Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2015-00308
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/06/2016
Parcel: 1 S135AB01002
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 571
Project: Trellborg Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Low voltage for HVAC
Contractor: AMERICAN HEATING INC Owner: LINCOLN CENTER LLC
5035 SE 24TH AVE BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97202-4765 235 MONTGOMERY ST, 16TH FLOOR
SAN FRANCISCO, CA 94104
PHONE: 503-239-4600 PHONE:
FAX: 503-239-7038
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/06/2016 $75.00
Type of Use: COM 12%State Surcharge-Electrical 01/06/2016 $9.00
Class of Work: ALT
Total Number of Systems: 0
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 0 Fire Alarm: 0
HVAC: 0 Instrumentation: 0
Intercom/Paging: 0 Landscape/Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 0 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 fo h in OAR
952-001-0010 through 08R 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.234
Issued By: 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 site at the time of each inspection.
Electrical Permit Applica>*d>tt'�l�'� g "`� • OFFICE USE ONLY
ReceivCity of Tigard (� ( G DateBea /� Permit No.: 309
13125 SW Hall Blvd.,Tigard,OR 9T123" 2 8 2015 Plan Review
Phone: 503.718.2439 Fax: 503.5 UM 960 Date/By: Other Permit:
Inspection Line: 503.639.4175 O IGARD Date Ready/By: Jaris: 21 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE,QF WORK
i3 PLAN REVIEW'
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 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.
A CATEC{3ItS' RIwN �,,: exceeds 10,000 amps at 150 volts or El Floating buildings.
` `' less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ I-and 2-family dwelling ®Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
El Emergency system. larger separately derived system.
Jp $11' TIOI'tI ANI) Lt7 CATION ❑Addition of new motor load of ❑"A" "E" "1
Job no.: 115030 Job site address: 12220 SW Greenburg Road 100HP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard OR 97223 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal-
Suite/bldg./apt.no.:#571 Project name:Trellborg at Lincoln 3 ❑Service or feeder 600 amps or more.
VEE,,,SCHEDULE
Cross street/directions to job site: Description Qty. I Fee. I Total
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'1500 sq.ft.or portion 33.92 1
Tax map/parcel no Limited energy,residential
75.00 2
with above s .ft.
1 DESCRIPTION OF:WORD )
Limited energy,multi-family 75.00 2
low volt wiring and T-stats residential(with above sq.ft.)
Renewable Ene' y 1 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Q PROPERTY;OWNED+ a T) ANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
200 amps or less 59.36 1
Owner installation:Tlds 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
Owner signature: Date: Branch circuits—new,alteration,or extension,per panel
®'APPLI AI ®,CONTACT PERSON
A.Fee for branch circuits with
z above service or feeder fee,
Business name:American Heating Inc. each branch circuit 7.42 2
B.Fee for branch circuits without
Contact name:Brandon Hutchinson service or feeder fee,first 56.18 2
branch circuit
Address:5035 SE 24th Ave. Each add'1 branch circuit 7.42 2
City/State/ZIP:Portland,OR.,97202 Miscellaneous service or feeder not included
Each manufactured or modular 67.84 2
Phone:(503)239-4600 Fax: :(503)239-7038 dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail:b.hutchinson@americanheating.net Pump or irrigation circle 67.84 2
_ ,h.... . . C IKACTC)J ; - Sign or outline lighting 67.84 2
Business name:American Heating Inc. Signal circuit(s)or limited-energy 1 See 'S—y
panel,alteration,or extension. Pae 2 2
Address:Brandon Hutchinson Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Portland,OR.,97202 Investigation(I hr min) 66.25/hr
Phone:(503)239-4600 Fax:(503)239-7038 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 33135 Electrical Li 26993CRE, - Suprv.Lic.: 2640LEB sp5cifically listed('/z hr min
ELEG"�RGiL''F' B�#I�'°FEES
Suprv.Electrician signature,requir t Subtotal: 7
Print name: T Steve Young Date: 42 3'V Plan review(25%of permit fee): ---
,� State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE: 9 1 dU
This permit application expires if a permit is not obtained within 180
Print name: Brandon Hutchinson Date: '�3IS days after it has been accepted as complete.
• Number of inspections allowed per permit.
1ABui1ding\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 4404615T(11/05/COM(WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK UNLY: _ sc"pui;
Fee for all residential systems combined........ $75.00 nesceition Fee TowRenewable electrical energy system `
s:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems*
15.01 to 25 kva 200.34 2
F] Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 552.26 2
❑ Heating,Ventilation and Air Conditioning OAR 918-309-0040)
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
F-1
Other: Each additional inspection is 66.25/hr 1
charged at an hourly I hr min
Inspections for which no fee is 90.00/hr
specifically listed(%2 hr min
COMMERCIAL WOE ONLY: ELEC:T1 C L`PERMfr FEES
Fee for each commercial system....................... $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
❑ Audio and Stereo Systems days after it has been accepted as complete.
' Number of inspections allowed per permit.
❑ 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: _
*No licenses are required. Licenses are required
for all other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013