Permit I
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
2 COMMUNITY DEVELOPMENT Permit #: ELR2009 -00134
T i C ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/15/2009
Parcel: 1S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 320
Subdivision: Lot: 0
Project: Ameriprise
Project Description: TI - Low voltage for HVAC
FEES
Owner:
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 05/15/2009 $75.00
CALIFORNIA ST 49TH FL 12% State Surcharge - Restricted Energy 05/15/2009 $9.00
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 $84.00
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 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. ATTE N: Oregon, law re. ires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0 10 through OAR 952 -00 -018.. Y. • may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issu By: A LL. / /i . Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNERS 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 Applicatiok - - FOR OFFICE USE ONLY
: ql W Tigard, OR 97223
III
City of 1 3125 s H CE IVED
0 • Phone: 503.639.4171 Fax: 503.598 tApy 1 5 zoo Received ,..., ty "
Date/By: 7 -/ ,, / Permit /
V 7
Plan Review
Date/By: , No...(44 5 ti
Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: Juris: ID See Page 2 for
TIGARto
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
ITY OF TIGARD
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Azavw-,16,40:,vomcv-ativg..,,,:,,„?„,-worzwt.TE,a
0 New construction ,/Addition/alteration/replacement 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 El Other: where the available fault current 0 Marinas and boatyards.
' :1444710144*"WaairiatiiiiPoPted/i4ifitiTelioSittA-V/W04"4"W exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 0 Commercial-use agricultural
0 1- and 2-family dwelling / 2rCommercial/industrial El Accessory building amps for all other installations. buildings.
0 Multi-family El Master builder 0 Other: 13 Fire pump. 0 Installation of 75 KVA or
Rfita'WtaxOP.iThrgiff'fi4O r" tk '''' -i'ii■hiliiiafiio - 4-
,„„,„,,,,,,,,,,,,,„:,„: 0 Emergency system. larger separately derived system.
1,,,k,.;,'/,,,, ,.,„.,&„.,,,,,,..:?•,„,,.,.F,„...., .-'1,...., ,..„„..,--,-11,i1I'Itft4 0 Addition of new motor load of
Job no.: Job site address: /0 0 6
22 r n
eeurj Rd. 100HP or more
0 Six or more residential units. occupancy.
0 Recreational vehicle parks.
City/State/ZIP: TI t y a . - 1 7/' 0 Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg/apt. no.: 32 0 - - • _
Project name: likv)eripriS(.--, 0 Service or feeder 600 amps or more.
' 131Matitag:}1C k vatestawai
Cross street/directions to job site: Description I Qty. I Fee. I Total 1 •
New residential single- or multi-family dwelling unit.
Includes attached garage.
-
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add] 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: . , . Limited energy, residential
iiip WORK EWIAWiREW010 (with above sq. ft.) 75.00 2
ile
- 0 " '
Limited energy, multi-family
r _ - ' , , ,..,c, j residential (with above sq. ft.) 75.00 2
' - - I I /
Services.or feeders installation, alteration, and/or relocation
/ 1/ 1/ Vol -- f4, w 1 (-14 7 200 amps or less 80.30 2
iii O
oildaVWEIVrW 00 M0 0,444 5ntri tisrAitrigni0-0 20
1,,,-,-,--,,.k 'M:' tMT4-::';, i:ett ' StA 1 amps to 400 amps 106.85 2
Name:
401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
APPLICANT .; xklr*,-1" ri;•;7_,:ma etowilali,iii above service or feeder fee,
,':--'. '-.1A4o 'ikl.•-. 4 -,-. - *6 'i'4,.. _,. 6.65 2
each branch circuit
Business name: Arner i (4 1-1(44 Iv 1 B. Fee for branch circuits ,
Contact name: Do k Hompl c 1- t without service or feeder fee,
first branch circuit 46.85 2
Address: 637 5 E 6/J eo 5--f- Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Or- 1"/4e, j 0 R '172 02.. Each manufactured or modular
90.90 2
dwelling, service and/or feeder
Phone: (03) 23/- 116,00 Fax: : (503 ) 23, -703 8 Reconnect only 66.85 2
E-mail: Pump or irrigation circle 53.40 2
Cf.n-ltitali-MMASAME00,W4(1,01
Sign o r outline 1 i g h t in g 53.40 2
A r). ) ertcao e 4 / -‘y Signal circuit(s) or limited-
Business name: energy panel, alteration, or
Address: /3S / S E 6 Coe) ff I- extension. Describe: Page 2 2
City/State/ZIP: P r y- 10,, c/ 0 /' 02. Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 237- I/ 6.0 0 Fax: (503 ) 23/-703 8 Investigation per hour (I hr min) 62.50 ,.
CCB Lic.: 33/3 5 Electrical Lic.:2(0 773 cii'F Suprv. Lic.: 2C0lf0 L.E6 Industrial plant per hour 73.75
Suprv. Electrician signature, requ ------ •
, .
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---- iWgirt....-WWELECTRICAL.:- PERMIVFEES,f,AAWM,,,
Subtotal: 75
-69—
00- -
Print name: 7- 5-t Y ov n4_ Date: s -1 y-- 0 c P review (25% of permit fee):
State surcharge (12% of permit fee): 9.0C)
Authorized signature: - 102...Zelot,<, Cs TOTAL PERMIT FEE:
Print name: d /vj hes-1- ef, Date: 5..../v-O 7 This permit application it expires ee if a permit is not obtained within 180
days after has bn accepted as complete.
* Number of inspections allowed per permit.
I: \BuildingTermits \ELC-PermitApp.doc 05/23/06 440-4615TO I /05/COM/WEB