Permit • CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
` COMMUNITY DEVELOPMENT Permit #: ELR2010 -00069
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/27/2010
Parcel: 1S135AB01004
• Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 380
Subdivision: LINCOLN CENTER/TWO LINCOLN Lot: 0
Project: Waldren
Project Description: Low voltage wiring t -stat
FEES
Owner:
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 04/27/2010 $67.84
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 04/27/2010 $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:
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
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
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 at 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 obbtaiin/a copy of the rules or direct questions to OUNC by calling 503.246.6699 / o or 1 / m
Issued By: t t �`""— - Permittee Signature: tl f 7 t �� ill '
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.
APR. 26. 2010 9:39AM 5032397038 NO. 8948 P. 2
Electrical Permit Application r<lli oil ic1: i'.st: u"l,1
City of Tigard Permit No. :aRa.0w - 000 • '
13125 SW Hall Blvd., Tigard, OR 97223 CEIVE [`!: , ' fan Review
' • Phone: 503.639.4171 Fax: 503.598.1960 Datc/B : Other Permit_
i t , A t , t JnSpettion Line: 503.639.4175 APR 262 n, Date Ready /By: Jc 0 See Page 2 for
Internet www.tigard I Notified /Method; Supplemental Information
V t�± (� 1 ^ ' r • �I1 'E% ! . : I d �OF lIG R]�'�/ • :;.'„ ;`4,,,- '"D> ,, -i, '•'�,yr. ,i 1 )1 .4/y�I `24 fit?'. : :: ;''
.-' 1
V . r = ��, � ,.. •' . : • \" � ; ^,. • T� ^r , �1a� •1 „r 2i ' .�,. : :. Hf � w�.: �I J :"l :J�'�'�`.4 :'4 �: )'. ,1't ''r
t 'l�
' i Please check all that apply (submit 2 set of plans w /items checked below);
❑ New construction it Addition /alterat :& Alp DIVISION
0 Service or feeder 400 amps or more 0 Building over three stories-
D Demolition ❑ Other: where the available fault cuncnt CI Marinas and boatyards.
r . �rgo �y}�,� r � , . r cxcccde 10,000 amps to 150 volts, or ❑ Floating buildings.
", ` ,:, leas Wound, or exceeds 14,000 ❑ Cornmereial.ose agricultural
El 1- and 2- family dwelling `�,�ommereial/industrial ❑ Accessory building I amps for all other installations. bw7dings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Firc pump. 0 Installation of 7 5 Y'VA or
❑ Emergency system. larger separately derived system.
: l , t li n t f ,400riACA,TI011i•;; :• . • ' 0 Addition of new motor load of ❑ ^A . °1.2 ",'
Job no.: Job site address:, 022 Q SW 6r t-e n V r IoolrP or mare. ey' parks.
. (] Six or mare residential writs. 0 Recreational vehicle
(
CityIStatc/ZIP: , Q 2 ❑ I'le lth -care &citifies. d Supply voltage for more than
y �rl , 1 s loon tions. 600 volts t10611111. t10611111. t10611111. l.
S e vice a
Suite/bldg./apt. no.: 3 So b Project name: G /e 0 ❑Service or feeder 600 amps or more.
, ... , S(3{IEiiiti' '.
Cross street/directions to job site: IDera • 1 Qty - I T
Fee 1 • 1 •
Ncw 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, residential
67.84 2
;�,, .;' :• : '; %` '' ' ) < a + i "' 00414 Q '�WO$K ' , , C: ''' „'' :. '' r•'�C„'�;ir?%, v (with above sq, ft.)
0'w / ,,t, Limited energy, multi-family 67.84 2
At V O / / e r V fr/n S'7 residential (with above sq. (t)
Services or feeders installation. alteration, and/or relocation
_ 200 amps or less J 1 100.70 2
, ',Q`BItU1 I'Y gt Flit' •, '' `•• , ';ID'; IPP�i1VTz , , 201 amps to 400 amp - 133.56 _ 2
401 amps to 600 amps 20034 2
Name:
601 maps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 55226 2
City /Sffite/Z1P' Temporary services or faders installation, alteration, and/or
_ - relocation
Phone: ( ) I Fax: ( ) 200 amp or Less 59.36 1
Owner installations 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
•' ',:,,; rA '' , '' .� : ' ,:, abov serv or feeder ee,
7
'' :. t.; .Q, i� '; . • .' ; .... ® , COI�T/iCFZ' , f f .42 2
each branch circuit
Business name: A v e c y an C et 4 / ,.7 Z,,7 G B- Fee for branch circuits
hout are d J A444 r1 c h es -t c Z wit bran c or feeder fee, 56.18 2
Contact name: � first branh circuit -
Address: /33 e7 5 E & 1 c e o r) S f- Each add'I branch circuit 7.42 2
` ����� r O � a an eons (service or feeder no included)
City/State/Z12: /State/ZIP: Y G . / 77202- Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 23'7- q6,00 Fax : (50 3 ) 23' -x,38 Reconnect only 67.84 2
E - mail: Pump or irrigation circle 67.84 _ 2
+a. ' ? :;t'''�' ';',;G.9. 'Gs TOR;4 : ;�,. ., }mi,, ,r, Sign or outline lighting 67.84 2
: r :,; .'' , . . Signal circuit(s) or limited-
Business name :4r er l ca" q / i - energy panel, alteration, or
Address: / SE i c o h 5 1- extension. Dcscribee,) J Paget 2
City/State /ZIP: /'/ 3r7 0, 72 02 Each additional inspection over allowable in any of the above
+� Per ins 66.25 .
