Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
D. COMMUNITY DEVELOPMENT Permit #: ELR2012 -00034
Date Issued: 02/21/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 / Parcel: 1 S135AB01002
414 Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 201
Project: Radiant Senior Living Subdivision: METZGER, TOWN OF Lot: 9
Project Description: HVAC system for VAV box. 3/13/12, reprinted to add additional thermostat wiring.
Contractor: MCKINSTRY ELECTRICAL LLC Owner: LINCOLN CENTER LLC
16790 NE MASON STREET SUITE 100 BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97230 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 278 -3954 PHONE:
FAX: 503 -331 -6907
FEES
Description Date Amount
Specifics: , Restricted Energy Permit 02/21/2012 $75.00
12% State Surcharge - Electrical 02/21/2012 $9.00
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
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other. N Total $84.00
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. ATTENTIO • Orc• • law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -001 rough OAR 95 1 1-0 ! =. You • ay obtain a copy of the rules or direct questions to OUNC by calli • . . . 987 or 1.800.332.2344.
"I' Issued By: Le! • 1 Permittee Signat �. !. _� •
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.
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2012 -00034
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/21/2012
Parcel: 1 S 135AB01002
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 201
Project: Radiant Senior Living Subdivision: METZGER, TOWN OF Lot: 9
Project Description: HVAC system for VAV box.
Contractor: MCKINSTRY ELECTRICAL LLC Owner: LINCOLN CENTER LLC
16790 NE MASON STREET SUITE 100 BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97230 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 278 -3954 PHONE:
FAX: 503 -331 -6907
FEES
Description Date Amount
Specifics: Restricted Energy Permit 02/21/2012 $75.00
12% State Surcharge - Electrical 02/21/2012 $9.00
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
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
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. ATTEN re law requires you to follow the rules adopted by the Oregon Utility Notificatio Center. Those rules ?re set forth in OAR
952 -001 -001 through OAR 9 001 -009 You may obtain a copy of the rules or direct questions to OUNC by calli•.; '3.232.1987 or 1.800.33 ,� 234 - 4. �
Issued Permittee Signa
, i
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 603.639.4175 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.
Electrical Permit Application FOR OFFICE USE ONLY Received City of Tigard Date /B ' — �� Permit No.: �� (�D� ��
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
' C Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit:
1 I G A R u Inspection Line: 503.639.4175 Date Ready/By: Janis: el See Page 2 for
Internet: www.tigard - or.gov Notified /Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition /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 dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SI'Z'E INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
['Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: 70747 Job site address: 10220 SW Greenburg Road 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard, OR ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 201 Project name: Radiant Senior Living ❑ Service or feeder 600 amps or more.
job site: Description FEE SCHEDULE
Cross street/directions to
J I Qtv. I Fee. I Total I•
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 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
Revision to permit # ELR2012- 00034. Revisions include addition of (1) low residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
voltage thermostat and associated controls. No line voltage work. 200 amps or less 100.70 2
❑ PROPERTY OWNER ® TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: Radiant Senior Living
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City /State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per 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: McKinstry B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Janel Lipe branch circuit
Each add'I branch circuit 7.42 2
Address: 16790 NE Mason Street Suite 100 Miscellaneous (service or feeder not included)
Each
City /State /ZIP: Portland, dwelling, service OR 97230 manufactured or modular
67 84 2
rvice and /or feeder
Phone: (503) 2783954 Fax: : (503) 331.6907 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: janell @mckinstry.com
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: Same as above panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City /State /ZIP: Industrial plant (1 hr min) 78.18/ hr
Phone: ( Inspections for which no fee is
) /(i /3b6 ( ) specifically listed ('/ hr min) 90.00 / hr
CCB Lic.: 442814 Electrical Lic.: 3 7-730 Suprv. Lic O,E3S ELECTRICAL PERMIT FEES
Subtotal:
Suprv. Electrician signature, required: 41(
Plan review (25% of permit fee):
Print name: / 1-11 dj "Ail L 626LL Date: 3 -j3-J a State surcharge (12% of permit fee):
TOTAL PERMIT FEE:
Authorized signatu This permit application expires if a permit is not obtained within 180
�j days after it has been accepted as complete.
