Permit •
e CITY OF TIGARD ELECTRICAL PERMIT
. COMMUNITY DEVELOPMENT PERMIT #: ELC2008
DATE ISSUED: 10/29/2008
TlGn1t 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 •
PARCEL: 1 S 135AB -00900
SITE ADDRESS: 10200 SW GREENBURG RD 700 ZONING: C - P
SUBDIVISION: LINCOLN CENTER /FIVE LINCOLN LOT : JURISDICTION: TIG
PROJECT: FARMERS INSURANCE
Project Description: (1) branch circuit for new lights in lobby.
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: SIGNALJPANEL:
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 CAPITOL ELECTRIC CO INC
ONE SW COLUMBIA ST #300 11401 NE MARX ST
PORTLAND, OR 97258 PORTLAND, OR 97220 -1041
Phone: 503 - 412 -4800 Contact #: PRI 503 - 255 -9488
FAX 503 - 257 -7121
FEES
Description Date Amount Reg #: ELE 26 -496C
[ELPRMT] ELC Permit 10/29/2001 $46.85 LIC 48748
[TAX] 12% State Surchar 10/29/2001 $5.62 SUP 3132S
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. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
ermttee S r
Issued By: Permittee Signature: 9 �7� G cr✓
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.
Electrical Permit Application FOR OFFICE USE ONLY .
Received
City of t , , �
, - • r =rmit no. .t
Citf Ti d Date/B ) , ' , C
. — � /
Cl
in 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
' i Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit: c� �/ G(1 '—� e 't
TIGARD
Inspection Line: 503.639.417 q p�� Date Ready /By: Jwis. ❑seePage2for
Internet: www.tigard-or.gov F ®fit
qY r F NoNotified/Method: ppltentnl In fonnauon
g e. > w, . ,... 7 t .. f `T..YPE ®FaW,,OR)0,r, > ry , ... , .r ' NI :u. t >< ...: F L AN`REUI,EW., ,t . ..,may, .x', ° _r ..
N New construction 0 Addition /alteration /replacement 1 � Please check all that apply (submit 2 sets of plans w /items checked below):
1111 Demolition III Other: C‘: ❑ Service or feeder 400 amps or more ❑ Building over three stories
' ` ' .« <, .,; .AETEG®R CONSTRU T,II®N' ` `� ; g? w here the available fault current ❑ M arinas and boatyards
boat
. C.. �, -team y
❑ 1 - and 2- family dwelling ❑ Commercial /industrial ❑ ccessory building exceeds 10,000 amps at 150 volts or Floating buildings
❑ Multi family Si Master Builder ❑ Other less to ground, or exceeds 14,000 Commercial -use agricultural
. A,,, °,,,, J,OB.SITEiNORMAT[ON AND:LOCATIQN; = "° w amps for all other installations. ❑ buildings
Job no.: 280850 Job site address: 10200 SW Greenburg Rd CI Fire Pump CI Installation of 75 KVA or
❑ Emergency system larger separately derived system.
City /State /ZIP: Tigard, OR CI Addition of new motor load of ❑ "A ", "E ", "1 - 2 ", "1 - 3 ",
100HP or more. ❑ occupancy
Sune-hIcialapt. no.: 700 Project name: Farmers Insurance ❑Six or more residential units ❑ Recreational vehicle parks.
❑ Health -care facilities ❑ Supply voltage for more than
Cross Street /Directions to job site: ❑ Hazardous locations ❑ 600 volts nominal.
❑ Service or feeder 600 amps or more
Subdivision: Lot no.: t- •'" ,.FEESCI- IEDLJLE , „° ,� ,; .:y ;, ,3 °• ,
Description I Qty. I Fee. I Total I { ;
Tax map /parcel no.: New residential - single or multi - family dwelling unit.
"" " 41: > ^`r r,,,.,,» >' d d DESGRIPTION W ®RK „ a .! ';'%.' ,. '. 1 Includes attached garage.
