Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -10028
DEVELOPMENT SERVICES DATE ISSUED: 3/8/2006
j Ii 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S101DA -00102
SITE ADDRESS: 13221 SW 68TH PKWY 020 ZONING: MUE
SUBDIVISION: TRIANGLE CORPORATE PARK LOT : 002 JURISDICTION: TIG
Project Description: (1) sub panel, (1) circuit in basement mailroom.
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: 1 W /SERVICE OR FEEDER: 1 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
TIGARD TRIANGLE I LLC GREENWAY ELECTRIC COMPANY
4650 SW MACADAM AVE STE 220 9460 SW TIGARD STE. 104
PORTLAND, OR 97201 TIGARD, OR 97223
Phone: Contact #: FAX 503 - 620 - 6124
PRI 503 - 620 -6020
FEES
Description Date Amount Reg #: ELE 34 -617C
[ELPRMT] ELC Permit 4/1/2006 $86.95 LIC 153421
[TAX] 8% State Surcharge 4/1/2006 $6.96 SUP 5025S
Total $93.91 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.
Issued By: � ) z �� Permittee Signature: i . O'1p
OWNER INSTALLATION ONLY `
The installation is being made on property l 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.
A CITY OF TIGARD ELECTRICAL PERMIT
BUILDING SERVICES DIVISION
r1 13125 SW Hall Blvd., Tigard, OR 97223
503 -639 -4171 www.tigard- or.gov PERMIT #: cda 6 -zeug
DATE ISSUED: . 3 - �' -
SITE ADDRESS: ) 3 ( � PARCEL #:
BLDG /STE #: ZONING:
SUBDIVISION: \A.pp h ¢ LOT: JURISDICTION: -/(-
This is an interim permit issued during computer system maintenance.
Construction work and inspections may proceed under this permit number.
The actual permit will be issued and mailed to the applicant within one week of the date issued above.
PROJECT DESCRIPTION: (■ S�� � � L �� t . , � � 1 \0q1-s- .,,,,'r �A�l 0a �.
RESIDENTIAL ! TEMP SRVC/FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500 SF: 201 - 400 amp: SIGN/OUTLINE LTG: _—
LIMITED ENERGY: 401 - 600 amp: _ SIGNAL/PANEL:
MAN F HM/SVC/FDR: 601+ amps -1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: / WISERVICE OR FEEDER: / PER INSPECTION:
201 - 400 amp: 15t W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRANCH 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 FEES
Name: Permit Fee $
Address: Plan Review Fee $ _
City /State /Zip: State Surcharge (8 %) $ ‘
Phone: Other Fee: $
CONTRACTOR
Other Fee: _ $
Total Fees: $ 93 9l
Name: C-c-C2 u �, fir
\∎
Address: 9k/6 6 0 S W
City/State /Zip: .2_2 7
Phone: 6 - Z 2 T 02 0 - __ - - --
Fax: 620" 6 1?.3_
CCB Lic #:
Elect Lic. #: may - 6 ; 7 c
Supr. Lic. #.
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 -0080. You may obtain copies of these rules or direct uestions to OUNC by calling 503 - 248 -1987 or
1-800- 332 -2344.
Issued By: �, Z(1 c Permittee Signature: ,..)
OWNER INSTALLATION ONLY 1
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. ELECTRICIAN: DATE:
LICENSE NO.:
Call 503 - 639 -4175 by 7:00 AM for an inspection that business day.
Note: If you cannot schedule an inspection while the system is down, please call 503- 718 -2433 for assistance.
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.
1:\ Building\ Forms\ lanualPermitForms \ManualELCpefmit.doc 03/06/06
Electrical Permit A �� 0 (9> ' VED r(,1i OFFICE IISE O i.Y
City of Tigard Received „ -
Date/B : s �f - 4 6 � �--- :�� �� s,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.196 2006 '‚ /, o i l'ff Other Pemtit:.
Inspection Line: 503.639.4175 i 1. � • „ Date Ready/By: ® See Page 2 for
Internet: www.ci.tigard.or.us CAT y q i, p a ➢ � Notified/Method: Suppkmental Information
iri, v !t J( t T tt% PLAN REVIEW
❑ New construction A ddition/alteration/ repl ace ° e J Please check all that apply:
❑ Demolition ❑ Other: ❑Service over 225 amps, corrun'I ❑Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ I - and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
El Multi family ❑Master builder ❑ Other: ❑Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: 30325 -4 Job site address: 13221 SW 68th Parkway ❑Health -care facility ['Other:
Submit 2 sets of plans with any of the above.
City/State/ZIP: Tigard, OR 97223 The above are not applicable to temporary construction service.
Suite/bldgJapt. no.: Basement Project name: Health Net FEE* SCHEDULE
Description I Qty. I Fee. I Total 1 **
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 0.00 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 0.00 1
Tax map /parcel no.: Limited energy, residential 75.00 0.00 2
Limited energy, non - residential 75.00 0.00 2
DESCRIPTION OF WORK Each manufactured or modular
Install Sub Panel and one circuit in mail room data room dwelling, service and/or feeder 90.90 0.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 1 80.30 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 0.00 2
401 amps to 600 amps 160.60 0.00 2
Name: 601 amps to 1,000 amps 240.60 0.00 2
Address: Over 1,000 amps or volts 454.65 0.00 2
Reconnect only 66.85 0.00 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: Fax: 200 amps or less 66.85 0.00 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 0.00 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 0.00 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT 1 ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each
Business name: branch circuit 1 6.65 6.65 2
Contact name: B. Fee for branch circuits
without service or feeder fee,
Address: each branch circuit 46 0.00 2
Each add'I branch circuit 6.65 0.00 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 0.00 2
Sign or outline lighting 53.40 0.00 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: Greenway Electric Company 0.00
Address: 9460 SW Tigard St., Ste. 104 Each additional inspection over allowable in any of the above
Per inspection 62.50 0.00
City/State/ZIP: Tigard, Oregon 97223 Investigation per hour (1 hr min) 62.50 0.00
Phone: (503) 620 -6020 I Fax: ' (503) 620 -6124 Industrial plant per hour 73.75 _0.00
ELECTRICAL PERMIT FEES*
CCB Lic.: 153421 Electrical L .: 34 - 617C Suprv. Lic.: 5025S
Subtotal $86.95
Suprv. Electrician signature, required: wl ✓ Plan review (25% of permit fee)
Print name: James V. Rooney Date:
State surcharge (8% of permit fee) $6.96
TOTAL PERMIT FEE $93.91
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
Fe e methodology set by Tri- County Building Industry Service Board
• • Number of inspections per permit allowed.
is\ Building \Pennia \ELC- PermitApp.doc 12/03 440-4615T(10/02/COM/WEB