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Permit
'+ �`�` CITY OF TIGARD ELECTRICAL PERMIT 4 r , - t Permit #: ELC2009 -00552 A s 1: COMMUNITY DEVELOPMENT T1ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/20/2009 G Parcel: 2S101 DA00102 Jurisdiction: Tigard Site address: 13221 SW 68TH PKWY 200 Subdivision: TRIANGLE CORPORATE PARK Lot: 2 Project: HealthNet Project Description: Add /alter (9) branch circuits and restricted energy for voice /data. Owner: FEES GK TRIANGLE CORPORATE PARK 111 L Quantity Description Date Amount BB# 73- 1771- GK1130, CBRE, PO BOX 2096 WARREN, MI 48090 1 ea Limited Energy 10/20/2009 $67.84 PHONE: 9 crt Branch Circuits 10/20/2009 $115.54 wo /Purchase Service or Feeder Contractor: 1 ea 12% State Surcharge - 10/20/2009 $22.01 Electrical PHOENIX ELECTRIC CO PO BOX 14037 PORTLAND, OR 97293 PHONE: 503 - 231 -8006 FAX. 503 - 235 -4300 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $205.39 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 throug 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: � at O! . �i 1 i Permittee Signature: OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale. lease or rent. OWNER'S SIGNA URE Date: x:::: CONTRACTOR INSTALLATION ONLY SIGNA URE OF S R. 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. '° ',Oct 16 09 01:08p Terry Koch 503 - 266 -8394 p.1 R i w mo � ,., Electrical Permit App6catio � A. _ , ' ", t.4. : ". T F,# ! " Alit ` ° , ` , _ '.' .: ' T. e Recived I li permit No. • (C ? l JLJ n( 6 2. City of Tigard 1 Receiv " a 13125 SW Hall Blvd., Tigard, OR 97223 OCT a 2009 Plan Review I , P�OO� �y� I n Other Permit : 4 Cy) 1 1 ® Phone: 503.639.4171 Fax: 503.598.1960 Date/Bv: r Inspection Line: 503.639.4175 Date Ready/By: Iuris: Pi See Page 2 for l:IC:ARD tP CITY OF TIGARD Internet: www.tigard- or.gov Notified/Method: '\--- I e'i Supplemental information Navirsaiale E OF WIPING DIVISION , PLAN REVIEW Please check all that apply (submit 2 sets of plans w /items checked below): ❑ New construction ddltl0n /a1LCrcl[lOR/IeplaCemeIll ❑ Service or feeder 400 amp or more ❑ Building over three stories. ❑ Demolition ❑ OtheI: where the available fault current ❑ Marinas and boatyards. exceeds 10,000 amps at 150 volts or ❑ Floating buildings. CATEGOR OF CONSTRUCTION Is to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1- and 2- family dwelling ommercial/industrial ❑ Accessory building amps for all other installations. buildings. builder ❑ Other: ❑ Fire pump. © Installation of 75 K V A or ❑ Multi- family ❑ Master Q Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION ❑Addition of new motor load of ❑ "A "E", "1 - ". "1 - 3", _ ^� q ,, 1001 or more. occupancy. Job no.: 3 5 j 7 Job site address: / 3.? / sty 4,5, Pj t7C/LL(,,, Q Six or more residential units ❑ Recreational vehicle parks. Q Health -care facilities. ❑ Supply voltage for more than City/State/ZIP: 1 ( ,.(� OR 9 �aa3 ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: Q 1 i -u-k- ❑ Service or feeder 600 amps or more. t \` FEE SCHEDULE Cross street/directions to job site: . Description 1 Q7. I Fee. 1 Total 1 • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: 7 Lot no.: 1,000 sq. ft or less 168.54 4 Ea. add'I 500 sq. 11. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential 67.84 2 DESCRIPTION OF WORK (with above sq. fl.) - _ Limited energy, multi- family 67.84 2 0/211-06.1-i 6 lGt% ( e , � 5 r i a 0 � 7 ©,t) residential (with above sq. ft) ( /, _ Services or feeders installation, alteration, and/or relocation /7 L ,72 ce.- 3 ' cZoo/a2- 200 amps or less 100.70 2 ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: 601 amps to 1,000 amps _ 301.04 2 Address: Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and /or City /State/7.IP: relocation Phone: ( ) F ax: ( ) 2 00 amps or less 59.36 1 125.08 2 Owner installation: This installation is being made on property' that 1 own which is not 201 amps to 400 amps 401 amps to 599 amps t 68.54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits — new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT L ❑ CONTACT PERSON above service or feeder fee, L 7.42 1 2 each branch circuit Business name: B. Fee for branch circuits / without service or feeder fee, / 56.18 54/ / (" 2 Contact name: first branch circuit Address: Eachadd'1 branch circuit " 7.42 " ;; 2 Nriiscellaneous (service or feeder not included) City /State/ZIP: Each manufactured or modular 67.84 2 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 _ Signal circuit(s) or limited - Business name: ?0,/ pE / ) 4 j ..