Permit 1 y n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1 11 3 COMMUNITY DEVELOPMENT Permit #: ELR2012 -00234
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Date Issued: 10/09/2012
Parcel: 1 S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 350
Project: Softsource Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Low voltage for T -Stat relocation
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 10/09/2012 $75 00
12% State Surcharge - Electrical 10/09/2012 $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• - - •on law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952- 001 -0010 rough OAR • -001 -e : - r 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: � /
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 503.839.4175 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.
RECEIVED
Electrical Permit Application r�iz •(irrier'vs1 (n'l:v
of Tigard u 9 2012
City T led PermitNo.:
25 o
SW f Blv
Ti d, 'Date.' . aA� g Ora - oo a 3,
° 13125
Plan Review
- I Phone: 503.718.2439 Date/B: Other Permit •
T I G A R I) Inspection tine: .1TIJIIDINGDIVISION Date-Ready/By: lam: El See Page 2 for
. _ Internet: www.tipm Notified/Metimd: Supplemental information
. 4 3 b.�� r �a:�'� i v i.0 V - �•� k�'N T• . 1 r +I' ✓ 'Kn� ,. _
1, �..:':x Wit.... •,p �; .J#"• +;^,.. � YtR:. i:1�51! ^ :�;r -.r '�;>�r:..o- >> ��°.g; -+. � �_ � .��l,a?ural'1�,`.rnax:•.,'�W
❑ New construction ® Addition /alterationFreplacement Please check•all that apply (submit tZ sets of•pianew/items checked below):
['Demolition ❑ Other: ❑ Service or feeder 400 amps or more '❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards.
exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
T� �r •{�p;aa. "`r "v f. .„;�r4A
ataxy . 4 10 2 i �r'a .4 ';vr-. , .:1 +i�� s ac u less to od ore ground. exceeds 14,000 ❑ Commercial -ate agricultural
❑ 1 - and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for another installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other. ❑ Fire pump. ❑ Installation of 75 KVA or
: ,V2,ti: : s? V ' q o.. ��•,,,,,..,�,.,. 0 - c j ,,. > ❑ Emergulw°Yam. larger separatelyderirdsystem.
0 .. I / 0 f , ,�_,,
x?"ik- �;>"rw �:��" " = "c�- �:'� - '433. _ -;._ _ Q�� ..,. ,_ ���::�W" � � . -- : - �• - -- ❑ Addition of new motor bad of ❑ "A ". "E". "1.2 ". "1.3 °.
Job no.: 70925 I Job site address :10220 - SW Greenburg Road IooHP or more. occupancy.
❑ Six or more residential units. ❑ Reateadonal vehicle parks.
City/State/ZIP: Tigard, OR 97233 ❑ Health-care facilities. D Supply for more than
❑llemrdous locations. •600 volts nominal.
Suite/bldgiapt, no.: 350 Project name: SoftSonrce ❑ Service or feeder 600 amps or more.
'S' ITAilli ,.' •.. ‘ `: `, E ::.7.;:t
Cross street/directions to job site: Description I Qtr. I Pee. Total I ' •
New residential single -or multi-fatally-dwelling unit.
Includes attached garage.
Subdivision: I Lotno.: 1,000 sq. or•less , 16834 4
areal no.: Ea, add'I 500 sq. ft. or portion 33;92 1
Tax maptparoel _ •
Limited energy, residential
-t 1 �" l�? 3 ° 'n° M, "` `' ""�, (with abovesq. ft)
75.00 2
' n Limited energy, multi - family
Relocate ('1) - low voltage thermostat to accommodate tbenew wall construction, residential (with above sq..R.) 75'00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
. y{x ; ��'�p" leg rL t 1, ��j +1� y 4 f "'1t " kx ;g -,`� j r p�� a:x . y; 201 ampsta400 amps 133.56 2
� ? *'�T!�:t:�'� •a��k:����- datD�t'' -^ �I{. �F" � i�Y+ S�f rs C "''' e., * �iuel:.'.�.�'- '��-'`1= Y
Name: SoftSource 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: • Over t;000 ampeor volts 552.26 .2
City/State/ZIP: Temporaryaen 'Ices-orfeedersinstallation, alteratlon, and/or
.. - relocation
Phone: ( ) Fax:. ( ) 200 amps or less 5936 1
Owner Installation : - This.installation is being made on property that I ownwhich is not 201 amps to a00.tttrrps 125.08 2
intended for sale, iease,.rent, or•exchange,• according to ORS 442,449, 670, and, 70,1. 401 amps to 168.54 Z
. Branch .circuits —new,. alteration, or extenslon,.Qer panel
Owner signature: Date: A. Feeforbrmtdh circuits with
� �.,,r � z ,., i•m * tq above service or fee,
� laeM : , .. .I4+ dM. d each branch circuit 742 2
Businessname: McKinsiry Co. LLC B. •Fen for branch - circuits without •
service orfeeder fee, first 56.18 2
Contact name: Janel'Lipe branch circuit
Each add'l brands circuit- 7:42 2
Address: 16790'NE Mason Street 1l9lsecllaacous (service or feeder not Included)
Each City /State/ZIP: - Portland, - 97230 dwelling, s a or modular 67.84 2
dwelling, service and/or-feeder
. Phone: (503).27$ - 3954 Fax:: ( ) Reeonnectonly 67:84 2
E - mail: jandll®mckinstry.com Pump or irrigation circle 67.84 2
r �,' F fi �: zrti t �s M _, Y£ o- d` i t' t , r: :v, Sign or outlind lighting 67.84 2
I ij •- - R ^ �*Ni�? r 'YKt o.., .. rt ""= t4 x `'' Signal 1
4=" ' ' +��` ',���(' ; �..�_ . „, .i _,a�.`:;.4 , ,rr. k�.- 'a: - � =; : � ';;. gne ireu t(s) or limited-energy ,.
Business name: $atncasabove panel, alteration, or extension. Page e2 7s 2
Each additionalInspection over allowable in -any of the above
Address: Additional inspection (I In min) 6625/ hr
City/State/ZIP: Investigation (I hr min) 6625/ hr
Industrial plant (1 hrmin) 78.18/hr
Phone: ( ) Fax: ( 1,0 7)' °------ / Inspections which no fee is 90.00,'hr
specifically list ed ( hr min)
CCB Lic.: 11 %Al Electrical Lic.• Suprv: Lic 13 0 , - ` - ; +_.:. _ 'yam ° �Ec L A iiistr MtT- I
Subtotal: 7SOO
Suprv. Electrician.nature, requited:.
A ^ �
stg
Plan review (25% of permit fee):
:I ;iyrttriam(:; , �� 6Z 7 )-T:1'Y: take"' 'fa"' ,,, State sumbarge(12 %ofpermit'fee): 9.
• TOTAL PERMIT FEE: g q . O C)
Authorized - stgna This permit application expires if a permit is obtained within 180
days after It has been accepted ds.eomplete.
Print name: � s ,i , Q� I Date: (o/- (Z • Number of inspections allowed per permit.
\ B
I: uadiogl?mmitsELC•PenahApp.doe 07,01.'10 j 440 -4615 (11,051COMAVEB
•
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
I RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ 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
❑ 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
1 \Building \Permits \ELC- PermitApp doc 07/01/10