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Permit „ CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT a : - COMMUNITY DEVELOPMENT Permit #: ELR2010 -00255 .T1GAAD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/12/2010 Parcel: 1 S 135AB01002 Jurisdiction: Tigard Site address: 10220 SW GREENBURG RD 601 Project: Matrix Absence Management Subdivision: LINCOLN THREE Lot: 0 Project Description: Install (3) 24 -volt thermostats for TI Contractor: MCKINSTRY COMPANY LLC Owner: LINCOLN CENTER LLC 16790 NE MASON ST., STE. 100 BY SHORENSTEIN PROPERTIES LLC PORTLAND, OR 97230 555 CALIFORNIA ST 49TH FL SAN FRANCISCO, CA 94104 PHONE: 503 - 331 -0234 PHONE: FAX: 503 - 331 -6907 FEES Description Date Amount Specifics: Restricted Energy Permit 11/12/2010 $225.00 12% State Surcharge - Electrical 11/12/2010 $27.00 Type of Use: COM Class of Work: ALT Total Number of Systems: 3 • Audio & Stereo: N Boiler Controls: N CCTV: N Clock Systems: N Data & Telecommunications: N Fire Alarm: N HVAC: Y Instrumentation: N Intercom /Paging: N Landscape /Irrigation: N Landscape Lighting: N Medical: N Nurse Calls: N Protective Signal: N Security Alarm: N Other: N Total $252.00 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. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: �'V 9 /' //' L i L� - ��d ' V ”` CCC 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 503.639.4176 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. 11/10/2010 1 6: 06 5033316907 MCKINSTRY PAGE 02/07 Electrical Permit Application C� � POR ciIi f(r: 1 si oNL City of Tigard Received IN .., i)ote/By: ParntitNo,: 13125 SW Hall Blvd.. Tigard, OR 9 Q1p // /�� o 8 7-A - �0 -D� ASS Plan Review N Phone: 503,718.2439 Fax: 503.598.1960 - . Drte/By: OthorPcrn, �' K/� / O/0 - eQ e 3 .3 .1.1, ; n r t-., Inspection Line: 503.639.4175 nF�G�� r , otttc Ready/By: ,t ll'� Ri See Paget for Internet: www.tigarti- or.gov ficditdenad: l oppicment I Information 1.: 11... , d , I 1 J. ...1 . .1. ull 1 . .. r` ,. : � • ,. • f ' :.. •, :...Slip' i'ie+ 1 { II l .." 1p ,1, I i L ', , r �,.., ;a '!i'i J ; i1' 11:.....i ;^ r 5.: 1 , i i:; I `' ii ,: ; :p.,, ; '.:. ,•:IF. ;:y, ,1� i , 1. n, •:!i. ,'I „It� �, ,, �, gyp 7 � , .:i:^ .�pi.r+ ...y +, .>.'� 11. -i � ;: r'I�,il, i � n, {1� bl,l. 'i 5 rit'a ..41:Ihe,, 1. 1'':.,;:•. ud•�,:i't, , 1�11..L.,� , .4...,:,t!.�'"�� >,�:. �:,,� , . ..., , .:r.,l .... 1,�... 'I'' .. � �,,:1,.��!�V .�rl l r1�ltii {� ❑ New construction ®Addititm /alterati I. aeement Please cheek ail that apply (submit 2 sets of plane w /items checked below); O Service or feeder 400 amps or More 0 guilding over three stories, El Demolition ❑ Other: whore the available fault current 0 Malian and boatyards. i `' i ! '!;i % 1 ilti, jMu!?li iirigi hre i •. ,'r, .',;,,' ; u+ exceeds 10.000 amps at 150 volts or 0 Fl -�' � "' ';., - cats 1,. c teas o ground or exceeds 14 000 C I agricultural buildings. n ❑ Commercial-use agricu ❑ 1- and 2- family dwelling ® Commercial /industrial ❑ AceMsery building amps for all other ir•<cki14"uions, buildings, ❑ Multi ❑ Master builder ❑ Other: 0 Fire pump, 0 Installation of 75 KVA or il'`" i ' i' ; ;1, r.' +: '; ii" j Emcr(tcncY aTatcm. larger separately derived system. 1, . I����lilil ^�u:. ;..�' "'111i7 .,:- ,:,,..,�,,..• ;.,,' �,� I.' .,. ... , ,,.�.�� �.'',�u• ,,,. 1, • ❑ Additionotocw motor loedof - Job no.: 9406 I Job site address: 10220 SW Greenburg IOOHP or mote. occupancy. © Six or more residential unie. ❑ Recreational vehicle parks. City/State/ZIP: 0 Health -can facilities, 0 Supply vnbage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: 601 I Project name: Matrix Expansion D Sarvice or treder 600 amps or more. T Cross street/directions to job Site: ;' • +' :' . -' P , Total ,1 gr De sutprlon 1 Qty. I Pre, � I ` , " o 1 m/ New residential single- or multi- family dwelling unit. Includes attached garage- Subdivision: 1 Lot no.: 01004 1,000 sq. R or less 168.54 4 Tax map /parcel no.: 1 SI35AB Pa_ id 1 500 y , es do or portion 33.92 1 ... ...:a,;. ;,� .. .. . .. ........