\' Phone: (5 03 ) Z39 - �D t? Fax: (So3 ) 23 -7 3 t 11 Investigation per hour (1 br min) 66.25
„\`' Electrical i 2w " '; Suprv Lic.: Z w O j Industrial plant per hour 78.18 _ J
:, ' , 0rEetIOC AID °0?,>k1t 1 .,, 1,: ','•;,
Suprv. Electrician signature, rcquir 1. Subtotal: Le/ - S
Print name:
T 5--[ d V ✓n Date: y - I b - 1 0 Plan review (25% o permit fee):
State surcharge (12 °% 0 /a of p fee): Sc (y-
Authorized signature. � '
r 8 * 4. TOTAL PERMIT FEE: 1,$ _' 5 (
'r r Anc es e y" Date `� CO ' 1 ^ 1 ` ! ' 1 0 This p er mit application expires If a permit is not obtained within 180
Print name: I C. days after it has been accepted as complete.
• Number of inspections allowed per permit.
r\a,dtding1Permtra\st.C- PermicMp doo 10101/09 440.415T(11 5/C0M/MM
APR. 29. 2010 2:23PM 5032397038 NO. 9054 P. 1
•
I li _ Community Development
Request for Permit ,Action
rlr,\lzr7 RECEIVED
TO; CITY OF TIGARD APR 2 9 2 014
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223 CITY OF TIGARD i
Phone: 503.718.2430 Fax: 503.598.1960 warw.tigard- or.gov BUILDING DIVISION„
FROM: ❑ Owner ❑ Applicant )Contractor ❑ City Staff
(check one)
REFUND OR Name: ^
INVOICE TO: *Aim or Individual) A rner 'car) 1 In 7
Mailing Address: J33 7 S E G i U eel h
City /State /Zip: P(% r -f /4n c/ O ! c! 720 2
Phone No.: _ 503 -234='/ 1 /0 0 0
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): of i° ' - / "
❑ CANCEL PERMIT APPLICATION, /" v C P ‘�P V
Er REFLJND PERMIT FEES (attach receipt, if available). It' r0 t4
❑ INVOICE FOR FRES DUE (attach case fee schedule and explain below). 0 110
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel, permit). / ' I 1 i
Permit #: ,ELR 2OI0 - OOO('1 (D
Site Address or Parcel #: / V 2 2 0 5 V./ (2 r e e r t b V rj # 3 5 0
Project Name: M ! c), e "
Subdivision Name: _ Lot #:
EXPLANATION: k e
f
-56 �4A 2 -- 000 6 /
� - / // A 446r1 Date: ` 1 / . 2 S - afore: � /�
Dint Name: greed MlnC iesi-e r
and diu
1. The Director or Building, Official may authorize die refund of:
a) any fee which was erroneously paid or collecrcd
b) nor more than 60% of the land use application fee when an application is withdrawn or canceled before any review cfforr has been expended.
c) nor more than 80% of the bind use application fee for issued permits.
d) not more than 80°!0 of the building plan review fee when an application is canceled before any plan review effort has been expended.
c) not more t 80% of the building permit fee for issued permits prior ro any inspection segues rs.
2, Refunds will Tx returned to the oxijnal Payer in dm same mxthexl in which payment was received. Please allow 1 -2 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to S s Admin: Date tyymilmara Rte to Bld: Admire: Date /4 AM 13 1�„ =
Refund Processed: Date B Invoice Processed: Date 3
Permit Canceled: Dare By Parcel Tag Added: Date B
Receipt # Date Method Amount $
I: \Building \Forms \RegPcrmiFAcdon.doc Rev 07/26/07