Permit CITY OF T1G/4R® ELECTRICAL RESTRICTED ENERGY PERMIT
rs n
COMMUNITY DEVELOPMENT Permit #: ELR2010 -00061
r E G`ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/16/2010
7
Parcel: 1S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 380
Subdivision: LINCOLN CENTER/TWO LINCOLN Lot: 0
Project: Waldron Co.
Project Description: Low voltage for thermostat
FEES
Owner:
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 04 /16/2010 $67.84
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 04/16/2010 $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: N 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: y
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 OAR 952-001-0100. 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: v Permittee Signature: 0A/ j.T( ,A Tx�/iv
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 RECEIVED FoR OFFICE_USE ONLY
City of Tigard APR 16 2010 Received '
IMMEEMME
Date/B :
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.196�ITy OF TIGARD Date/B : Other Permit:
I' I (.i ARP Inspection Line: 503.639 BUILDING DIVISIO Date ReadyBy: tuns: 10 See Page 2 for
Internet: www.tigard- or.gov Notified/M Supplemental Information
TYPE OF WORK PLAN REVIEW
0 New construction ,ddition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or 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.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwellingommercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E", "I -2 ", "I -3 ",
100HP or more. occupancy.
Job no.: Job site address: /022 0 5 w 6,. cc . h ll f rCJ ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: SC r G/ O 2 Cl ❑ Health -care facilities. ❑ Supply voltage for more than
/ ❑ Hazardous locations. 600 volts nominal.
V
Suite/bldg. /apt. no.: 3 8o Project name: V G( IcJ ✓e /? ❑ Service or feeder 600 amps or mare.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qtv. 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
Ea. add'I 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 67.84 2
/ 'A/ n Limited energy, multi-family 67.84 2
2 VO /�0Gf �Jk'7P7 J ^s�C/ fi residential (with above sq. ft.)
J J 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 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
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
d
Business name: , I pv et - / c C ,, 7 1-1C44 / , 771 Z G B. Fee for branch circuits
/ . without service or feeder fee,
Contact name:
I3r4d M / 4 - ,I c 4 es 7L e first branch circuit 56.18 2
Address: /33? 5 E (� 1 cJ e O rl s I- Each add'I branch circuit 7.42 2
�/ G O/ 1'72 ® Mis (service or feeder not included)
City /State /ZIP: r Cj 2 Each h mf manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (SO3) 2,3 Fax: : (503 ) 23 - 7038 Reconnect only 67.84 2
•
E -mail: Pump or irrigation circle • 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Signal circuit(s) or limited-
Business name:
ri er- / CGn q / n �/ energy panel, , alteration, or
Address: � 33 °/ S E / c O n .S �- extension. Describe: Page 2 2
City/State /ZIP: P/ '� /�h OR g 72 02 Each additional inspection over allowable in any of the above
Per inspection 66.25 .
Phone: (5 03 )239 y 00 p Fax: (S03 ) 23 9 -703 8 Investigation per hour (1 hr min) 66.25
CCB Lic.: 3 3' /3 5 Electrical Lic.: 2( ' ?Kea Suprv. Lic.: Z "/V L ES Industrial plant per hour 78.18
ION ELECTRICAL PERMIT FEES
Suprv. Electrician signature, require*- Subtotal:
Print name: y 5 eve, O V Date: y { - e - I (' Plan review (25% of permit fee):
-7 State surcharge (12% of permit fee):
Authorized signaturer�l? /�� TOTAL PERMIT FEE:
Print name: �re& /!/��c / e5 - S 1 G Date: y ^ I ( - i O This permit application expires if a permit is not obtained within 180
Gj ' L I . r lQ days after it has been accepted as complete.
Number of inspections allowed per permit.
1:\ Building \Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(11/05 /COM/WEB