Permit (2) r
' CITY OF TIGARD ELECTRICAL PERMIT
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t , = e :;, COMMUNITY DEVELOPMENT Permit #: ELC201000357
cT 6GR
4 Date Issued: 07/14/2010
AD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
;-,-.,..,:•,.,„. Parcel: 2S101 BB01500
Jurisdiction: TIGARD
Site address: 12256 SW GARDEN PL, BLDG# 1
Subdivision: PARK 217 Lot: 0
Project: CTA Lab
Project Description: (12) branch circuits for TI
Owner: FEES
WALTON CWOR PARK BC 8 LLC Quantity Description Date Amount
BY TTA/EPROPERTYTAX DEPT 325, PO BOX
4900 12 crt Branch Circuits 07/14/2010 $137.80
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 07/14/2010 $16.54
Electrical
Contractor:
TIMBERLINE ELECTRICAL CONTRACTORS
PO BOX 918
LAKE OSWEGO, OR 97034
PHONE: 503 - 459 -4089
FAX: 503 - 254 -4227
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $154.34
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 OAR 952 - 00 - 0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: C/r .114 /I:l%._i Permittee Signature: /6.4 J/cl
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' -. ' : At ilggr� ` Date:
1'
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.
07/13/2010 02:25 FAX ti e
a001 /002
, 9!_ leaf - Periliii � Appbca�io116 , , r y '1 , " : , ; 4 S f i i 1 ' k r 1
e' r t I 11 City of Tigard � )\.., .. •
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Permit No.: L. �06 "Qe✓ - ..
} 4 13125 SW Hall Blvd, Tigard, OR `�7.23 `` ``� , Plan Review
Phone: 503.639.4171 Fax 503.598.196tV . ,`r CO , Dat /B . Other Permit:
:� , Inspection Line: 503.639.4175 � .- r �;) h Date Ready/By: H See Page 2 for
:.: Internet: www.tigard- or.gov r> �; ti " � p NotifiedllvSathod SaPPkmental7afetmwfloo
�f y M , ;�. A� .. _ H'; '"�5 F Yr t ?� r r i , , ,,,. ; 4 Y 1 , r .* ' L f t
_t' r a r e ✓ y 2 ...z rfx ti4j l sN 3 Z
❑ New construction r': Addition/altelatitin/replacemeat
Plcaae clack all that apply (submit 2 seta of pia a rrows cheakad belo
�. I1eTnol1t1011 0 Other ❑ Service or feeder 400 amps os more ❑ Building over three stories.
I. J where the available fault current ❑ Marinas and boatyards.
"" ' r } ? .,,;;: , t ; r �4 � 2 ' ereeeds 10,000 amps at 150 volts or ❑ Floating buildings. ,
?,•% ._. „_S z
,. fisn', .. ;t M >t., , kook. gwood,ormoods14.000 ❑Gamomercisl- oaeagricultural
1- and 2- family dwelling P. Commercial/industrial 0 Accessory building amps for all other installations. buildings.
❑ Multi famll ❑ Master builder ❑ Other ❑ Fire pump. ❑ Installation of 75 KVA or
t t , ? m y . ` r s ❑»gRO�7 aysta<a larger separately derived system.
:;::,:l'..:'?':,:::‘ .... ...< , '' ... z ' ' ; £ ?';- -' . ' ❑ Addition of new motor load of ❑ "A ', "11' "1 -2 ", "t -3",
Job o ccupanc no.: . Job site address: ZZJ�p 10013P or morn.
n� ❑ sic or mom taside offal writs. ❑ li areatioa al vehicle parks.
City/Ste/IC/VP: Ti toast , i\ 2:2.3 ❑ Health -cara facilities. ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nomtnaL
Suitelbldg. /apt no.: I Project name: 0:1 )1%. (41,455 ❑ Service or feeder 600 amps or more.
Cross street/directions to lob site: > Q i
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map/parcel n0.: Ea. add'I 500 sq. R or portion 33.92 I
y 7 s n, L M . a y . h 1 4 Limited , 67.8.4 2
mCa'gy, residential
. . _ .. -_ . _... , s _ ... , : ... . ,c .a: 2„, 1 <i1- iiIc4o . ;:,.s i.4 . , .. ?>ivY ? _ (with above sq. t1.)
'�-^ C Llmded energy, mttlti-family
Ii r.s. t7 YYW id. -V.... residential (with above sq. R) 67.84 2
Services or feeders alteration, and/or relocation
• 200 amps or less 100.70 2
. r - ! k r 3 g'r .., d' .., r F Yi v, fa a i
.:; .:. ': ' G F xlrr �' 3 .i : 1 t ? . '' ... v1 �" . ; ' x { ` ...Gti 201 amps to 400 amps 133'56 2 S.
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: ( ) 1 Fax: ( ) 200 amps or loss 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 70L 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or erten:don, panel
Owner signature: Iane. A. Fee for branch circuits with
k 141 i [ ki fi I {? 17" $ F'w' l T above service or feeder fee,
7A2 2
Business name: B. Fee for branch circuits / /
Contact 10.91:132: wIthout service or feeder fee, i 56.18 . l 2
first branoh circuit
Address: Each add'/ branch circuit 1 ( 7.42 9(.(0.1 2
Miscellaneous (service or feeder not hnduded)
City/StaterEP: Each tnamtfactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
E -mail: Ptunp or irrigation circle . 67.84 2
c ,. l > r , . 4 c ,∎ a w .' ; Sign ar outline lighting 67.84 2
Business name: Signal cirouit(p) or limited-
T T,i C . C energy panel, alteration, or
Address: PO bV `c R i C7 extension Describe: Page 2 2
City/St> (L 6O, oz. q 10� Each additional Inspection over allowable In of the above
Ph one: ) ) 9# 4 — (, t 22 In v inspection 66'25
(�� '��— �'Q j a Fa x: ( Investigation per hour p hr min) 66.25
. , CCB Lic.: .7 !) • `
` ,p � b d � � 7 � � : 0� 1p " i prv. Lic.: lttdtlatrtal plml per hour 7818
U r' r a `i $
,., mac?,,:,. r 9 _ _ '.
Suprv. Electrician si: required: fill, Subtotal: * O F
7113 1•701° Plan review (25% of permit fee):
Printnamle: t ,`i• g' i State surcharge (12 % of permit Ice): i Authorized signe� � TOTAL PERMIT FEE:
Print name: *' I Date. ?r bi31201° This permit app allcaUfter Iice U s. d withpa 18 * Number of inapeotima allowed been accepted as complete.
per permit ' / 13 7
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