Permit (114) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
2 '> COMMUNITY DEVELOPMENT Permit#: ELR2017-00233
dS'1.R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/02/2017
43-�
Parcel: 1 S 135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 1000
Project: Miller and Kim CPA's Subdivision: METZGER,TOWN OF Lot: 9
Project Description: HVAC system.
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 11/02/2017 $75.00
Type of Use: COM 12%State Surcharge-Electrical 11/02/2017 $9.00
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 btain a copy of the rules or direct questions to OUNC by calling 503.23 87 or 1.800. 3 344.
Issued By: _____A ' Permittee Signature: ��
� �/ C �,
7-
OWNER INSTALLATION ONLY Ci ,,c
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 FOR OFFICE USE ONLY
City of Tigard "" �_P Received
II " 13125 SW Hall Blvd.,Tigard,OR 9 " t DateBy: ill ill" permit No.:
Plan Review "-�'lJ 7 }
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:f )l
T I GARD Inspection Line: 503 639.4175 V I 11/ Date Read B l 2 for
Internet www ti and or ov Ready/By: Sufis: I H
g g �c� Notified/Method '� '-+ See Page 2 for
0 1 * *� � --y,-)f
� * ��i OP���/ _ u"1 Supplemental Information
S �) ` i" ,. 1 A - , . e maa h s A ": irCE
❑New construction ®Addition/altai i i f� :emen Please cheek all that a i "
lI pp y(submit 2 sets of plans w/items checked below):
0 Service or feeder 400 amps or more ❑Building over three stories.
0 Demolition ❑Other
where the available fault current 0 Mannas and boatyards.
4 r . : CA 'E9oQ f7i1s'C;I111IL4'>f1T 2 i. x y exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑ 1-and 2-family dwelling ®Commercial/industrialless so ground,a exceeds ons ❑Commercial-use a 'cultural
0 Accessory building �'
❑Multi family ❑Master builderampsirefor all other installations. Installation
0 Other: 0Fire pump. ❑Installation of 150 KVA or
lX " ; ;IQ$yIj' L? TIo1�I A A ❑Emergency system. larger separately derived system.
„ i .< j 0` ❑Addition of new motor load of ❑"A","E","1-2","1-3",
Job no.: I Job site address: 10260 SW Greenburg Road 100HP or more. occupancy.
❑Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP:Tigard OR 97223 ❑Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.:#1000 I Project name:Miller Kim CPA ❑Service or feeder 600 amps or more.
Cross street/directions to job site: :, ;SI1El ,, j a„ -
Description I Qty. I Fee. I Total
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq.ft.or less 168.54 4
Tax map/parcel no.: Ea.add'l 500 sq.ft.or portion 33.92 1
,,K _- E� IO f P O Limited
ith eneabove
sq.residential
u J
y (with above sq.ft.) 75.00 2
low voltage wiring and T-stats ::-
Limited energy,multi-family
residential(with above sq.ft) 75.00 2
'Renewable Energy 0 See Page 2"
r � E � Services or feeders installation,alteration,and/or relocation
In 19A1 200 amps or less 100.70 2
`F Fy l
Name: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
City/State/ZIP: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Phone:( ) I Fax:( ) relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: 401 amps to 599 amps 168.54 2
Date:
� ;4:04. Branch circuits—new,alteration,or extension,per panel
0PPI.I i0 -**,soxt, A.Fee for branch circuits with
� �"� COI�tI`�.�'PERsf1
Business name:American Heating Inc. ✓ y above service or feeder fee,
each branch circuit 7.42 2
Contact name:Brad Manchester B.Fee for branch circuits without
service or feeder fee,first
Address:5035 SE 24th Ave.
branch circuit 56.18 2
Each add'l branch circuit 7A2 2
Miscellaneous(service or feeder not included)
City/State/ZIP:Portland,OR.,97202
Each manufactured or modular
Phone:(503)239-4600 I Fax: :(503)239-7038 dwelling,service and/or feeder 67.84 2
E-mail:brad@americanheating.net Reconnect only 67.84 2
e I' Co1044ii 1 4 Pump or irrigation circle 67.84
2
"' Sign or outline lighting 67.84
Business name:American Heating Inc. 2
Signal circuit(s)orlimited-energySee
panel,alteration,or extension. 1 Page 2 'Js 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 I Fax:(503)239-7038 Industrial plant(1 hr min) 78.18/hr
CCB Lie.: 33135 I Electrical Lie.: 6993CRE Suprv.Lie.: 2640LEB Inspections for which no fee is
P specifically listed(%hr min) 90.00/hr
Suprv.Electrician signature,required: 4. `` ELl TRIC4L` I'U IT F I,S 1.'-'' '' ;,
— Subtotal:
Print name: T Steve Young
I Date: 10-31-17 Plan review(25%of permit fee):
ed'"C���� State surcharge(12%of permit fee): rJ'''
Authorized signatur . �(,
TOTAL PERMIT FEE: IV(
This permit application expires if a permit is not obtained within 180
Print name: Brad Manchester I Date: 10-31-17
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