„,: , ,:�„ t, n: r: ; +.., ,. net 75.00 2 It,,.,y�,:{�ilg!IO (. ;��ll"'i 1 rn�iUVllll'!011!rtg# S . P. 4 1 . 0 :Ii ;1 ;,'.: " ''� : :;! !� !.;,. q' ,,:• - (with above sq. fl.) 4 Limited energy, mufti- family Relocate (3) - 24 volt thermostats residential (with above sq. R) 75.00 2 - Services or feeders instaflatio , alteration and/or relocation He c4i, ' f 1 0 ^ 045'7 e- 200 amps or Icss 1 00.70 2 ;1.1':. -: I: Y 1: ∎ ; 1 :, , t �$vi; ,r e ' 201 amps to 400 amps 13156 2 11 Name: Matrix Expansion 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 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,-Qerpancl Owner signature: Datc: A. Fee for branch circuits with 11 i' .;•!.:, "' ; ;l above service or feeder fee. ..):: !,;, 8',.sr7 4, ; ; ; kw ,: ;: ,; �'.:? .: •, , 1;: o it r� 0strop C :, , •,�� 7.42 2 ;" ea ch bran( h c Business name: McKinstry Company, LLC B. Fee for branch circuits wtthow service or feeder fec. first 56.18 z Contact name: Diane Parke, Project Coordinator branch circuit , Each add'1 branch citctiit 7.42 2 Address: 16790 N.E. Mason Street, Suite 100 Miscellaneous (service or feeder not Included) City / State/ZIP: Portland, OR 97230 Each manufactured or modular 67.84 dwelling, service and/or feeder Phone: (503) 331.2465 33/ -t) A391 Fax: : (503) 331.6907 Reconnect only . . 67.84 2 E -mail: dianep@mekinstry.com Pump or irrigation circle 67 2 ai p(l 1i ).•„ „ :' ; ' .. :' :F • ;4;•r(r: ,. `: . :- 1' r iiS ` .L' 'il:''.. : .:r.• �; G1:::'1',:''. ;.! ;:• ;:. 67.84 2 1.�1a ; ,•., , . :. :. ' '1[�i:. . ' .'. lifi:r ;., outline - lighting Signal circuit or limited - energy 3 Business name: Same as applicant panel, alteration, or extension. Pagc 2 2 - Each additional inspection over allowable in any of the above Address; Additional inspection (1 hr min) 66.25/ hr City/ State/ZIP: /1 Investigation (I hr min) 66.25/ hr // industrial plant (1 hr min) 78.1 8 / br 1 ' one: ( ) GL E 1-7 F : //( ) Inspeuions for which no fcc is 90,00 / hr specifically listed ('4 its min) • CCB Lic,: 172$11 ► . :. a, Suprv. Lic.: 2274LEB 1 4 °. ,E ;`I . VErg ; : ;e'1.,.�: Electrician si ae >. ire • 1 J N. o Subtotal: c • a ,2.5' " . ' frr) Suprv. 1 .t i ` . I �� i i Plan review (25 /o of permit fee): Print name: Wayn , _ Date: 11 /10 /10 State surcharge (12 0 4 of permit fee): pl 7. t Authorized si +,�T// ' / TOTAL PERM rT FEE: A . Sa .e ) L,/ if This permit appnmfinn mph= If A permit Is not obtained wIthia 1 W days after It Iran been accepted in complete_ Print name: Di. e Pat, Date: 11/10/10 R Number of inspections allowed per permit I:\ Budding \Permlrn \at,C- senneApp,dor 07/01/10 00t1461 ;T(1I/p$(CQMIw$B 11/10/2010 16:06 5033316907 MCKINSTRY PAGE 03/07 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: 7. -- aRtmoggorgaingw.p7:..001,7.77, Fee for all residential systems combined ... $75.40 Check Type of Work Involved: • Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other h.n. ,, r• r p•mxr�r•.w .r+r•. " ., : 11,�i ',A i i� " ;'.: 9D. IE�k ''!'•'i: �i , " j:^ ; p� ", j�f n �.,.t��%�1� r ... , , , Fcc for each commercial $75.00 system (SEE OAR 918 -309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation [] Fire Alarm Installation ® HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical • Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required • for all other installations 1ARuH1dng\Pamue\eLC.rur,;vApp.aoc mm,nn