Permit n CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00444
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/26/2010
Parcel: 1 S 135AB01002
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 125
Subdivision: LINCOLN THREE Lot: 0
Project: Hood River Distillers
Project Description: (7) branch circuits for TI
Owner: FEES
LINCOLN CENTER LLC Quantity Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555
CALIFORNIA ST 49TH FL 7 crt Branch Circuits 08/26/2010 $100.70
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 08/26/2010 $12.08
Electrical
Contractor:
WILLAMETTE ELECTRIC INC
PO BOX 230547
TIGARD, OR 97281
PHONE: 503 - 624 -3631
FAX: 503 - 624 -2938
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $112.78
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 503.246.6 ,
699 or 1.800.332.2344.
Issued By: _ Permittee Signature: Q� £/ 99 'Z .2
/ / ✓�
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.
08/24/2010 TUE 14:45 FAX 5036242938 Willamette Electric E1002 /002
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Electrical Permit Application . .'':. FOR 'OFFICE USE ONLY
a r
City of Tigard �0 \ % tc/ y �......c r ' 10 i% i7' Permit No. /0 -4,e0 — ee / 7 Y
' 13125 SW Hall Blvd., Tigard,OR 97223 - , Plan Review
, Phone: 503.639.4171 Fax: 503.598.1960P \ G Other Pcrmit&( � ��� — ,00/9 d
A
,� Date/By:
T IG AR D Inspection Line: 503.639.4175 � : ` ' Da ReadylBy: Juris: B1 Sec Page 2 for
.3 Internet: www.tigard or.gov -, . ' Notified/Method: T Supplemental Information
TYPE OF WORK . • . PLAN REVIEW
❑ New construction ® Addition /alteration /replacement Please check all that apply (submit 2 sets of plans wrtems checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION • exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
Tess to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling X Commercial /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
CI Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A "E ", "1 - ", "1 - ",
I00HP or more. occupancy.
Job no.: e//0 Job site address: // p - 10 S c:4..1 (rYiae 1 L,. r- n / P
1 vC G( 0 Six or more residential units. ❑ Recreational vehicle arks.
City /State/ZIP: 7 el ( /L ❑ Health -care facilities. ❑Supply voltage for more than
/ r4 ❑ Hazardous locations. 600 volts nominal.
Suit ldg. /apt. no.: / 2 Project name: �/,! 4e 46 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street /directions to job site: btu /2/b', ' ,)/S T/L c&-xs Description 1 Qtr. 1 Fee. 1 Total 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R. or less 168.54 4
Tax map/parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi- family 75.00 2
i ^
residential (with above sq. ft.)
�i°z Via / `3-' w `7.1 Services or feeders installation, alteration, and /or relocation
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
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Y relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
Owner i nstallation: T installation is being made on property that I own which is not 201 amps to a0o amps 125.08 2
intended for sale, lease, 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, per panel
Owner signature:__ _ _ Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first / /e 5- 6. / e 2
Contact name: branch circuit
Each add'l branch circuit 6 7.42 / y 5 -7 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67 84 2
tY dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
CONTRACTOR • Signal circuit(s) or limited - energy
Business name: Willamette Electric Inc. panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: P.O. Box 230547 Additional inspection (1 hr min) 66.25/ hr
City /State/ZIP: Tigard, OR 97281 Investigation (1 hr min) 66.25/ hr
Industrial plant (I hr min) 78.18/ hr
Phone: (503) 624 - 3631 Fax: (503) 62,4 Inspections for which no fee is 90.00/ hr
/ specifically listed (h hr min)
CCB Lic.: 75059 ✓ Electrical Lic.: 34 -283C Suprv. Lic.: 4226 -S ELECTRICAL PERMIT FEES
Subtotal: /00..I —t'
Suprv. Electrician signature, requiredr'"' -- "`
Plan review (25% of permit fee):
Print name: David Fife Dater/ " l' //0 State surcharge (12% of permit fee): / 2 G �
TOTAL PERMIT FEE: // 7 e—. o/
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Num o inspections allowed per permit.
IABuilding\Pc,miiiI ELC- PcrmitApp.doc 07/01/10 440-4615T(11/OS /COM/WEB