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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT ��r 777 COMMUNITY DEVELOPMENT Permit*: ELR2017-00232 TE13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/02/2017 �A Parcel: 1 S 135AB04500 Jurisdiction: Tigard Site address: 10250 SW GREENBURG RD 125 Project: Spec Space Subdivision: 1991-055 PARTITION PLAT Lot: 1 Project Description: HVAC system. Contractor: AMERICAN HEATING INC Owner: LINCOLN CENTER LLC 5035 SE 24TH AVE BY SHORENSTEIN PROPERTIES LLC PORTLAND, OR 97202-4765 555 CALIFORNIA ST 49TH FL 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 12%State Surcharge-Electrical 11/02/2017 $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 2-001-0090. Y may obtain a copy of the rules or direct questions to OUNC by calling 50 2.1987 or 1.800.33 .2344. Issued By: � �[/` Permittee Signature: d 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 Application FOR OFFICE USE ONLY CI Of Tigard Received _ 25 g P ,: ", r a y. 11 , 1 7 97,...... Permit No.: icr,e 7 14 I 13125 SW Hall Blvd.,Tigard,OR 97223 i r,c,,.,1,..,..#,, i f i,_ Review � Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: eC 90 i 7'1,406-6-5".-- 1, "c�— TI GA RD Inspection Line: 503.639.4175 t 201 BJuris: See Page 2 for `'W Internet: www.tigazd-oC.gov J NotiDatefied/ReadyMethoy:d: Supplemental Information • ''''M IV''' NRvww- ,' ! P' EClWORKO: IG l ❑New construction E Addition/alteration Veplleelil nt i '14!,,,r Please check all that apply(submit 2 sets of plans w/items checked below): 0 Service or feeder 400 amps or more 0 Building over three stories. 0 Demolition 0 Other: where the available b e fault current ❑Mannas and boatyards. y - cAT� RY l(+' c(NsTR' 'Tio1,1 �i exceeds 10,000 amps at 150 volts or 0 Floating buildings. 0 1-and 2-family dwelling ®Commercial/industrialAccessorybuilding/ less to ground,ailother oexceeds ons14,0 ❑Commercial-use agricultural 0 g amps for all installations. buildings. ❑Multi-family ❑Master builder ❑Other: 0 Fire pump. ❑Installation of 150 KVA or % � ❑Emergency system. larger separately derived system.w JOB TIO 7 ND L SONifi: 4_ �' ❑Addition of new motor load of 0 Job no.: Job site address: 10250 SW Greenburg Road 10011P or more. occupancy. El Six or more residential units. 0 Recreational vehicle parks. City/State/ZIP:Tigard OR 97223 El Health-care facilities. 0 Supply voltage for more than ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt.no.:#125 Project name:VSP 0 Service or feeder 600 amps or more. I. `' Cross street/directions to job site: Description I Qty. Fee. I Tottalal 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 sq.ft.orort portionn 33.92 1Tax map/parcel no.: Limited energy,residential 75.00 2I ©FWO� jc (with above sq. ft) DECRIPTq" ' / Limited energy,multi-family low voltage wiringand T-stats 75.00 2 g residential(with above sq.,ft.) Renewable Energy ,r-,-- C) See Page 2' Services or feeders installation,alteration,and/or relocation t illtOPERTY,OWNER / ❑ 'I oNT. ho 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: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 ►gid AOMAST ANT 'P A.Fee for branch circuits with \ ''"` "�` ,::'"" 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) 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:brad@americanheatmg net �� Pump or irrigation circle 67.84 2 % i %i ... CONTRACTOR i ,•' ,.. T Sign or outline lighting 67.84 2 Business name:American Heating Inc. Signal circuit(s)or limited-energy 1 See ,-7,.._rh 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 specificall listed(%2 hr min) It %' E RICAL:PE IMI', ..,EBE .: Suprv.Electrician signature,required: .;I Subtotal: Print name: T Steve Young ate: 10-31-17 Plan review(25%of permit fee): ic... Statenii- surcharge(12%of permit fee): H Authorized signature. do, ..-.,-C. TOTAL PERMIT FEE: �`1. 4 This permit application expires if a permit is not ob ined within 180 Print name: Brad Manchester 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.doc Rev 05/21/2013 440-4615T(11/05/COM/WEB