New downlights in Lobby 1000 sq. ft. or less $ 145.15 4
Ea. Add'I 500 sq. ft or portion $ 33.40 I
I_es> ❑',4PROPERWON N>~R • ' .'.';il _ „ `n LATENA']VT„ > `V Limited energy residential
Name:
(with above sq. ft.) $ 75.00 2
Shorenstein Realty Services Limited energy, multi - family
Address: One SW Columbia #300 residential (with above sq. ft.) $ 75.00 2
Service or feeders installation, alteration, and /or relocation
City /State /ZIP: Portland, OR 200 amps or less $ 80.30 2
201 amps to 400 amps $ 106.85 2
Phone: Fax: 401 amps to 600 amps $ 160.60 2
601 amps to 1000 amps $ 240.60 2
Owner installation: This installation is being made on property that I own which is not Over 1000 amps or volts $ 454.65 2
intended for sale, lease, rent or exchange, according to ORS 447, 449, 670, and 701 Temporary services or feeders installation, alteration, and /or
Owner signature: Date: relocation
200 amps or less $ 66.85 1
'.` ❑ t1PF Ic N.'r da:,. : - Z °'fk- 5 (;`h`.<.: LI rCl` ?.rCCT .., „ 201 amps m 400 amps S 1 2
I • Business Name: 401 amps to 600 amps $ 133.75 _ 2
i Branch circuits - new, alteration, or extension, per panel
I Contact name: A. Fee for branch circuits with
service or feeder fee, each
Address: branch circuit $ 6.65 2
B. Fee for branch circuits
City /State /ZIP: without service or feeder fee,
first branch circuit 1 $ 46.85 46.85 2
Phone: Fax: Each additional branch circuit: $ 6.65 2
. Miscellaneous (service or feeder not included)
i E -mail: Each manufactured or modular
:: ;' q ,. s >. e, r """'.°�°`°T . 4 .4th., t
1�a� _� '� :; �_� � �, - . Cti'ONTR�C�I'OR, - �, <, „�,; , � � a :z ,) , >,,_ , dwelling, service and or feeder $ 90.90 2
Business Name: CAPITOL ELECTRIC CO., INC. Reconnect only $ 66.85 2
Pump or irrigation circle $ 53.40 2
Contact name: Sign or outline lighting $ 53.40 2
Signal circuit(s) or limited -
Address: 11401 NE MARX ST. energy panel, alterations, or
extension. Describe: Page 2 2
City /State /ZIP: PORTLAND, OR 972204 041
Each additional inspection over allowable in any of the above
Phone: 503 - 255 -9488 Fax: 503- 257 -7121 Per inspection $ 62.50
Investigation per hour (1 hr min) $ 62.50
I CCB Lie.: 48748 Electrical Lie.: 26 -496C ISuprv. Lie.: 3132 -S Industrial plant per hour 1 5 73.75
'- ' ELECTRICAEL.ERMIT EEES,*>:> "t x`
R •°'
Suprv. Electrician signature, required: '` a. ' ° °' � ”
% ,1 -/ 14/h-J ,t// Subtotal $ 46.85
.
L
Print Name: DARK MCNEE Date: 10/28/08 !' F ° Plan review (25% of permit fee) .
State surcharge ( 12% of permit fee) $ 5.62
Authorized signature: _ "�j ¢_ f� TOTAL PERMIT FEE $ 52.47
Print Name: DA C EL VI) d This permit application expires if a permit is not obtained within 180
. ( days after it has been accepted as complete.
1 * Number of inspections per permit allowed.
INSPECTOR'S SIGNATURES ARE NOT
Inspections Required for: for: -a_ REQUIRED ON GREEN INSPECTION CARD.
✓ Code I Inspection Description PASS Date I By ✓ Code Inspection Description I PASS Date By
•
BUP - Building Permit ELC - Electrical Permit
405 Excavation 105 Underground /slab cover
410 Fill 110 Temporary electrical service
415 Grading 115 Electrical service
205 Footing 120 Electrical rough -in
805 MFG- Structure grading /footing 125 Wall cover
210 Foundation walls 130 Ceiling cover
215 Footing drain 135 Low voltage
220 Slab • 140 Sign installation
310 Crawl drain 145 A/C or heating unit circuit
•
225 Post /beam structural 150 Hot tub /spa /pool
230 Underfloor insulation 195 Misc. inspection:
235 Shear walls /anchors x 199 Electrical final
, 240 Exterior sheathing
245 Firewall
250 Roof nailing ELR - Restricted Energy Permit
255 Wtr proofing basement walls 135 Low voltage
260 Tilt -up panel 195 Misc. inspection:
265 Masonry 199 Electrical final
270 Reinforcing steel (rebar)
275 Framing
810 MFG - Structure set -up MEC - Mechanical Permit
•
280 Insulation 605 Post /beam mechanical
285 Drywall nailing 610 Gas line
287 Suspended ceiling 615 Mechanical rough -in
•
295 Misc. inspection: 620 Hydronic piping
899 MFG - Structure final 625 Duct work
498 Grading final 630 Fire damper
299 Final inspection 635 Smoke detector shutdown
640 Exhaust hood
695 Misc. inspection:
699 Mechanical final
BUP - Fire Protection System Permit
905 Sprinkler underfloor /slab PLM - Plumbing Permit
910 Sprinkler rough -in 305 Plumbing underslab
915 Fire alarm rough -in 310 Crawl drain
920 Suppression trip test 315 Post /beam plumbing
995 Misc. inspection: 320 Plumbing rough -in
998 Alarm final 322 Shower pan
999 Sprinkler final 330 Water service
335 Rain drain
340 Storm drain
SIT - Site Work Permit 505 Sanitary sewer
405 Excavation 345 Culvert/catch basin
410 Fill 350 Septic tank
415 Grading 395 Misc. inspection:
•
205 Footing 399 Plumbing final
210 Foundation walls
215 Footing drain
420 Sprinkler supply lines SWR - Sewer Permit
495 Misc. inspection: 505 Sanitary sewer
498 Grading final 595 Misc. inspection:
499 Final inspection 599 Final inspection
I: \ Bull ding \Forms \InspCard- AOP- Blank.doc 02/02/07
City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
1111
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TIGARD
December 9, 2008 w"
Capitol Electric Co., Inc.
