Permit CITY OF TIGARD ELECTRICAL PERMIT
`• COMMUNITY DEVELOPMENT Permit*: ELC2010 -00446
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/26/2010
Parcel: 2S 101 DA00100
Jurisdiction: Tigard
Site address: 13010 SW 68TH PKWY 100
Subdivision: TRIANGLE CORPORATE PARK Lot: 7
Project: US Bank Equipment Finance
Project Description: (8) branch circuits for TI
Owner: FEES
PACIFIC NW PROPERTIES LIMITED PA Quantity Description Date Amount
6600 SW 105TH AVE #175
BEAVERTON, OR 97008 8 crt Branch Circuits 08/26/2010 $108.12
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 08/26/2010 $12.97
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 $121.09
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 503.246.6699 or 1.800.332.2344.
Issued By: ,(0 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
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.
08/25/2010 WED 9:59 FAX 503624RECEIVE�Electric a002/002 Electrical Permit Application FOR OF USE ONLY
City f Ti and AUG 25 ' , (3 Re �" Ewa ; �" Permit Nn.
1 Y g DatcBy: ; �'.. �� 62Cro2d/0 --ea 95/6 13125 SW Hall Blvd., Tigard, OR 97223 clan Review
' a • Phone: 503.639.4171 Fax: 503.59�i i OF TIGARD Date/By: Other Permit:
T I G ARD Inspection Line: 503.639 BUILDING DIVISION
DateReady/By: ] el See Page 2 for
Internet: www.tigard or.gov Notified/Method: ' /' Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction .,Q lion /alteration/replacement
Please check all that apply (submit 2 sets of plans w /items 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. •
-. less to ground, or exceeds 14,000 ❑ Commercial•usc agricultural
❑ 1 - and 2- fatnily dwelling 2 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 ANT LOCATION' ❑Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E , "1 -2 "1.3 ",
Job no.: t// / Job site address: / 3 0 / 0 3' t . C b' F) Isi /e -.,j 1 OOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: r; S } ..J J `) 7 L r.-- .? ❑Health cart facilities. 0 Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt.no.: / 1. Project name: E'. .. ;, .9, a.,/- , . c • DService or (cccicr 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. I Fee. I Tot*t 1
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. R. or less 168.54 4
' Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK • (with above sq. ft.)
Limited energy, multi - family
1.--C '- 4,f ti C c ,p ,,. i t, i v' / e f r — residential (with above sq. ft) 75.00 2
r Services or feeders installation, alteration, and /or relocation
t ■ n r 1-� , c.. , . a J 4 200 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/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
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, 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, eer panel
Owner signature: Date: A. Fee for branch circuits with
—
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fce, 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first / 56.18 ti ` Y 2
Contact name: branch circuit
Each add'I branch circuit - 1 7.42 Si - 'Y 2
Address: Miscellaneous (service or feeder not included)
City /State/ZIP: dwelling, serviice nd/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: Signor outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: Willamette Electric Inc. panel, alteration, or extension. Paget _ 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 (1 hr min) 78.18/ hr
Phone: (503) 624 - 3631 Fax: (503) 624 - 2938 Inspections for which no fee is 90.00/ hr
/ , / - specifically listed ('h hr min)
' . CCB Lic.: 75059 Electrical Lic.: 34 - 283C Suprv. Lic.: 4226 ELECTRICAL PERMIT FEES •
111
<-- Subtotal: f O s?' j L
Suprv. Electrician signature, retlu' a
Plan review (25% of permit fce):
Print name: David Fife Date: 8-z. 7' - , State surcharge (12 %ofpermit fee): f 2, 1 —!'
TOTAL PERMIT FEE: ` 2 / el z
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 of inspections allowed per permit.
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