Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2013 -00182
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/25/2013
Parcel: 1 S 135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD
Project: One Lincoln Subdivision: METZGER, TOWN OF Lot: 9
Project Description: (1) branch circuit for control cabinet and (2) low voltage for HVAC controls
Contractor: CHERRY CITY ELECTRIC Owner: LINCOLN CENTER LLC
8100 NE ST JOHNS ROAD #D -101 BY SHORENSTEIN PROPERTIES LLC
VANCOUVER, WA 98665 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 360- 571 -4411 PHONE:
FAX: 360- 571 -4410
FEES
Quantity Description Date Amount
2 ea Limited Energy 03/25/2013 $150.00
Spec ifics:
1 crt Branch Circuits wo /Purchase 03/25/2013 $56.18
Service or Feeder
Type of Use: COM 1 ea 12% State Surcharge - 03/25/2013 $24.74
Class of Work: ALT Electrical
Type of Const:
Occupancy Grp:
Total $230.92
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 0 2-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or X 1.800.332.2344. � /1
Issued By: /. / J 80
( l Permittee Signature: tJI 4 ! I" �-/ t9 T) ) Ji
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.
MAR /22/2013/FRI 09:01 AM Polk HALO Program FAX No. 5036064257 P. 002/002
Electrical Permit A licati - - FOR OFFICE LSE ONLY
City �L Received
of Tigard DateB : 3 as /3 51 Permit No.: 6 3 -cot g.)-
13125 SW Hall Blvd., Tigard, OR 977,7,3 Alan Review
II Phone: 503.718.2439 Fax 503.598.1119 2 5 2013 Date/13 . °u1esPermi>
TIGARD Inspection Line: 503.639.4175 Date Ready 6 12 See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental Information
. TYS ethliklinN G DIVISION' : : :i ' :;.:.,: ... ... - PIL01 REvIEW ..
El New construction Ej Additioll/alteration/replacement Please check all that apply (submit a eats of plans wfnems checked below):
❑ Service or feeder 400 amps or more ❑ Bolding over thres stones.
❑ Demolition El Other" where the available fault current CI Marinas and boatyards.
. ... ' . .:: CATEGORY :OF CONSTRUCTION. • , ''. .:' ;.; , :. ` ❑ Floating buildings. - , exceeds 10,000 a mps at 150 volts or
. less to ground, or eaeeeds 14,000 ❑ Commerclal•ue agricultural
❑ 1- and 2- family dwelling El Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
El Multi-family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ hastalletion of 75 ICVA or
(� Emerseocy system. larger separately derived system.
. • : . JOB SITE INFORMATION A ND LOCATION ::''' :: : ,.... ' ❑ Addition of new motor load of 13 "A ", - E".•1-2; - I3',
Job no.: 34L3318 Job site address: 10300 SW GREENBURG RD 1001•>P or more. occatioy.
Q Six or more residential units. ❑ Recreational vehicle parka
City/State/ZIP: TIGARD, OR 97223 ❑ Health - care facilities. ❑ Supply voltage fir more than
_ ❑ Hazardous locations. 600 volts nominal
Suite/bldg. /apt no.: Project name: ONE LINCOLN 0 Service or feeder 600 amps or more.
job site: :.FEE $CRE y. I E
j Aeacrtpuoo I Qty. I Pee I Total I Cross street/directions to
New residential single- or multl- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. err less i 168.54 4
Tax map/parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 1
p p Limited energy, residential
`;:�::.':. (with above it 75.00 2 • • :.. :..:. -: • = ::..:-::';,.:.:;;:; ;<:: DESCRIPTION; %OFRrO1tIC,' t:.. ;r:::':: : �'. .. s4. ) — - -
Limited energy, multi - tinily
Extending (1) branch circuit for control cabinet. (2) low voltage closets for residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
RVAC controls. 200 amps or less 100.70 2
II •; PROPERTY . . r '
• TENANT t . 201 amps to 400 amps 133,5 2
401 amps to 600 amps 200.34 2
Name:
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: ( ) I 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 to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
;A: : • feeder fee,
,� :•r: .:. above service or
i( `.;.•,•,;•„,•,. `'APEI;ICI�NT�: ' ;biz ` ''': c:, ��c� F� CU ' %';:- ;l`�i f 7.43 2
... ...:�. > :...... .... . ........ ,... ,.a..,,..... r . .. ,.... ..e, , . ....., ....
Business name: CHERRY CITY ELECTRIC B. fee for breach circuits without
service or feeder fee, fast 1 56.18 56.18 2
Contact name: MICHELLE USSELMAN branch circuit
- Each add'l branch circuit 7.42 2
Address: 1596 22" ST SE Miscellaneous (service or feeder not included)
City/State/ZIP: SALEM, OR 97302 a manufactured ins service servi ceed or modular 67.84 2
and/orfeeder
•
Phone: (503) 566 -5600 I Fax: : ' (503) 540 -8147 Reconnect only 67.84 2
• Pump or irrigation circle 67.84 2
E- mail: musselman@cherrycityelectric.com
'" CO U Sign or outline lighting 67.84 2
: ter' Signal circuit(s) or limited-energy
2 1 50
Business name: CHERRY CITY ELECTRIC panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 1596 22" ST SE Additional inspection (1 hr min) 66.25/ hr
•
C i t y / S t a t e / ZZ I P : SALEM, OR 97302 InvestiBStioa (1 h r m i n ) 25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 566 -5600 Fax: (503) 540 -8147 Inspections for which no fee is 90.00/hr
specifically listed GS. hr min)
CCB Lie.: 91668 Electrical . ic.: 7620C Suprv. Lic: ELECTRICAL "PERMIT :•FEE ;' ' `:'' ";::`; :� ;';
Suprv. Electrician signature, required: fr�,t �*�w'i`� t, Subtotal: 206.18
Plan review (25 rb of permit feu):
Print name: DOUGLAS HAYCOCK Date: 03/22/2013 State surcharge (12% of permit fix): 24.74
Authorized signature: TOTAL PERMIT FEE: 230.92
'Phis permit appl;ntion expires If a penult is not obtained within J180
daps mbar It bas been accepted as complete
Print name: DOUGLAS HAYCOCK Date: 3f22/2013
• Number of inspections allowed per permit.
cesettdcuswemitO P- LC-PamitApp.doc 07101110 44046151(11/O5/COMnvea
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
❑ 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: 2
*No licenses are required. Licenses are required
for all other installations
L\ Building \Permits\ELC- PermitApp.doc 07/01/10