Permit SEP.18.2006 10 :14AM 5032397038 NO. 8716 P. 1/2
Building Division
I'►' Request for Permit Action or Refund
of Tig ard
TO: CITY OF TIGARD SFp
Permit System Administrator Fi
1 8
13125 SW Hall Blvd., Tigard, OR 97223 8 -44 �� r,� �� u
Phone: 503.718.2430 Fax: 503.598.1960 4 / 4 %
FROM: ❑ Owner ® Applicant ❑ Contractor ❑ City Staff
(chcdc onc)
Name: American Heating, Inc.
Vo l D (B» or Individual)
Mailing Address: 1339 SE Gideon Street
73 SE
City /State/Zip: Portland, Oregon 97202
V2.6/6 Phone No.: 503 - 239-4600
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
1: CANCEL PERMIT APPLICATION.
11 REFUND PERMIT FEES.
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Ea.
Permit #: 2006 -00199
Site Address or Parcel #: 10200 SW Greenburg Rd, #340
Project Name: Pacific NW Telco
Subdivision Name: Lincoln Center Five Lot #:
EXPLANATION: Pnematic Controls - did not need electrical permit
Signature: EnL9Ylk 41'ft d( Date: 9 -18 -06
Emma J Gomm, jest Coordinator
Print Name:
Refund Policy
1. The Building Official may authorize the refund of
a) any fee which was erroneously paid or collected.
b) not more than 80 percent of the permit fee for issued permits prior to any inspection requests.
c) not more than SO percent of plan review tee when an application is canceled before any plan review effort has boon expended.
2. Refunds will be returned to the original Payer lathe same method in which payment was received.
(•01: 01:1 1( is l 11: 0 \1.1
Rte to S Admin: Date *DAMII B 1 r - : , _ Admin: Date
Processed: • : 106 , Z Invoice Processed: Date [w'
Permit Canceled: Date y 64 B ., P l Tag Added: Date By
Receipt # 04 -f gyp' Dat 2'/D 6 Method Cck— Amount $ P/, ,
1:1Building\Fortas�I •ennitAction -Bl gd .doc Rev 10/17/05 /Qt74cnip 6 o
C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
� � DEVELOPMENT SERVICES PERMIT #: ELR2006 - 00199
I II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/22/2006
PARCEL: 1 S 135AB -00900
SITE ADDRESS: 10200 SW GREENBURG RD 340 ZONING: C -
SUBDIVISION: LINCOLN CENTER/FIVE LINCOLN LOT: JURISDICTION: TIG
Project Description: Limited energy for HVAC.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
EQUITY OFFICE PROPERTIES TRUST AMERICAN HEATING
ONE SW COLUMBIA ST #300 1339 SW GIDEON ST
PORTLAND, OR 97258 PORTLAND, OR 97202
Phone: 503- 412 -4800 Contact #: PRI 503- 239 -4600
FAX 503- 239 -7038
FEES Reg #: ELE 26- 993CRE
LIC 33135
Description Date Amount
[ELPRMT] ELR Permit 8/22/2006 $75.00
[TAX] 8% State Surcha 8/22/2006 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notific- • Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or ect ques on • • U C at 503 - 246 -6699. � /
Issue. y: ' e. 4 Permittee Signature : �G G
l j "' /�i�,c `�eS�
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'N: 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 Application FOR OFFICE USE ONLY
City of Tigard R ed �p , Permit No.: , ,, eso I 9'
13125 SW Hall Blvd., Tigard, OR 97223 , Plan Review Other Permit
Phone: 503.639.4171 Fax: 503.598.1960 '''�`iii,MM I'� Date/B
Inspection Line: 503.639.4175 . 4_1J. l Date Ready/By: See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
S� F k....a a° r. ' T-� S Q °F t7 . O i } la r _i i ?1g aZ ' * ' ? . j { i r- y 1A 1. 9 � . 8: , 45 i.
t7. c ' r� � : 'L - i �.rf_ " n r Ji.. ° . _lx 7..1. -� �..v � - ' j x�:�� :� � ,l �h ' ..; , - c• t _ y
❑ New construction e Addition/alteration/replacement . Please check all that apply:
OService over 225 amps, comm'I 0Hazardous location
El Demolition ❑ Other:
❑Service over 320 amps
�;; ri � rating ❑ Buildng over sq. ft.,
-_ -- '� ? „ ` �c`� ; 1 _ , -" � t _l5 f '`n , X ,k i , T { o f 1- a 2- fam d 4 or more new residential
❑ 1 and 2 family dwelling ►:t Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
El Multi family ❑Building over three stories ❑Faders, 400 amps or more
❑ Master builder ❑ Other
���; H � �.�� -�7f K . �-rr r--� ��:� � � �r _ Fi � DOccupant l oad over 99 persons OManufactured structures or
: v_�77�� r ','- t '< G 'j 1 t �.757%Ls? 44 iX,.0 oyyJ(��, 4 e" i i 'e .. 4 x' �i`h k. 1 Egress/lighting lan RV park
�'iSrt� 11... _S�L Y). �.� , �• C -�,.. � . •. T�.. F�.��1. -�ri -T�., ti il.J9rl�. lr l.ciL; ❑ P
Job no.: Job site address: I,, ❑Health-care facility ❑Other:
. 'w � t/ Submit 2 sets of plans with any of the above.
