Permit } ' -, CITY OF TIGARD ELECTRICAL PERMIT
C COMMUNITY DEVELOPMENT Permit #: ELC2010 -00220
T.fd AMS 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/06/2010
Parcel: 1S135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 710
Subdivision: LINCOLN TOWER Lot: 0
Project: Axiom EPM
Project Description: 11 branch circuits
Owner: FEES
LINCOLN CENTER LLC Quantity Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555
CALIFORNIA ST 49TH FL 11 crt Branch Circuits 05/06/2010 $130.38
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 05/06/2010 $15.65
Electrical
Contractor:
WILLAMETTE ELECTRIC INC
PO BOX 230547
TIGARD, OR 97281
PHONE: 503 - 624 -3631
FAX: 503 - 624 -2938
Type of Use: (j 'I
Class of Work: A L i Type of Const:
Occupancy Grp:
Total $146.03
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.
/ j
Issued By: a 'H v Permittee Signature: ar A J' (% . -i 12 u / ✓`
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 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.
05/05/2010 WED 10:12 FAX 5036242938 Willamette Electric 2002/002
.Electrical Permit Applicati y�-,II((�� CEVED FOR OFFICE USE ONLY
City of Tigard FOR
"
L
C . M
III Dale kiy: Pcnnil No.: !7 -60,,10 13125 S W [call Blvd., Tigard, OR 972 Pian Review
m Phone: 503.639.4171 Fax: 503.598.I �/ — Other Permit:
mA I ? t Datc• B
TIGARD Inspection Line: 503.639.4175 Date Rcady't3y: Juris: , H Sec Page 2 for
Internet: www.tigard or.gov CITY OF TIGARD Notified:Method: Supplemental Information
TYPE osun. NG.DIVISION :" P REVIEi%
❑ New construction Z. Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w: iteins checked below):
❑ Service or fecdcr 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other:
where the available fault cuncnt ❑ Marinas and boatyards.
CATEGORY Of CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14 -000 ❑ Commercial -use agricultural
❑ 1- and 2-family dwelling 2 Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 Kb'A or
❑ Emergency system. larger separately derived system.
'JOB. SITE INFORMATION AND ., . •
_ ❑ Addition of new motor load of
6I/ /D 2 Gd n / I00 or more. occupancy.
Job no.: J Job site address: ( `(/f
t rGCPV (.t/ ❑ Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: r
/ ■ ` G // ❑ Health-care facilities. 0 Supply voltage for more than
(1 J ❑ Hazardous locations. 600 volts nominal.
SUIT 1d /a t. no.: Project name: ❑ Service or feeder 600 amps or mono.
' g p ��a j po
-- FEE SCHEDULE ;
Cross street /directions to job site: Description I Qty. 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
Tax map /parcel no.: Ea. add'I 500 sq. R. or portion 33.92 1
Limited energy, residential
67.84 2
: DESCRIPTION OF )YORK . • (with above sq. 0.)
� �, Limited energy, multi - family 67.84 2
�h�, -, / L ,.t., A e — residential (With above sq. 0.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
❑ 'PROPERTY. OWNER 0 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 /StatcIZIP: 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 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 070, 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
•: , 0, APPLICANT ❑ CONTACT PERSON above service or feeder lee,
each branch circuit 742 2
Business name: B. Fee for branch circuits
without service or feeder fee, /e
Contact name: / 56.18 5' 2
first branch circuit
Address: Each add'I branch circuit /� 7 .42 ��!/— 2
Miscellaneous (service or feeder not included)
• City /State/ZIP: Each manufactured or modular 67 44
dwelling, service and /or feeder
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, alternation. or
Address: P.O. Box 230547 extension. Describe: Page 2 2
City /State /ZIP: Tigard, OR 97281 Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone: (503) 624 - 3631 Fax: (503 - 624 - 2938 Investigation per hour (1 hr min) 66.25
CCB Lic.: 75059 Electrical I•ie.: 34-283C Suprv. Lic.: 4226 - 5 industrial plant per hour 78.18
'• ELECTRICAL PERMIT "FEES: -
Supra'. Electrician signature, required" - - -- ' ___ _.-- .- _..__....... Subtotal: / 3 a, 0.—
Print name: David Fife Date: `7/ 5/ / 0 Plan review (25% of pcnnit fee): G
State surcharge (12% of permit fee): / S —
�
Authorized signature: "TOTAL PERMIT FEE: // d
This permit application expires if a permit is not obtained within 180
Print name: Date:
days after 11 has been accepted as complete.
° Number of inspections allowed per permit.
1: Building -Pc:mils EI.C-Pcr:uitApp.doc 10 01 09 .140-4o1.5011 05 CON{ WEB