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Permit CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2010 -00563 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/12/2010 Parcel: 1S135AB01004 Jurisdiction: Tigard Site address: 10220 SW GREENBURG RD 500 Subdivision: LINCOLN CENTER/TWO LINCOLN Lot: 0 Project: Concero Project Description: Electrical for TI. Owner: FEES LINCOLN CENTER LLC Quantity Description Date Amount BY SHORENSTEIN PROPERTIES LLC, 555 CALIFORNIA ST 49TH FL 4 crt Branch Circuits 10/12/2010 $78.44 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 10/12/2010 $9.41 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 $87.85 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 OA 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 • • 699 or 1.800.332.2344. Issued By. ' I Permittee Signature: • G/. /_ 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. 10/12/2010 TUE 8:21 FAX 5036242938 Willam Electric f j002 /002 • Electrical Permit Application C � V �� FOR OFFICE USE ONLY City of Ti a nd OCT 1 , c� q Received I g 2 I Datc/By ©/ ID Permit No.: 4 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review fff III Phone: 503.639.4171 Fax: 503.598 OF TIGARD DaICQ3y: Other Pcnnit: T [ G A R D Inspection Line; 503.639 Date Ready /By: turfs: ® See Page 2 for Internet: www.tigard or.gov BUILDING DIVISION Notified /Method: jay Supplemental Information TYPE OF WORK PLAN REVIEW : P lease check all that apply (submit 2 sets of plans w /items checked below ❑ New construction ® Addition /alteration /replacement ) ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where Inc the available fault current ❑ Marinas and boatyards. CATEGORY -OP CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. • • less to ground, or exceeds 14,000 ❑ Commercial -rase agricultural 0 1- and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: El Fire pimp. ❑ Installation of 75 KVA or r ❑ Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION ❑Addition of new motor load of ( 7 J / 100HP or more. occupancy. Job no.: /' ) �� Job site address: fr , �C, S CA — s 47'C - r's , 1!/ - .4 f ❑ Six or more residential units. ❑ Recreational vehicle parks. City / State/ZIP: —' —' // ❑Health -cart facilities. ❑ Supply voltage for more than / (J r --/ 15,� - ❑ Hazardous locations. 600 volts nominal. 6 t7 bldg. /apt. no.: _ j(�C Project name: 6 G , (, err ❑ Service or feeder 600 amps or more. 1.1 — ��� FEE SCHEDULE Cross street/directions to job site: Description I Qtv. Fe e. t • I ] Total 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' 1 500 sq. R. 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 75.00 2 residential (with above sq. ft.) / iloyv'`-r-\ ,41,;(/ art Services or feeders installation, alteration, and /or relocation 200 amps or l 100.70 2 ❑ PROPERTY OWNER ❑ 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: /State /7IP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) Fax: ( ) 200 amps or les 59.36 1 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 2 Branch circuits - new, alteration, or extension, Lrer panel Owner signature: TT _ Date: A. Fee for branch circuits with ❑ APPLICANT • ❑ CONTACT PERSON above service or feeder fee, 7 42 2 each branch circuit Business name: 13. Fee for branch circuits without service or feeder fee, first / 56.18 . Z' 1�" - Contact name: branch circuit Each add'1 branch circuit ' 7.42 r, 2_ a 2 Address: Miscellaneous (service or fecdcr not included) City / State/ZIP: Each manufactured or modular 67.84 2 dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E - mail: CONTRACTOR Sign or outline lighting 67.84 2 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 (% hr min) CCI3 Lic.: 75059 Electrical Lie.: 34 -283C Suprv. Lic.: 4226 -S ELECTRICAL PERMIT FEES < ---- Subtotal: '7 ky Suprv. Electrician signature, requi , Plan review (25% of permit fee): _ Print name: David Fife Date: /) /i. / /(') State surcharge (12 %ofpemtit fee): 7 `f Authorized signature: ( TOTAL PERMIT FEE: 7''7 :::...i This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: s Number of inspections allowed per permit. I: BuitdinglPermitslELC •PcrmitApp.doc 07/01/10 440 - 46157-(11 /05!COM/WEn