City/State/ZIP: ,1 i 6 1 d of- The above are not applicable to temporary construction service.
c�:�:.`J 'fir: '-,^.;?;t r ,,�h -� .r..• ",.. ;; ;•%:y,.� :. ?..%
Suite/bldg. /apt no.: .3 Project name: 0 J 0 ` ••
Deserlptloo Qty. Pea T ota l
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft or less 145.15 4
Subdivision: Lot no.: Ea. addl 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no
)�. � J z e- �� rT -• _ � ,r f /,�+Fa - ( F � � Limited energy, non - residential 75.00 2
P. 1 ks F 7 - . alt „ 1C i, 1 i . u� ib iW 0i d ;' ,a r .{ rs F / r i ; ,ti.r ; Each manufactured or modular
dwelling, service and/or feeder 90.90 2
n 1=. .:. ..:roc ,.4ee_... : . - ; _.;. h ,s:'S.., �,. .. -
t \ l
f 1 • _ at of Y±'1.�5 _ i `t o ' i , - Services or feeders Installation, alteration, and/or relocation
� i 200 amps or less 80.30 2
s r y-' ^'a _ ., r, 2 M • 1 ry -r H . .n ,.. 201 amps to 400 amps 106.85 2
7
y � Y . . .�h�J ( �`j'Cl f4�, t f 1 . h �iF•ly . -? J . r F � 7 ;.h-� +•v ' 7" y � cv..
- � r,..�,:•.. ��L- t ����'��-- ��- �-- •--� -- 2'-� - 401 amps to 600 amps 160.60
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
' Reconnect only 66.85 2
City/ State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( )
200 0 aamps mps or less 1 66.85 1 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 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
/ I r ,a �. u n ff l�"r -: _' A. Fee for branch circuits with
:ti• b .. CENV r ' `L' { #r �, o Ent sy X o >� -- r
t' , bra ?W iu� yl_� ,. ._c._... L..._ service or feeder fee, each
branch circuit 6.65 2
B. Fee for branch circuits
Contact name: 0 _ i @t V_ Tri. � without service or feeder fee, 46.85 2
q L r I each branch circuit
Address:
@"39 ^ 9 3 ■ r iv S4 . Each add'l branch circuit 6.65 2
City / State/ZIP: ' ✓ V vi i w d 012. ql a G a Miscellaneous (service or feeder not included)
, Pump or irrigation circle 53.40 2
Phone: • ) '13'" / �I _ (�O Fax :: ( ) a J' 1 Q3� Sign or outline lighting 53.40 2
E - m ail : Signal circuit(s) or limited -
4 c} yky.15 -alb i ,, : '' "' ` ;''' ~.�=j energy Panel, alteration, or
rr r�1�du i l ' F(x'f3 ° F` lstu��rr� .: # s din xa ;ril:i)}5
�'� '��`'" ''" ",S+RC. extension. Describe: Page 2 2
• �
t ' .
Address: �° 3"( se t • , , Each additional inspection over allowable in any of the above
t Per, inspection 62.50 _
City/ State/ZIP: �Qy4 , 4 0 e S - 1 -30.D Investigation per hour (1 hr min) 62.50
Phone: O
(53) a3 ( 0 0 Fax ) e- .,033 Industrial plant per hour 73.75
I ,2 O '. -W.X6. 2 t g ,.. -,''45
IMENIL Electrical Lic.: , 6q (,e,e Sup Lic.: )4 0 I Subtotal 75*"
"
Suprv. Electrician signature, required: .,,. �I' ' /'n�� - Plan review (25 °/s of permit fee)
� State surcharge (8% of permit fe f1
% Print name: �'1' t . �O _ Date: . , D U
V / - T O TA L PER MIT FEE
Authorized signature: � , ■ I ' / 4 ∎ ; i 4 Thus permit application expires if a permit Is not obtained within 180
^ days after It has been accepted as complete
1 •i Date: g i al (!p • Fee methodology set by Tri- County Building Industry Service Board
- ` •• Number of inspections per permit allowed.
.I:\Building‘Pe mita\ELC- PerndtApp.doe 12/03 440- 4615T(10 /02/COM/'EB