Permit y q CITY OF TIGARD ELECTRICAL PERMIT
111111 !� COMMUNITY DEVELOPME Permit #: ELC2011 -00141
t G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/17/2011
-T
Parcel: 2S101 DB00100
Jurisdiction: Tigard
Site address: 7340 SW HUNZIKER RD 210
Project: Cornerstone Clinical Services Subdivision: Lot: 0
Project Description:
Contractor: AC & E ELECTRIC Owner: HILLTOP BUSINESS CENTER LLC &
3535 DEL WEBB AVE #100 HUNZIKER LLC
SALEM, OR 97303 9430 NW KAISER RD
PORTLAND, OR 97231
PHONE: 503 - 363 -2301 PHONE:
FAX: 503 - 363 -2302
FEES
Quantity Description Date Amount
10 crt Branch Circuits wo /Purchase 03/17/2011 $122.96
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/17/2011 $14.76
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $137.72
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. Thos- ules are set forth in OAR
952 - 001 -0010 through •AR 95 - 001 -00. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.: 0.33 . 344.
Issued By: 0 I
~ Permittee 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 the next available inspection date.
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.
Electrical Permit Application FOR OFFICE t SL O\l.l
City of Tigard may. , /7 4 Permit No.: ei `��j'}t!7
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
■ ' Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T I G : is B Inspection Line: 503.639.4175 Date Ready/By: hail H See Page 2 for
Internet: www.tigard-or.gov
N�Med Supplemental Information
Pl ease check all that apply (submit sets of plans w/items checked below):
El New construction ® Addition/alteration/replacement
❑ more Building
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
" j 8 ' :, s g , t t r „ >v = tf exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
al ` ' ,
ess to ground, or exceeds 14,000 0 Commercial-use agricultural
1- and 2 family dwelling ® Commercial/industrial ❑ Accessory bu amps for all other installations. buildings.
El Multi 0 Master builder ❑Other: ❑ Fire pump. ❑ Installation of 75 KVA or
s;' ON AND LOCATION ❑ Emergency system. larger separately derived system
d .. ['Addition of n e w motor load of ❑ A ", "E", °1 -2 ", "l -3 ,
Job no.: Job site address: 7340 SW Hunziker Rd 100HP or more. occuP y.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: Tigard, OR 01ealth -care facilities. ❑ Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: 210 Project name: Cornerstone TI ❑ Service or feeder 600 amps or more.
true .."'-'4!itt •,
Cross street/directions to job site: Desernptioa Qtr. Fee. 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'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: 1. m s ited energy,
� it 7500 2
a !' . ;:. r (with above sq. ft.)
Limited energy, multi - family 75.00 2
TI Remodel residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
s
sA' ' fl ,
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
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Own installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
3 .a ; r t,£ " is s : , . - LI above service or feeder fee, 7.42 2
,- ti �� each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 1 56.18 56.18 2
Contact name: branch circuit
Each add'l branch circuit 9 7.42 66.78 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City / State/ZIP. dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pwnp or irrigation cycle 67.84 2
E - mail: Sign or outline lighting 67.84 2
, Signal circuit(s) or limited- energy
Business name: AC &E Electric panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the abov
Address: 3535 Del Webb Additional inspection (1 hr min) 66.25/ hr
City /State/ZIP: Salem, OR Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 363 - 2301 Fax: (503 it , 3 - 2302 Inspections for which no fee is
.` s cific: listed r% hr min 90.00/ hr
CCB Lie,: 591 Electrical Lie.: 2 C ,Suprv. Lie.: 5387S M a �, t g 4 2, a
Suprv. Electrician signature, required: Subtotal: 122.96
t Plan review (25% of permit fee):
Print name: Carl Duncan Date: 3/16/11 State surcharge (12% of permit fee): 14.76
TOTAL PERMIT FEE: 137.72
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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