Permit M CITY OF - �IGAR® ELECTRICAL RESTRICTED ENERGY PERMIT
i a q
" ss COMMUNITY DEVELOPMENT Permit #: ELR2010 -00048
T I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/26/2010
Parcel: 1 S 135AB01002
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 305
Subdivision: LINCOLN THREE Lot: 0
Project: Comsys
Project Description: Add /alter (1) low voltage sytem for t -stat.
Owner: FEES
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 03/26/2010 $67.84
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 03/26/2010 $8.14
PHONE:
Contractor:
AMERICAN HEATING INC
1339 SE GIDEON ST
PORTLAND, OR 97202
PHONE: 503 - 239 -4600
FAX: 503 - 239 -7038
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: y Instrumentation: N Total $75.98
Intercom /Paging: N Landscape /Irrigation: N Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
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 R 952 -011-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Q�Vd. 4iatiLi_ ! g St / / Cs--/(i
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 an inspection that business day.
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 a ° ° r :f, I eI 01 I I(441JSl o l u; 44 ' � 4 ; , ti ": • F ; ,�. ved Permit No.. is m
.:.g.: V City of Tigard f r q a w 1 fir, r• `rr ■t�
11 Il 5 " fl� I Plan Review
AA DateB
13125 SW Hall Blvd., Tigard, OR 9223( Recei
, Other Permit:
,j �, ,, Phone: 503.639.4171 Fax: 503.598.1960 tD ' t1 Cyr L Date/By:
I I c A Ic ID' Inspection Line: 503.639.4175 A � n Date Ready / • Ilisl., ® See Page 2 for
., Internet: www.tigard - or.gov MA 6 2010 Notifed/Method: (c1 Supplemental Information
TYPE OF BORIC n f� 75-% / t , r)ry PLAN REVIEW
❑ New construction Addition /alteiation/replace" ' 1. Please check all that apply (submit 2 sets of plans w /items checked below):
me i
=t'u" 1••1- !! =':.h ti.li Ir i. i® ❑ Service er feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
Tess to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling *Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ID Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION , ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ",
Job no.: Job site address: 10220 5' / 'v eer7 bL i
r Six or or more residential occupancy.
more rest dential units. ❑ Recreational vehicle parks.
City /State /ZIP: - 77,01,--,./ O / o J ❑ S or ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 3 0 S Project name: C YVl .5/ 5 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential
DESCRIPTION OF WORK - (with above sq. ft.) 67.84 2
Limited energy, multi - family
/a 1// Vo /71 67.84 2
j e w /K7 s lj residential (with above sq. ft.)
� f Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
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
Branch circuits - new, alteration, or extension, s er panel
Owner signature: Date: A. Fee for branch circuits with
. ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: 4 er can 11 e q 't hi,/ B. Fee for branch circuits
Contact name: / J without service or feeder fee, 56.18 2
/��ol / first branch circuit
Address: /33 S F t 2I e%Orl 51— Each add'I branch circuit 7.42 2
Imo Q DR q72 02 E ach lan manufactured
Miscellaneous
red (service omodular 67.84 2
or feeder not included)
City /State /ZIP: p 1 /� / �� G� -7 Each far or (503 ) 239 — y1'0D 603 ) / % Q g Reconnect
dwelling, t on ye and/or feeder
Phone:
� Fax : Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
. CONTRACTOR Sign or outline lighting 67.84 2
Business name: / Signal circuit(s) or limited-
/'? e/ / C Ci / / t�C! /�'! energy panel, alteration, or
Address: 133 / SE GI el eo, S 4 extension. Describe: Page 2 2
City /State /ZIP: 1P - 44 V Q R 72 02 Each additional inspection over allowable in any of the above
Phone: (5q 3 ) 23 " ! D O ax: ( F S03 )239—'703e Per Investigation 66.25
on per hour (1 hr min) 66.25
CCB Lie.: 33 /3 S Electrical Lic.26 773 6 'E Suprv. Lic.:26,9OLE& Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, requi / Subtotal:
Print name S --F . Y 0 \.)C t Date: 3 f 2( 1 / d Plan review (25 %of permit fee):
f 111 State surcharge (12% of permit fee):
Authorized signature: 7 ! � j f a c £ „s TOTAL PERMIT FEE: 7f 4 g
This permit application expires if a permit is not obtained within 180
Print name: i3/oci "Il h - Date: 3/26.7/0 days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(1 l /05 /COM/WEB ./�
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Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:. • • •
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
H Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
H Landscape Irrigation Control*
❑ Medical
n Nurse Calls
H 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,doc 10/01/09