- 2G �I energy panel, alteration, or Address: fl i r � A D, AL X .4 03c extension_ Describe: Page 2 6 r 2 W City /State/LIP: /70 Rr i - -- ' Q Q C/ 7 g3 Each additional inspection over allowable in any of the above _Per inspection 66.25 Phone: ( 3 ),;1.3 i � ( 06,,, Fax: (5e3) 23 — 4-3 co Investigation per hour (t hr min) 66.25 CCB Lic.: /(0 ,2753 Electrical Lic.: �,, y Suprv. Lic.: 576 S Industrial It per hour 78.18 �� e ELECTRICAL PERMIT F 18 Suprv. Electrician signature, required: Subtotal: /'k,3 3F" Plan review (25 %of permit fee): Pant rain /620. Date: /0 — ; 4� n_9 G K C State surcharge (12% of permit fee): j 2 .0/ Authorized signature: e TOTAL PERMIT FEE: a 0 5, 3Y A;iii J/- 1 This permit application expires if a permit is not obtained within tgal Print name: _�£ 2 w Gr ` accepted P Date: /® -- /( sue -erg da y s after it has been acce ted as complete. r~ CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit#: ELC2009-00552 . • 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/20/2009 Parcel: 2S 101 DA00102 Jurisdiction: Tigard Site address: 13221 SW 68TH PKWY 200 Subdivision: TRIANGLE CORPORATE PARK Lot: 2 Project: Health Net Project Description: Add/alter (9) branch circuits and restricted energy for voice/data. Owner: FEES GK TRIANGLE CORPORATE PARK III L Quantity Description Date Amount BB# 73-1771-GK1130, CBRE, PO BOX 2096 WARREN, MI 48090 1 ea Limited Energy 10/20/2009 $67.84 PHONE: 9 crt Branch Circuits 10/20/2009 $115.54 wo/Purchase Service or Feeder Contractor: 1 ea 12% State Surcharge - 10/20/2009 $22.01 Electrical PHOENIX ELECTRIC CO PO BOX 14037 PORTLAND, OR 97293 PHONE: 503-231-8006 FAX: 503-235-4300 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $205.39 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 throug 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: f Q_~ ,y vL Xl~ Permittee Signature: 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 - 111~let-~ SIGNA URE OF S /61R. 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. ,Oct 16 09 01:08p Terry Koch 503-266-8394 p.l Electrical Permit Annlicatio>Qj?' FOR OrFlCF USE ON'LY Received _ City of I Tigard Yern„t No 4 Z • 13125 SW Hall lvd., Tigard, OR 97223 6 2 0 ~ J Plan ev ew e I 0 Phone: 503.639.4I71 Fax: 503.598.1960 DatelBy: OtherPervnr: Inspection Line: 503.639.4175 } . Date ReadyBy: huffs: RI See Page 2 for Internet: www.ligard-or.gov ; P TIGAR 1 Notifsed/Metlwd: Supplemental information "N E OF WORK PLAN REVIEW ❑ New construction dditiou/alteration/replacement Please check all that apply (subunit 2 scL of plans w/items checked below): ❑ Demolition ❑ Other. ❑ Service or feeder 400 amps or more ❑ Building over three stones. Where the available fault current ❑ Marinas and boatyards. CATEGOR OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. I ess to ground, or exceeds 14,000 ❑ Commercial-use agricultural ❑ I- and 2-family dwelling ommercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi-family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system QAddition nfnew motor load of ❑ "A", "E", "1-Z", "I-3", Job no.: 3 j J Job site address: f 3~ 1 SG(.1 aVAPt444„/ 10 011P ix or or more e residential occupation. more. ❑ Six or units. ❑ Recreational vehicle parks. City/State/ZIP: J 1~ lj •-j ❑ Health-care facilities. ❑ Supply voltage for more than v K• , ❑ Hazardous locations. 600 volts nominal. Suite/bldg./apt. no.: Project name: t ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to jab site: Deaal Fee iota) New residential single- or multi-family dwelling utdt. Includes attached garage. Subdivision: Lot no.: 1,000 sq. tt or less 168.54 4 Ea. add71 500 sq. ft. or portion 33.92 1 Tax map/parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above s q. R.) 67.84 2 Lirnite4d n, multifamily 67.84 2 residential tial (with atxtve . R resid ,rte ~ , _ rJ Services or feeders installation, alteration, and/or relocation 'z~e' 3 200 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/Statc/71P: Temporary services or feeders hmtatlation, 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, ren( or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168,54 2 Owner signature Date: Branch circuits - new, alteration ore tension, er anel - A Fee for branch circuits with ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, each branch circuit 7.42 2 Business name: B. Fee for branch circuits Contact name: without service or feeder fee, first branch circuit 56.18 t)4 f 2 Address: Each add'I branch circuit 7.42 2 A'y Miscellaneous service or feeder not Included City/State/ZIP: Each manufactured or modular 67,94 2 Phone: ) Fax:: ) dwellin service and/or feeder Reconnect only 67.84 2 E-trail: Pump or irrigation circle 67-84 2 CONTRACTOR Sign or outline lighting 67.84 2 lo~~(X Signal circuit(s) otlimited- Buslness name: I T ! ~s energy panel, alteration or a'7 Address: Q extension- Describe: Page 2 (r 2 City/StatcJZIP: J Each additional hes on over allowable in an of the above Phone: 3 35-- 't Per inspection 66.25 ( 3 ) 3l ' Fax: ( G ~*300 Investigation per lour (t hr min) 66.25 1 CCB Lic.: `~r l j" Electrical Lic.: Suprv. Lic.: J(a 5 Industrial plant per hour 78.18 ELECTRICAL PE Suprv. Electrician signature, required: PERMIT FEES _ Subtotal: • 1~ Print name: Date: / L) ` d Plan review (25% of permit fee): State surcharge (12%ofpermit fae): Authorized signature: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within IRO I Print name: { pp Date: l,J day's after it has been accepted as complete.