11401 NE Marx St.
Portland, OR 97220
Attn: M. Hansen
Re: Permit No. ELC2008 -00608
Dear Sir /Ms.:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following.
Site Address: 10200 SW Greenburg Rd., 700
Project Name: Farmers Insurance
Job No.: N/A
Refund: ® Check #60622 in the amount of $41.98.
❑ Credit card "return" receipt in the amount of $
❑ Trust account "deposit" receipt in the amount of $
Notes: All work was performed under ELC2008- 00517. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
•
Dianna Howse
Building Division Services Supervisor
Enc.
•
I:\ Building\ Refunds \Administ ration \LtrRefund- CancelPermitdoc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov . TTY Relay: 503.684.2772
1111 I a City of Tigard
TIGARD Tidemark Refund Request
This form is used for refund requests of land use, engineering and building application fees.
Receipts, documentation and the Request for PermitAction or Refund form (if applicable) must be
attached to this form. Refund requests are due to Tidemark System Administrator by Friday
at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Tidemark
System Administrator for distribution. ease a ow 1 -2 weeks for processing.
PAYABLE TO: Capitol Electric Co., Inc. DATE: 11/26/08
11401 NE Marx St.
Portland, OR 97220 REQUESTED BY: Dianna Howse
Attn: M. Hansen
TRANSACTION INFORMATION:
Receipt #: 2008 -3720 Case #: ELC2008 -00608
Date: 10/29/08 • Address /Parcel: 10200 SW Greenburg Rd., 700
Pay Method: Check Project Name: Farmers Insurance
EXPLANATION: All work was performed under ELC2008 -00517 per Gary Noble. Refund 80% of
permit fees.
REFUND INFORMATION: ; ; . .
Fee Description From Receipt; Revenue Account No. . Refund
Example: [BUILD] Permit Fee. Example:. 245- 0000 - 432000 $ Amount
[ELPRMT1 ELC Permit 220- 0000 - 431510 $37.48
[TAX] 12% State Surcharge 100- 0000 - 207020 4.50
TOTAL REFUND: $41.98
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager
If under $22,500 Department Manager ✓ ����
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR: TIDEMARK SYSTEM ADMINISTRATION USE ONLY •. ' .
Case Refund Processed: I Date: I j / 1-' k/ I B I
I:\ Building \Refunds \RefundRequestdoc 05/23/07
pr CITY OF TIGARD 11/3/2008
13125SWHallBlvd. 3:49:28PM
Tigard, OR 97223 503.639.4171
TIGARD
Receipt #: 27200800000000003720
Date: 10/29/2008
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
ELC2008 -00608 [ELPRMT] ELC Permit 220 - 0000- 43I510 46.85
ELC2008 -00608 [TAX] 12% State Surcharge 100- 0000 - 207020 5.62
Line Item Total: $52.47
Payments:
Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid
Check CAPITOL ELECTRIC CO., INC. BTT 34337 By Mail 52.47
Payment Total: $52.47
•
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cReceipispi Page I or I
02/1B/2005 14:54 5036243681 TIGARD BUILDING DEPT
•
PAGE 01/01
. RECEIVED
Building Division
11!
Applicant Request for Pp Pernaft Action g
My of Tigard F TIGARD
�! neN DIVISION CITY OF Tall Blvd., , B T igard, OR G 97223 4J.
13125 SW Hall Blvigaxd, 97223
Phone: 503.639.4171 Fax: 503.598.1960
FROM:. Applicant Name: CA o PTb 1 6,_
Mailing Address: l f lld / jE .SL .591
V 0 . 1 D cityistatwzi dp.... d `, q7
/ / /Z4, P Mom No.: 543 -a3'S - 'wog
Fax No.: $'93 257- 71.G2-/
P . ASE TAKE ACTION CHECKED (1) FOR TM FOLLOWING PERMIT:
�! CANCEL PERMIT APPLICATION.
► REFUND PERMIT FEES.
Permit No.:
Type of Permit: Z1£c_-/-ie-;d 1
Site Address: / /), D0 [`TwejA 0/ - 7 e)
Subdivision:
Lot No.:
EXPLANATION: Per- / 1�9. e 11 Guam f',44
( '
�c,ana� -oa5
Signature: 9 Date; r ��
D o8
Print Name: 41056A/
FOR OFFICE USE ONLY •
Route to Amin.: Date: Ara l : '17 _:
Permit Canceled: Date; ( z Co a d'
Refund ' o = .. - . Date: #1170 e
By: i ■
Cashier Recci •t: Date: /e)/127 0d- OUNEMIni Pa �• ent T .e: ee • Per: $
Per:
•
1Asadinoo m 'on d9.27.0
TO 39t1d 01a0313 70lIdV0 996Z95ZE09 00:91 800Z /E0 /TT