Permit (97) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
e COMMUNITY DEVELOPMENT Permit#: ELR2019-00021
TEGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/07/2019
Parcel: 1 S 135AB01002
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 571
Project: Trellborg 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: 503-412-4800
FAX: 503-239-7038
FEES
Description Date Amount
Specifics: Restricted Energy Permit 02/07/2019 $75.00
12%State Surcharge-Electrical 02/07/2019 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems:
Audio&Stereo: Boiler Controls:
CCTV: Clock Systems:
Data&Telecommunications: Fire Alarm:
HVAC: Instrumentation:
Intercom/Paging: Landscape/Irrigation:
Landscape Lighting: Medical:
Nurse Calls: Protective Signal:
Security Alarm: Other: 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. Y a obtain a co of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800. 32.2344.
Issued By: 6 �� '` Permittee Signature:
1//'i C/ 4." C '7< "-
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
..,,, Received r
City of Tigard '�'b}» Date/B : ' ' b Permit No.:C, "1 , r ,
1111 r 13125 SW Hall Blvd.,Tigard,OR�� g .4 Plan Review
Date/B : Other Permit:/17 _, , e•
Phone: 503.718.2439 Fax: 503.598.1960e"_
r GAR 0 Inspection Line: 503.639.4175 FEB $ 2 010 Date Ready/By: Juris H See"a'e 2 or
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
mit"
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❑New construction ®Additio e 011t1 e Pi ! t' f 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 fault current 0 Marinas and boatyards.
CATV 1' OF C+D exceeds 10,000 amps at 150 volts or 0 Floating buildings.
°;° s ice,,, ,,, °
1-and 2-familyless to ground,or exceeds 14,000 ❑Commercial-use agricultural
El dwelling ®Commercial/industrial 0 Accessory building amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
0,000,000000, , / Emergency system. larger separately derived system.
4 ;,JoB 9 'TI<#'► _ Aid", ,r„,m q ,,.• Addition of new motor load of
Job no.: Job site address: 10220 SW Greenburg Road 1001W or more. occupancy.
0 Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP:Tigard OR 97223 0 Health-care facilities. 0 Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.:#571 Project name:Telleborg 0 Service or feeder 600 amps or more.
7v I t HF,1?1J1� y �/'i
Cross street/directions to job site: c Qty. I Feee. Total ”
Description 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, n reside tlai
s�;% y/� : 13E �IW�•,,UP t e (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
r -A ' 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
" AFee for branch circuits with ftr th
, API11 4 ' a t CCt " .ON .
,/•; 'i„ , -,,,, 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
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
;y- r,> C9, a, ,7 "8 R ,-. .�. Sign or outline lighting 67.84 2
Business name:American Heating Inc. Signal circuit(s)or limited-energy 1 See
panel,alteration,or extension. Page 2 2
Address:Brad Manchester Each additional inspection over allowable in any of the above
City/State/ZIP:Portland,OR.,97202 Additional inspection(1 hr min) 66.25/hr
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.: 26993 CRE Suprv.Lic.: 2640LEB specifically listed(Y2 hr min)
,,,,, ;,ELr CAL MJt ES . :, , .%r,
Suprv.Electrician signature,required. K 11/4__,...,____,----- ----. Subtotal:
Print name: T Steve Young Date: 2-9-19 Plan review(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: /W7/.0frel TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Brad Manchester Date: 2-9-19 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