Permit rr i CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00275
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/25/2011
TIGARD Parcel: 251018801400
Jurisdiction: Tigard
Site address: 12100 SW GARDEN PL, BLDG# 4
Project: Ikon Subdivision: PARK 217 Lot:
Project Description: (1) branch circuit
Contractor: CAPITOL ELECTRIC CO INC Owner: WALTON CWOR PARK BC 8 LLC
11401 NE MARX STREET BY CTMT - WALTON RE TAX
PORTLAND, OR 97220 4678 WORLD PARKWAY CIR
ST LOUIS, MO 63134
PHONE: 503 - 255 -9488 PHONE:
FAX: 503 - 257 -7121
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 05/25/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/25/2011 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 52- 1 -009 . You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /
Issued By: Permittee Signature:
oA/ /77 /oN
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.
05/23/2011 10:34 5032577121 CAPITOL ELECTRIC PAGE 02/02
i s t FOR, OFFICE °NMI
Electrical Permit .A licat n
Y p' Rnecivcd s /
Perin m it li
p -1-i n >1 �/ . �Q � ��
C of Tigard MAY 2 3 2011 Date/By: / / /,, c .20/J
flan Review
• • f "4 13125 SW Hall )31vd., Tigard, OR 97223 Dare /f3
i
_ Phone: 503,639.4171 1:
nx: 503 -591V i°OF TIGA9D y:
gp Tnection Line' 503.6394175 � � r . , ION Rcadyl[ay; Sect' "r` ' "'
TI,G1� Rp fntcrrtct wvVW.tigarrl- or.gov
�UIL D(I ` �t,? +� /Iy�({�I`I NotilediMeiltocl: tupplcmciiwier,nnntinn
TYPE OF WORK PLAN REVIEW ,
I _I New C ,n.lrnction iV Addition /alteration /replacement Please check all that apply (submil 2 sets or plans w/lteme checked below): ,
I Dcmuliton I-J Othert Ti Service or feeder 400 amps or more L.J Building aver three stories
— CATEGORY OF CONSTRUCTION where the available, fault current I. J Marines and boatyards
7 1- and 2- family dwelling [] Commercial/industrial ❑ Accessory building nxcaeds 10,000 amps st 150 voila or Floating buildin
❑ Multi - family H Master Builder ❑ Other less to ground, Or exceeds 14,000 Commorra -use egrlcvltural
.100 SITTI INFORMATION AND LOCATION _ amps for all oilier Installations, [--I buildings
El Fire Pump Li Installation of 75 KVA nr
,lob no.: 110633 lob site address: 12100 SW Garden Place ear separately system.
Emergency system ger se aratel derived s stem.
Ti ❑ Addition of new motor load of ❑ "R ", "E ", "1 - ", "1.3 ",
CitylStntc/l ll` T Ot. 100HP or more., n occupancy
n Six or more residential units Ti Recreational vehlGe park:;,
Suite /bldg,/apt. nn.: IKON Project Ikon Cord Drop
r ❑ Supply voltage for more Than
I Health -care facilities
Cross SU'CCUDirecl I 0h site El Hazardous loe1lions CI 600 volts nominal.
❑ Service or leader 000 amps or more:
FEE SCFIEDULr•
Subdivision:: 1 Lot no.; Dczcriplaen I Qq. r Fcc. I Toro'
Tax maj pareel no,; — New residential - single or m,llti- ramily dwelling unit
DE.SCRiPTION OF WORK Inclines attached$nrnp,c- -
install dedicated outlet 1000 sq, i6. or less S 108,54 4
F Add'I 500 sq I') or partinn $ 33.92 I
H PROPERTY OWNER 1 I TENANT limited energy residtnlinl
(with above sq. (i.) 5 75.00 2
Name: I.imircd energy, mull i.fnmily
residential (with above $q, Ii.) $ 75.00 2
AddreSS; Service or feeders installation, alteration, and /nr relncntien
• —'" - _.— 200 amps or less 5 100,70 2
City /SI;tICr7.IP: 201 amps to 400 amps $ 133.56 2 -
401 amps in 600 amps $ 200.34 2
Phone; hex; S 301.04 2
601 amps to 1000 amps
Owner lostnllntiun: This installation is being made on property that I own which is not Over 1000 ales or voll$ _ S 552,26 2
intended for sale, lease, rent or exchange, according to ORS 447, 449, 670, and 701 Temporary services or feeders Instnllntion, alteration, and /or
C)wncrsignnutre; pale: relocation
200 arn•s or less $ 59.30 I
I APPLICANT I Li CONTACT' PF.R$ON 201 amps to 400 amps $ 125.08 2
401 aims to 599 amps $ 1 10.54 _ 2
Business Name: Branch circuits • new, alteration, or Ca tension, per nand A. Fee f or blanch circuits with
Contact name, service or feeder rue, each
branch circuit $ 7.42 2
Address: I3, Pee for branch circuits
without service or feeder fee,
• City /Stoic /Zll'; first branch circuit 1 $ 56.15 56.18 2
- Eneh additional branch cire„il: 5 7.42 2
Phone, Fax: Miscellaneous (service or feeder not Incladed) __
E - mail; Each manufactured Or modular
CONTRACTOR dwelling, ecrvide and or feeder 5 07.04 2
Reconnect only S 67.04
11psincvs Name: CAPITOL ELECTRIC CO., INC. -_ 2
Pomp irrigation circle 5 67.84 2
Sign or outline lighting .5 07.04 2
Contact name: Signal eircuit(s) or limiled-
energy panel, altoraionc, or
Address: 11401 NE MARX ST-
extension, pcccrlbe: Fire Alarm $ 75,00 2
_ rage
CityJSlute /7.IP: PORTLAND, OR 97 22 0 -1 04 1 Each additional Inspection (tier allowable In any of the shove
• Per inspection 5 06.25
• Phone; 503 255.9488 Fax: 503 257 - 7121 Investigation per hour (1 hr min) $ 00.25
I CCi3 Lie,; 48748 Ulectrical Lie.: 26 - 4960 Sri rv. Lie.: 3132 - S Industrial plant per hour r 5 78.18
ELECTRICAL PERMIT PEES'
Suprv, f- ?Iectrician signature. retpured! Ali y Sublolnl $ 56.18
r�t
Print Nome: DARRELL MC a are: _ 05123/11 Man review (25 %of permit roc)
State surcharge ( 12% of permit fee) $ 6.74
Authorized signature! Jr TOTAL PERMIT ERE $ 62.92
Print Name; DARRELL M . ' L 'clue permit nppltcntf„a expire* lrn permit Ix not ol,lnlecd „hldu tan
Sir,■cnrr II he, been nceemed n■ ormpIrI
• * Number of' inspections per permit-allowed.