Print name: Janel Lipe Date: 0 .5• , • Number of inspections allowed per permit.
I:\ Building \Pcrmits \ELC- PcrmitApp.doc 07/01 /10 440- 4et5T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
El Audio and Stereo Systems*
El Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other.
F COMMERCIAL WORK ONLY: -
Fee for each commercial $75.00
system
(SEE OAR 918 - 309 - 0000) •
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
El Data Telecommunication Installation •
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
El 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
I:\ Building \Pcrmits \ELC- PcrmitApp.doc 07/01/10
Electrical Permit Application FOR OFFICE USE ONLY • City of Tigard ` 't ; ;T , I' P erm i t No.: r. ' ,'� .itI
I A . ° 13125 SW Hall Blvd., Tigard, OR 97223 ' an Review
C Phone: 503.718.2439 Fax: 503.598.1960 Date/I3 : Other Permit: ✓V) , h}Ti u
T I G A Ft D Inspection Line: 503.639.4175 Date Ready/By: j � M See Page 2 for
Internet: www.tigard- or.gov y .\ otified/Method: Supplemental Information
TYPE OF WORK �C�� ���
p ^�� �� PLAN REVIEW
Os '\ `1 C, \C Please check all that apply (submit / sets of plans w /items checked below):
❑ New construction ®A ddition /alteration /replacemen \
o\ ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: G\ ®\ 4 Q where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTIOT > 3\" exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less 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 ❑ 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 ", "1 - ", "l - ",
Job no.: 70747 Job site address: 10220 SW Greenburg Road or more. occupancy.
El S Six x o or r more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, OR ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 201 Project name: Radiant Senior Living ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description l Qtv. I Fee. I Total I •
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 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
Connect (1) 24 volt electronic thermostat to a new cooling only VAV box. residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
No line voltage work. 200 amps or less 100.70 2
❑ PROPERTY OWNER I ® TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: Radiant Senior Living
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT I ® CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: McKinstry B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Janet Lipe branch circuit
Each add'l branch circuit 7.42 2
Address: 16790 NE Mason Street Suite 100 Miscellaneous (service or feeder not included)
Each Ci /State /ZIP: Portland, OR 97230 dwelling, service and/or d / r modular wider 67.84 2
tY dwelling, service and/or feeder
Phone: (503) 278.3954 Fax: : (503) 331.6907 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: janell @mckinstry.com
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: Snn at aho 'e / C �[ r `l6 t/ Z�� YrP /,[-
panel, alteration, or extension. / Page 2 2
( fv J ` ' Each additional inspection over allowable in any of the above
Address: Additional inspection (I hr min) 66.25/ hr
City/State /Z1P: Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18 / hr
Phone: ( ) 'f $ b$5 Fax: ( Inspections for which no fee is 90.00 / hr
q C specifically listed (V2 hr min)
CCB Lic.: 474811 Electrical Lic. SSuprv. Lic.: 51 2,1S ELECTRICAL PERMIT FEES
a
Suprv. Electrician signature, required: � / C�tl� GG Subtotal: 77500
Plan review (25% of permit fee):
Print name: ate: - State surcharge 12 %of permit fee): 0
�YL� C-1"�« Date: Z Z � IL (12% P )� ,O
• TOTAL PERMIT FEE: QS • Authorized signat This permit application expires if a permit is not obtained wit lfi 180
days after it has been accepted as complete.
Print name: Jane] Lipe Date:
O. .01.. ? • N um b er o inspections allowed per permit.
•
I: muilding \Permits\ELC- PerrnitApp.doc 07/01/10 0 let 1 /1, ,41 � 11/OS OMM'E /` �1/J��.
/ l ' G /' \ �( v J
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
El Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
El Clock Systems
El Data Telecommunication Installation
❑ Fire Alarm Installation
® HVAC
El Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
El Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Pennits\ELC- PermitApp.doc 07/01/10