Permit •
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
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a COMMUNITY DEVELOPMENT Permit #: ELR2012 -00266
T I G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/03/2012
Parcel: 1 S135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 110
Project: Fidelity Title Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Low voltage for HVAC
Contractor: AMERICAN HEATING INC Owner: LINCOLN CENTER LLC
1339 SE GIDEON ST BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97202 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 239 -4600 PHONE:
FAX: 503 - 239 -7038
' FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/03/2012 $75.00
12% State Surcharge - Electrical 12/03/2012 $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. ATTENTION: Ore on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those ruts re se forth in OAR
952- 001 -0010 thro OAR -001-0 0 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19 or 1 00.33 4.
Issued By: 14 1 ` C -CY et.---pi-LA-0 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 503.639.4175 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 -
1 111 Ci ty of Tigard DEew 13125 SW Hall BlvdTigard, O CEllf ED P Phone: 503.639.4171 Fax: 503.59 1 6 Date/B : Other Permit:
T I GARD Inspection Line: 503.639.4175 U b 1, U 3 2012 ived Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
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❑ New construction C Additio
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n 7 ■ R ►t I H a n l �! hl! w t Please check all that apply (submit 2 sets of plans w /items checked below):
1
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
s ° exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
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less to growl, or exceeds 14,000 0 Commercial-use agricultural
1:1 1- and 2- family dwelling Com mercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
T; -_. ; : _ - , .- « : -��„„ u .,.:. ...,.�tt .. ; �,,, .,s-_,-. ❑ Emergency system. larger separately derived system.
= _ _ : JUB S ,� I ` 'cA34D LOC#1`II 1V'
_ . ,•`�� rre �r ^• : -.. .. . - , -� .... ... _ ❑Addition of new motor load of ❑ "A" "E" "1 -2" "( -3 ",
Job no.: Job site address: 102(( Six or mo re a residential 5W 6(ee'ibbty /ICJ S es. units. ❑ R occupancy.
7 J ❑ S or more vehicle parks.
City/State /ZIP: T c r ,1 Q ey - / g / 22 ❑ Healthcare facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 7---/ d e l / --> Ti f / ❑ Service or feeder 600 amps or more.
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Cross street/directions to job site: Description <.,. 1 Qty. I Fee 1 Total ,)
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New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. Merl 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: _ Limited energy, residential
_ _ _ : - � __ _ _ _ _ 67.84 2
- _ - _ :.1_ -- 4yr'S:"r _ .- ..- y-s _ _ _ " ?: r`,. ;':4,-
- ...Er _ _ _ _ ::.2 i +
(with above sq. ft.
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. - � ._ -, i ��'Viy . s � v_x .a: . ._- ... a - i v ,
Limited energy, multi - family
/0 ►n/ V o / - 1 - A5 e w I ( 1 /I 43 residential (with above sq. it.)
67.84 2
J Services or feeders installation, alteration, and/or relocation
V -• •..,..- ;,::..n .:,•. ` :., -.:,;. t ,,,, _ = 200 amps or less 100.70 2
"
i Y':>4OEERT�Y'�O R ?- - � ;f s ;•- • f 'itNANT 201 amps to 400 amps 133.56 2
Name: 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
relocation
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, per panel
Owner signature: Date:
A. Fee for branch circuits with
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J - PLIt d =COl!] TACT PERK " lY -
�' %;;.'"i,, _`-,r- - ... -:�.`.�`�rr.,. .__; . ..:� ;� , . ,'5`: : -.., .- ._ : -t e . �.... _ .: above service or feeder fee 7.42 2
n each branch circuit
Business name:
A m e le- l c a 17 H eO B . Fee for branch circuits
Contact name: 8 ,,-- tJ /14 t 77 C h e s T e 1''
without t bra service or feeder fee, 56.18 2
p / first branch circuit
Address: /3 1 s e C(/ 1 cI eon s '* Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City/ State/ZIP: Po r -•I- fan d O 7 2 02 Each manufactured or modular
1/& / _ dwelling, service and/or feeder 67.84 2
Phone: (503 )231 0 O Fax: : (.5 3�- 7 O3 9
Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
r outline lighting 67.84 2
Sign or outlin li
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Business name:Arn er' / c G/.-7 /y e9 7 //7 Signal circuit(s) r limited -
//-- CJ / energy panel, alteeration, or
Address: /331 5E Co 1 e O f I -f extension. Describe: Page 2 2
City/ State/ZIP: / 7 f - / - - /G fJ 0 c-72 02- Each additional inspection over allowable in any of the above
Per
Phone: (503)23?-- y6,00 Fax: (So3 ) Z31- 703 S Investigation 66.25
inspection
q per hour (► hr min) 66.25
CCB Lic.: 3313 s Electrical Lic.:2 9 13 ckz Suprv. Lie.: 2 (o IO LEe Industrial plant per hour 78.18
C irk: "'r "''j T E,OWSI s PE 2MTTsk'1 ES`_'; -
Suprv. Electrician signature, requireQ T \ \\ . Subtotal:
Print name: T S tc V e y 0 V ✓1 q Date: 12 of permit fee / State surch (12% of permit fee):
Authorized signature: -72,e ,-/-7,4„.. A.
Authorized PERMIT FEE:
es Date: /Z�f / Print name: t /�
�od ,, /rn d// ,fff/// 2 This permit application expires if a permit is not obtained within 180
( � f days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ Building ,Permits\ELC- PermitApp.doc 10/01/09 440 -4615T(11 /0S /COM/WEB