Permit CITY OF TIGARD ELECTRICAL PERMIT
.?I Y
COMMUNITY DEVELOPMENT PERMIT #: ELC2008-00501
DATE ISSUED: 9/3/2008
iTtGAR1:5:1 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S135AB-01004
SITE ADDRESS: 10220 SW GREENBURG RD 540 ZONING: C - P
SUBDIVISION: LINCOLN CENTER/TWO LINCOLN LOT : JURISDICTION: TIG
PROJECT: PAXTON & MILLER
Project Description: (1) branch circuit new outlet and lighting.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
SHORENSTEIN REALTY SERVICES WILLAMETTE ELECTRIC INC
ONE SW COLUMBIA #300 PO BOX 230547
PORTLAND, OR 97258 TIGARD, OR 97281
Phone: 503 - 412 - 4800 Contact #: PRI 503 - 624 -3631
FAX 503 - 624 -2938
FEES
Description Date Amount Reg #: ELE 34 -283C
[ELPRMT] ELC Permit 9/3/2008 $46.85 LIC 75059
[TAX] 12% State Surchar 9/3/2008 $5.62 SUP 4226S
Total $52.47 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 through OAR 952 - 001 -0100 • . may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: � Permittee Signature: C ��i� -71
f
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'N: 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.
09/02/2008 TUF. 15:53 FAX 5036242938 Willamette Electric a002/002
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In tecUOn L,inc. >0..539.4 i 7:>
� tl q G* � ^�(.�� D' 1 pale Ready/13y: 1��ris [d See Page 2 for _._.__ _.........
is ` °E?Ys4. Internet: www.tlgard - or. "v MT OF TIGAR NoGGed',b ( Supplernen ial htforma4iou
I T '!JI J DIVi PLAN REVIEW - - _ j ---,
❑ New construction 0 Addition /alteration /replacement P lease check all that apply (submit 2 sc,s of plans tv;i,ems checked below):
ID ❑ Service 0; fceder 400 amps or more ❑ Building over three sl ics.
Demolition — ❑ Other: __ — where the available fault ctuTent ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 ; at 150 volts or ❑ Floating iiiiiiiikis.
- - - ----- less lo ground, or exceeds 14,000 ❑ Commercial -nse acricult,nal
❑ l- and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: 0 Fire pump. ID tnstallatinn of 75 KVA or
— — JOB SITE INFORMATION AND LOCATION ❑ Emergency system. huger sepa,atcly clef system.
❑ Addition ofnea• motor load of ❑'A" li j 2 3
loll no.: Job site address: �i to G s 1001 or more. occupancy.
`/ ' - l.�' ❑ Six or more residential wets. ❑ Reueational vehicle parks.
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V f', / ' r ' � � �;, ^,'7r . p
City/State/ZIP: �,;� . <•{ f >' r, 4 ,F! c r� „ � I / � ( r � Y ❑ llcalth -care facilities- ❑Supply voltage for mote than
1 j -- -� "' � (Z._ "" - I I ' _ ❑ Hazardous locations. G00 volts nominal.
Suite /bldg. /apt- no.: Project name: pp R ❑ Service or feeder 600 amps or more.
..FEE SCHEDULE
Cross strecUdilectionslo job site: t T _
. .__ , (�� t:.' 01, Description 1 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 145.15 4
Ea. add'1 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
-' .DESCRIPTION OF WORK . (with above sq. 6.) 75 2
8. p Limited energy, multi- family
/i41 ` ,. . -/y Ap..,: (7 ' . : [ _ ei— N : .1 { f C; '.'/ /!( residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80 30 2
DPROPERTI' OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 — 2
- - -- - -_. - -- I 601 amps to 1.000 amps 240.60 2
Address: --- --- ---
— - - - _ Over 1,000 amps or volts 454.65 �_ 2
City /SlatelllP: Temporary services or feeders installation, alteration, and /or
-_ - _.. _ ----- -- relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449 670. and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration. or extcnsion,. pc anel
Owner signature: Date:
A. Fee for branch circuits will?
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee,
_each branch circuit 6.65 2
Business name:_ B. Fee for branch circuits —
without service or feeder i feed fee, / Fr%
Contact name: _ first branch circuit 46.85 �J .' 2
Address: Each add'1 branch circuit 6.65 2
- - - Miscellaneous (service or feeder not included)
City /Stale /ZIP: Each manufactured or modular
- - _ - - - dwelling, service and /or fceder 90.90 2
!hone: ( ) _ Fax: ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 - 2
.CONTRACTOR Sign or outline lighting _ — 53.40 2
Business name: 'Willamette Electric Inc. Signal circuit(s) or limited-
energy panel, alteration, or
Address: PO Box 230547 extension. Describe: Page 2 2
City /State /21P: igard, OR 97281 -- Each additional inspection over allowable in any of the above -
— — Pcr inspection r 62.50
Phone: (503) 624 -3631 Fax: (503) 624 -2938 - — — -
Investigation per hour (I hr min) I 62.50 - -!
CCB Lic.: 75059 Electrical Lic.: 34 -283C Suprv. Lie.: 4226 -5 Industrial plant per hour 1 73.75
-- r - ELECTRICAL PERM['T r t:,fs
5uprv. Electrician signature, required: a
Subtotal: o ' --
Print name: David Fife Date: C -� Plan review (25% of permit fee):
- -- ° -- — ' �� - -_ State surcharge (12% of permit fee): -/ --
Aulhorired signature: TOTAL PERMIT FEE: 7 ,/7
Print nature: Date:
This permit at,plicalion expires if a permit is not obtained within 100
days after it has been accepted as compieic.
' 11i1inber of inspcceinns allowed per permit.
1 lnuddia. il'crmitsJ ?LGPermitApp.doc 05/23(06 .140 I 1 105 /COMJ6'E1l
•
CITY OF TIGARD
BUILDING DIVISION .
PERMIT #: El C OC) OtlStri
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: arP 14itil)
• Phone: (503) 639 -4171 ''''r 1 f
Inspection Requests (24 Hrs.): (503) 639 -4175 A A R 'I
INSPECTION WORKSHEET FOR DATE: 10/16!200$ TIME: 7:0 "iAh� PAGE: 35
SITE ADDRESS: 102.? � af1E_ENRIJPta RD MO
OF WORK:
SUBDIVISION:
LINCOLN CENTER/TWO t LINCOLN
LOT #: • TYPE OF USE:
PROJECT NAME: PAX- I_ON & MILLER
DESCRIPTION: (1) branch circuit new outlet and lighting.
OWNER: SHORENSTEIN REALTY SERVICES, PHONE #: fyx3 4 - i•2_4800
CONTRACTOR: WILLAMETTE ELECTRIC INC PHONE #: 503.624_::;631
Inspection Request Scheduled For: Date: 10116/2000 Pour Time:
Code # Inspection Description Confirm # Contact # Message
s.
199 Electrical final 076711-01 '1 503-700-3222 N
Corrections /Comments /Instructions:
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL NO ACCESS
n FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: (1q/S6L-Cr. Date: 16 [l-b Phone #: (503) 718 - 2-gg4