Permit %
t ELECTRICAL PERMIT
�` Ilp ' CITY OF TIGARD
q
. s /,;, COMMUNITY DEVELOPMENT Permit #: ELC2009-00577
s Date Issued: 10/29/2009
rT[GAAD 13 SW Hall Blvd., Tigard OR 97223 503.639.4171
,,; Parcel: 25101 DA00101
Jurisdiction: Tigard
Site address: 13190 SW 68TH PKWY 110
Subdivision: TRIANGLE CORPORATE PARK Lot: 3
Project: Spec Space
Project Description: (6) branch circuits for TI.
Owner: FEES
PACIFIC NW PROPERTIES LIMITED PA Quantity Description Date Amount
STERN FAMILY LIMITED PARTNERSHIP &,
STERN, HELEN R REV TRUST, 6600 SW 105TH 6 crt Branch Circuits 10/29/2009 $93.28
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 10/29/2009 $11.19
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 $104.47
Required Items and Reports (Conditions)
This permit is ued subje • the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in ccordance with app •ved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. AT ENTION: Oregon law -cuira yo to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001- 010 thr •ugh OAR 952 -• a 1100. Yo - obtain a copy of the rules or direct questions to OUNC by calling .246.6699 or 1.800.332.2344. ,
K l ■
/ � f ,� ilk_ 1 - � �! 0 Issue B i Perm ittee Si o. ea A i /L/r�
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent
OWNER'S SIGNATURE Date:
_ CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' , m EV`� Date: A 0/ A9
LICENSE NO. 1 /9.57 S
CaII 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
11W2.7/2009 20:15 FAX Cf3j 002 /002
Electrical Permit ApplicatiRECEI V E � MR OFF1( F. 1 SF. O\ 1.Y
City of Tigard Received `c D /�
IN • ( 1 C i 2 8 L Date c f Permit No ■ r 2
l
13125 SW Hall Blvd., Tigard, OR 972$ Plan RmeR
C • Phone: 503.639.4171 Fax: 503.598.1960 Date By Other Pertwt
1 , , i 1 R it Inspection Line: 503.639.4175 C I'T`Y O TIG ARC Date Ready By run- El See Page 2 for
Internet: www.tigard- or.gov B1 Ill-DING DIVISIO No�ed/Method: � ❑OU000noaoaonooro
- TYPE OF iVORK PLAN REVIEW .
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 1 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault assent ❑ Marinas and boatyards.
' CATEGORI' OF CONSTRICTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ 'Multi -family 0 Master builder ❑ Other ❑ Fire pump. ❑ Installation of 75 KVA or
❑Emergency system larger separately derived system
' ' JOB • SI I FORMATION AND LOC'�1TION . - • ID Addition of new motor load of ❑ "A", "E ", "1 2 ", "1 - ",
Job no.: I Job site address: 13190 SW 0 111 Parkway 10°HP or more. occupancy.
D Ns or more resideutfai units. ❑ Recreational vehicle parks.
City/State/Z1P: Tigard, Or. 97223 ❑ Healdreare fatalities ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: 1/ D Project name: T 1 � 7 gle-bil ' Or i _ . 0 service or feeder 600 amps or more.
FEE - SCHEDULE .
Cross street/directions to job site: Description 1 Qtr. 1 Fee. 1 Total I
New residential single- or multi -family dwellhtg unit.
Inchsdes wedgarage.
Subdivision: 1.ot no.: 1,000 sq. IL or less 168.54 4
• Ea add'' 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential 67.84 2
DESCRIPTION OF WORK • (with above sq. 8.)
Six new brabch circtrlits
Limited energy, multi- family
residential (n7th above s� ft } 67.84 2
Services or feeders installation. alteration, and /or relocation
200 amps or less 100.70 2
❑,PROPERTY, OWNER. • ❑ 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
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_ (ease, 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. -r panel
()vvner Signature: Date:
1 Fee for branch circuits with
• - APPLICANT 1 . - ❑_ CONTACT PERSON above service or feeder fee,
each branch circuit 7'42 2
Business name: B. Fee for branch circuits
Contact 11RIDC: without service or feeder fee, 1 56 18 56.1 2 �/ v 4
first branch cacuit ✓V
Address:
Each add'' branch circuit 5 7.42 aS:60' 2} I°
- - ---- Miscellaneous (service or feeder not included)
City/StateJZIP: Each manufactured or modular 67.84 2
dwcli : service and/or feeder
Phone: ( ) I 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: Timberline Electrical Contractors Signal circuit(s) or limited
energy panel, alteration, or
Address: Po Box 918 eon. Describe: Page 2 2
City /State/ZIP: Lake Oswego, Or. Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone: (503)459-4089 Fax: ( 503) 245 -4227 / Investigation per hour (1 hr min) 66.25
ak // J CCB Lic.: 160037 Electrical L : 26 -1212C Stipr�. Lic.: 4957S j Industrial plant per hour 78.18
J v Q F.L•EC.TRICAL- PERMIT FEES
Suprv. Electrician signature, required ,, a j' Subtotal: .9..1R8 IS •
''rV "� /V / nS fir` Plan review (25% of permit fee):
Print name: Patrick Aic I. •1 / Date. G j 6
,,,, ! State surcharge (12% of permit fee): 13.07 r' , 19
Authorized signattue: 14 ..', TOTAL PERMIT FEE: 1
Print dame: Paul H u t s o n D a t e 6 (J w Q u A 'This permit app6nrlian expires if a permit is not o b t a b s e d within 180' ' Li
days after lit has been accepted as complete. l N