Permit y C�TY ®F T�GARD ELECTRICAL PERMIT
11 1 2: . COMMUNITY DEVELOPMENT Permit #: ELC2011 -00283
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/25/2011
TiGAAD Parcel: 2S112DD00200
Jurisdiction: Tigard
Site address: 15862 SW 72ND AVE 150
Project: Immunology Subdivision: PACIFIC CORPORATE CENTER Lot: 0
Project Description: (1) 200 amp or less service and (9) branch circuits
Contractor: CONRICH ELECTRIC LLC Owner: PACIFIC REALTY ASSOCIATES
PO BOX 42126 15350 SW SEQUOIA PKWY #300
EUGENE, OR 97404 PORTLAND, OR 97224
PHONE: 541 - 359 -1192
PHONE: 503 - 624 -6300
FAX: 541- 461 -0507
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 05/25/2011 $100.70
Specifics: amps or less
9 crt Branch Circuits w /Purchase 05/25/2011 $66.78
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 05/25/2011 $20.10
Electrical
Type of Const:
Occupancy Grp:
Total $187.58
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 0 • ' 95+ 0. •u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ! mi 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:
CON ) CTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' — J ' , Date: `—
LICENSE NO. 4/879_5
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.
05/24/2011 07:11 5035981960 �,� CITY OF TIGARD PAGE 01/02
Electrical Permit Application y�i� i
a nd � i�' ,.
- City of Tig ' - ✓/
® 13125 SW Hall Blvd„ Tigard,OR 97223
• �� Received
P R r: �f2s�!/ ��` Permit 14° Z- C+�V// oO� G-
d Phone: 503.718.2439 Fax: 503.598.1960. Plan Review U
I1I// II Dual/ Other Perm. -p� o rOS�
i ' ,` l :. I i Ins
lnte pection Line: 503.639.4175 ®ppkm gee PeRC 2 for
2 5 2011 Noto >�� ,
o �
lie me L www,tigard pr,gov Notified/Method: hod: Su laformaAnn
Ot a te' OF TIGA� — —
3 ( : -: : P1I:rkN `REVIE�oir :
to
/altt f ����y airMia E(>f(d(1t 1SION Please cheep all that apply (submit a seta ofplans w /itcma checked below):
❑ Demolition Other. ❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault ;anent ❑ Marinas end boatyards. i 0 CATEGORY OF. Cu1NSYTtuCITON exceeds 10.000 amps at 150 volts nr ❑ Floating bmldings.
l and 2- family dwelling CommcrciaUindostrial lees to around, or exceeds 14,006 ❑ Comn,creial -see agricultural
❑ Accessory building amps for all other inatallatians. buildings. ❑ Multi - family ❑ Master builder
❑ Other: I� Fire pump. ❑ Installation o(75 KVA er
JOB 91IE INFORMAI<TON AND LrJCARON ❑I= mergc>cyayatcm. Iargerseparntcly derived system.
NC —� ❑ Addition o(rtcw motor Iond of ❑' A , "E "I.2 ", "I - ",
C-. Job no,: – 26 Job site address; S IOOHP ormorr. occupancy,
t� ❑ Six nr more residential units, ❑ Recreational vehicle parks.
City/State /ZIP: 1 // 6 A- 0 c� ,n 4e fi - ❑ Health -care Facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: /(0 I Project name: //22UNOL g4 / / ❑ 9arvice or feeder 600 amps or more.
til
Cross street/directions to job site: % FEES EDULE
Ae" an 1 017.1 el. I Total I
New residential single- err multi-family dweelling unit.
f‘.) — includes attached gara
Subdivision:
Lot no.: 1,000 an,. R or Ices ►68.54 a
Tax map /per>rcl no.. Fa. add'! 500 sq, It. or portion 33.92 1
Limited energy, residential
DESCRIPTION . OF WORK (with above sq. ft,) 75.00 Z
/ ° �&Jl / Limiter) energy, muhidamily 75.00 2
tili �`� A - - / N e 064,,. S residential (with above 3u ) r
Services or feeders Installation alteration, and /or relocation
_ 20 0 a mps or lee _ 1 10 0.70 00 2
6 0 PROPER? , OWNER 0 'IENA NT 201 amps to 400 amps 133.56 2
NatltC: T uS , 401 amps to 600 amps 200.34
2
0
601 amps to 1,000 amps 301.,04 2
Address: Over 1.000 amps or volts — 55226 2
�lj City /state /7_TP: Temporary services or feeders Installation, alteration, and /or
t relocation
Phone: ( ) Fax: ( ) 200 amps or he 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 nape 125 08 2
intended for sale, lease, rent, or exchange, according to ORS 447.449, 670. and 701. MN amps m 599 stags 158.54 2
Owner signawrC: _ Branch circuits – sew, atteratien or extension, p,cr panel
Dom A. Fee far brmuh circuits wirh
❑ APPEICAIV7- . 1 ❑ come -pEascnv above service or feeder fee, 9 each branch circuit 7.42 6G, .1g 2
Business name: C6A /An, i.,(4 6LZ iz. �� B. Fee for branch circuit? wirhwrr
Contact name: /
service or feeder fee. first
�.. A4'. i 1 4 i/ ere_ branch cirrtti 56.1 g 2
Address: r° D , ga - 2k=? Each add') branch circuit 7.42 2
`f Miaceflanro unserviec or (ceder not included)
/Statc/ZIP: '
ty 1 i '( �+� 7
G i /D , / Each ma service a nr modular
Ci 67 84 2
/ '7 dwelling, service and/or feeder
Phone: (b'1/ ) ' / /9a Fes :: (jy /) W1 Os-0 7 Reconnect only 67.84 2
_ E - mail; �e�J/yrP1Cf/ _ ,e Q C , 4..),-:T-7-- Pump or irrigation circle 57,84 2
CON1 RAGTOR — _ Sign or outline lighting _ 67.84 2
Signal circuit(,) or limitcd.ertergy -
Business name: ! `i_ �/� / �� ,, alteration, or extension. .Page 2 , 2
_
D ' /1
Address: QQ C r�// Each additional ins eti over allowable In an ref the above
/ fa[� Additional inspection (1 hr min) 66.25/ hr
City /StatdZlP: Investigation (I hr min) 6625 / hr
/ 6_, g7yC/ Industrial ptarn (1 hr min) 78.1 8 / hr
o (,ry /) — ll9a Fax
/) ,l --QS0 ] Ine
CB Phne: Li �y �Elcctrieal Lic.: – ;/ specifically fisted (h hr m i ll ) 90 hr
-
9 a a • Suprv. Li F7F5 ELF.�,TpiiCA),'p$Jt11 pE1�5
Strprv. Electrician signature, required: i / Subtotal! Ali 7 - � �
.4e-.., • �_ Plan review (25% of permit fee):
Print name: l �l�o4re/J
i A � DatC: / L i / J State surcharge (12 %of permit fee): . , i
Authorized signature: TOTAL t?FJtMIT FE
This permit applketinn expitw if a permit is not altbemed withi IAO
Print .name:
D days ever N h0.. been accepted as enmplel[.
• Number of inspections stowed per permit.
1 : Pemlupp.doc 07/0,110 440-1615T(e 7 /05/COM/W6p
• ea— — y( '" E - a.) oc-9
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