Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
:F ! 11 : COMMUNITY DEVELOPMENT Permit #: ELR2013 -00183
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/31/201
Parcel: 1S135AB04500
Jurisdiction: Tigard
Site address: 10250 SW GREENBURG RD 110
Project: Family Health Subdivision: 1991 -055 PARTITION PLAT Lot: 1
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 07/31/2013 $75.00
12% State Surcharge - Electrical 07/31 /2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 0
Audio & Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data & Telecommunications: 0 Fire Alarm: 0
HVAC: 0 Instrumentation: 0
Intercom /Paging: 0 Landscape /Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 0 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. ATTE • ■ • Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 6 010 through • . R 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2 44.
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C S Is ued B / GAG h
By: ! I 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 OFFICE USE ONLY
City of Tigard RECEIVE 11' Received �
3 G /
Date /B : f I Permit No.: 6
ea III 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
1S Date /B Other � -{f� Phone: 503.718.2439 Fax: 503.598.1960 JUL 3 0 2013 O Permit: „9 -DD 3
TIGARD Inspection Line: 503.639.4175 Date Ready /By: kris: ® See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: Supplemental Information
e
TYPE OF w ILDING DIVISION 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
❑ I- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
0 Addition of new motor load of ❑ "A ", "E ", "1- 2 ", "I -3 ",
Job no.: Job site address: 10250 SW Greenburg Road I or more. occupancy.
❑ Six x o or r more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Portland OR 97223 ❑ Ilealthcare facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 110 Project name: Family Health ['Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. 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'( 500 sq. ft. or portion 33.92
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
low voltage wiriing (t - stat) residential (with above sq. ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation, alteration, and/or relocation
❑ PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) Fax: ( ) relocation
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
Owner signature: Date: Branch circuits — new, alteration, or extension, •_er panel
® APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: American Heating Inc each branch circuit
B. Fee for branch circuits without
Contact name: Brad Manchester service or feeder fee, first 56.18 2
branch circuit
Address: 5035 SE 24 Ave Each add'( branch circuit 7.42 2
City/ State/ZIP: Portland OR 97202 Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
Phone: (503) 239 - 4600 Fax: : (503 - ) 239 - 7038 dwelling, service and/or feeder
Reconnect only 67.84 2
E - mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: American Heating Inc Signal circuit(s) or limited- energy I See ��
panel, alteration, or extension. Page 2 2
Address: 5035 SE 24 Ave Each additional inspection over allowable in any of the above
City/State/ZIP: Portland OR 97202 Additional inspection (I hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
Phone: (503) 239 -4600 Fax: (503) 239 - 7038 Industrial plant (I hr min) 78.18/ hr
Inspections for which no fee is 90.00 / hr
CCB Lic.: 33135 Electrical Lic.: 26993CRE Suprv. Lic.: 2640LEB specifically listed (% hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, require - Subtotal: -767 )
Print name: T Steve Young Date: 7/31/2013
Plan review (25% of permit fee):
g m � � � c � ./e-------- State surcharge (12% of permit fee): 9 . Uo
Authorized signature: /��— r TOTAL PERMIT FEE: W .c'e
Print name: Brad Manchester Date: 7/31/2013 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\ Building\ Perm its \ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-46 15T( 1 1/05/COM/WEB
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10250 SW GREENBURG RD 110, TIGARD, OR,
97223
Commercial - Electricial Limited Energy
199 Electrical final
2013-10-30 (null)
ELR2013-00183
PASS - No C of O
Violation Summary:
Inspector Contractor