Permit (108) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
- ' COMMUNITY DEVELOPMENT
Permit#: ELR2017-00165
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/27/2017
T f Parcel: 1 S 135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 250
Project: Keyence Corportation 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 07/27/2017 $75.00
12%State Surcharge-Electrical 07/27/2017 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 0 Fire Alarm: 0
HVAC: 1 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 forth in OAR
952-001-0010 through OAR 952-001-0090. You
ma obtain a copyof the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344 4-5—i
Issued By: na / 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 i ii EC IVE FOR OFFICE USE ONLY
ReceivedB4/7/2-7/4/7
/2� //� A
7,ny0/6,611 City of Tigard e / PermitNo.: Ll2 t�
w 13125 SW Hall Blvd.,Tigard,OR 972} j I7 Plan Review
6 Phone: 503.718.2439 Fax: 503.598.1960 2 2Q 7 Date/By: Other Permit: U N� ; rr;/
T1 GARD Inspection Line: 503.639.4175 CITY �� �� � Date Ready/By: Juris: H See Page 2 for
Internet www.tigard-or.gov Notified/Method: Supplemental Information
T'1 Pi OE WO`t s 1 v
CI 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 0 Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
/ ; E R 6FYcoNS ON t exceeds 10,000 amps at 150 volts or 0 Floating buildings.
•-•,-87,77,'' ` "' less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi family ❑Master builder ❑Other: Fire pump. 0 Installation of 150 KVA or
r' ❑Emergency system. larger separately derived system.
' % JOB FORM TION AIS t ''HON ❑Addition of new motor load of ❑
100I3P or more. occupancy.
Job no.: Job site address: 10300 SW Greenburd Road
0 Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP:Tigard OR 97223 ❑Health-care facilities. 0 Supply voltage for more than
Ty gan0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.:#250 Project name:Keyence 0 Service or feeder 600 amps or more.
SOl1Ei}i�l fr
Cross street/directions to job site: Description I 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'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
DE` 1.1PTIfl r0 _WORK IL! `°_ (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
low voltage wiring and T-stats residential(with above sq.ft.)
Renewable Energy 0 See Page 2-
Services or feeders installation,alteration,and/or relocation
,- ,. s ' 200 amps or less 100.70 2
QPEIIT ' ! a ,' TENANT P
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
0 to 1 000 amps
301.04
2
Address: 6 1 amps p
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: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
Owner signature: Date: Branch circuits—new,alteration,or extension,per panel
® A.Fee for branch circuits with
PLI AI:IT -11p, gs +Cf.rstA r PEI o
• above service or feeder fee,
Business name:American Heating Inc. each branch circuit 7.42 2
B.Fee for branch circuits without
Contact name:Brad Manchester service or feeder fee,first 56.18 2
branch circuit
Address:5035 SE 24th Ave. Each add'l branch circuit 7.42 2
City/State/ZIP:Portland,OR.,97202 Miscellaneous(service or feeder not included)
t3 Each manufactured or modular
Phone:(503)239-4600 Fax: :(503)239-7038
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
E-mail:brad@americanheating.net Pump or irrigation circle 67.84 2
%?,iff "',CONTRACTOR %ir Sign or outline lighting 67.84 2
Business name:American Heating Inc.
Signal circuit(s)or limited-energy1 See
panel,alteration,or extension. Page 2 2
Address:Brad Manchester 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(1 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 Lic.: 26993CRE Suprv.Lic.: 2640LEB specifically listed(9z hr min)
E+ (FRICAL ritRIVI l` h EB ,,'. i
Suprv.Electrician signature,required: — Subtotal:
Print name: T Steve Young Date: 7-25-17 Plan review(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature:
TOTAL PERMIT FEE: 23,-4-44Z)
This permit application expires if a permit is not obtained within 180
Print name: Brad Manchester Date: 7-25-17 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp ELR ERE.doe Rev 05/21/2013 440-4615T(11/05/COM/WEB