Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00175
Date Issued: 04/15/2010
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
TIGARD Parcel: 1 S135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 130
Subdivision: LINCOLN ONE Lot: 0
Project: Balance Your World
Project Description: (2) branch circuits for TI
Owner: FEES
LINCOLN CENTER LLC Quantity Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 2 crt Branch Circuits 04/15/2010 $63.60
CALIFORNIA ST 49TH FL wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 04/15/2010 $7.63
Electrical
Contractor:
WILLAMETTE ELECTRIC INC
PO BOX 230547
TIGARD, OR 97281
PHONE: 503 - 624 -3631
FAX: 503 - 624 -2938
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $71.23
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- 001 -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: Permittee Signature: 3/i.!' /97 /- / l .4/
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.
CaII 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.
04/15/2010 THU 16:38 FAX 5036242938 Willamette Electric 8002 /002
Electrical Permit Application FoR or l USE aivLY
City of Tigard ���E� Rece ' Pennit No.y / n
Dateft3y: / S la �% C[�(.0 QQ/ 25
I. " 13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review At p j
Datcrpy: Other Pennir / A O7 /
TIGARD inspection Line: 503.639.4175 APR 1 5 2010 Dale Ready /13y: hurls: 61 Sce Page for (O
interact www.tigard Notified /Method: Supplemental Information
of Tlc
: ' T QF c4''aTtSifJpi• �1 �1SION ... PLAN RtVMEW _
P lease check all that apply (submit 2 sets of plans ++ items checked below):
New construction 54 Addition /alt re acelnent p )
0 Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑ Other: where the available fault current 0 Marinas and boatyards.
:CATEGORY OF CONS FRGCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less 10 ground, or exceeds 14.000 0 Commercial -use agricultural
❑ 1- and 2-family dwelling Fa Cornmercial/Industrial ❑ Accessory building amps for aIl other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: 0 Fire pump. 0 installation of 75 KVA or
SIT INFORMAT 10N AND LOCATION Emergency system. larger separately derived system.
108
. - A of new motor load of D ! `A " r i -2"
100HP or more. occupancy.
r ,
Job no.: 5""- 8 Job site ,� Y
address: "e S �, , } ' tI
l
A°C °E; e � a � kt „111 D Six or more residential writs. 0 Recreational vehicle parks,
City /State /ZIP: �- " Z. r . ,,,
„ " / / �� 0 Health -earn facilities. 0 Supply voltage for more than
�
0 Hazardous locations 600 volts nominal.
( �uit id /apt. 110. k �''' , Project name: �''' // d y% /< , I D Service or feeder 600 amps or more.
- ,,. , #EE S01iiDUL-E ,
Cross street /directions to job site: Description ' 1 Qt+ 1 ` Fee 1 Total 1
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'I 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
67.84 2
DESCRIPTION" Ox WORK _ (with above sq. ti.)
y L imited energy, multi- family 67.84 2
'',."f „witi. / /. ,„..,)/1 ,,% " a r ',.t t 7 residential (with above sq. ft)
Services or feeders installation, alteration, and /or relocation_
200 amps or Tess 100.70 2
Q PROPERTY'. NER ❑ TENANT 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 20 t 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
❑,:APPLTCA T :,:: ( n CONTACT;: PER :: above service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fcc for branch circuits
Contact name: without scivice or feeder fee, (/' 56.18 56 18 :';'(,:-,K. i? „ ' 2
first branch circuit
Address: Each add'l branch circuit ,</ 7.42 2 %,f!, 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service and /or feeder 67.84 2
Phone; ( ) Fax:: ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR : : , , - Sign or outline lighting 67.84 2
Business name: Willamette Electric inc Signal circuit(s) or limited
energy panel, alteration. or
Address: P.O. Box 230547 extension. Describe: Paget 2
City /State /ZiP: Tigard, OR 97281 Each additional inspection over allowable in any of the above
Per inspection
(503) 624 -3631 Fax: (503 -) 624 -2938 t i g at o on 66.25
Investigation per hour (i hr min) 66.25
CCB Lic.: 75059 Electrical Lic.: 34 -283C Suprv. Lic.: 4226 trial plant per hour 78.18
P .. -.
ac..7 __....._ . ..... Industrial ;: LRCT'RIOW,= ERMIT FREE
Suprv. Electrician signature, required. — Subtotal ",, b , .. - -
Print name: David Fife Date: / 0 Plan review (25% of pennit fee):
( �`” _ ��` State surcharge (12% of pennit fee): ` J ,4.
Authorized signature: TOTAL PERMIT FEE: j'g 44, .
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete. L/
* Number of inspections allowed per permit. ^
l:`Buildhs PennitslE1.C•PennilApp.dnc 10'01109 440.4615T(11'0i;COM - WEB /) ( n\/!'l