Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00555
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/08/2010
Parcel: 1 S 135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 487
Subdivision: LINCOLN ONE Lot: 0
Project: Farmers Insurance
Project Description: (5) branch circuits for TI
Owner: FEES
LINCOLN CENTER LLC Quantity Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555
CALIFORNIA ST 49TH FL 5 crt Branch Circuits 10/08/2010 $85.86
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 10/08/2010 $10.30
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 $96.16
Required Items and Reports (Conditions)
This permit is i- - • • • - •+ 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 : ccordance with a • : oved 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. • ENTION: Oregon la . req 'res you to follow the rules adopted by the Oregon Utility N • ' , ; • enter. Those rules are set forth in OAR
952 -0• -0010 through OAR 95 •01 -i 10•. Y• may obtain a copy of the rules or direct questions to OUN • - m. 99 or 1.800.332.2344.
i s .
Is ed By: � 'l U Permittee Si • > • % ` �,"_7 Qi' ���
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: lO w
LICENSE NO. S
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.
10/06/2010 WED 13:44 FAX 5036242938 Willamette Electric (1002/002
Electrical Permit Application ` FOR oEFICE USE O; i,v
IIIII City of Tigard � .-� i , I PumRif • % --- itNo.: � o/o
, en. :
l0 e/}.f/!
q 13125 SW Hall Blvd., Tigard, OR 97223 � ilk ,:t cceivc
1 Phone: 503.639.4171 Fax: 503.598.196 6 Other Permit:
i'
1'IGARD Inspection Line: 503.639.4175 QC 1 -. orris: ET See Page 2for
Internet: www.tigard or.gov , -\\ �'r_ff,�y Supplemental Information
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TYPE OF WORK , s � V`
F "° PLAN REVIREVIEW ❑ New construction WI Addition /alteration /replace�tn ' Please check all that apply (submit 2 sets of plans w /items checked below):
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❑ 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 -use agricultural
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JO B SITE INFORMATION AND LOCATION . . ❑ Addition of new motor load of ❑ "A ", "E", "1 -2", "1 -3",
Job no.: 93 Job site address: , // 100HP or more. occupancy.
/a 7 �f9 � l e J L rr`e'eh r. err ❑Six or more residential units. ❑ Recreational vehicle parks.
City /State/71I': �' j (J �f C L ❑ Healthcare facilities. ❑ Supply voltage for more than
/ V _ C+ lD 79 Z 0 Hazardous locations, 600 volts nominal.
wt bldg./apt. no.: ysy 7 Project name: f ❑ Service or feeder 600 amps or more.
f l 4. r rf -5 �h S - " -4i ,e. FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1 •
' New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. 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
residential (with above sq. ft.)
7-r;--.40,,,,>----...:%—",,-, /�'--r "v." 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
• 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 sate, 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 ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: 1 3. Fee for branch circuits w ithout
service or feeder fee, first /£'
Contact name: branch circuit
56.18>Co 2
Each add'I branch circuit / 7.42 0 2 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
dwelling, service and/or feeder 67.84 2
CitylStatc/ZIP:
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 (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 (t4 hr min)
CCB Lic.: 75059 Electrical Lic.: 34 - 283C Suprv. Lic.: 4226 - ELECTRICAL PERMIT FEES .
Suprv. Electrician signature, requi ""1 t/3 o Subtotal:
Plan review (25% of permit fee):
Print name: David Fife Date: /6/6//e) State surcharge (12 %ofpermit fee): / .J
/ TOTAL PERMIT FEE: 96 Lk—
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.
Number of inspections allowed per permit.
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