33 t 135 Electrical Lic.: - 3' (1e Sup Lic.: D4 y' Subtotal
Suprv. Electrician signature, required: - �' J• Plan review (25% of permit fee)
0 State surcharge (8% of permit fee)
Print name: v , � _ . Date: q ... _ ( - 0( o $ I
TOTAL PERMIT FEE - OLP
Authorized signature: .4 // - 1L / A ∎ / ` ` / This permit applies don expires if a permit is not obtained within 180
days after It has been accepted as complete
IMIZEMPAMMILIMMIN Date: C 3 (....c) • Fee methodology set by Tri- County Building Industry Service Board
Number of inspections per permit allowed:
i:\ Building \Permits‘ELC- PerrnitApp.doc 12/03 440- 4615r(10 /02ICOM/WEB •