Permit CITY OF TIGARD ELECTRICAL PERMIT
:; - COMMUNITY DEVELOPMENT Permit #: ELC2011 -00313
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06(08!2011
Parcel: 25101 DC00200
Jurisdiction: Tigard
Site address: 13535 SW 72ND AVE 200
Project: Optilink Subdivision: 72ND AVE OFFICE BUILDING Lot:
Project Description: Electrical for TI.
Contractor: CHRISTENSON ELECTRIC INC Owner: PNWP LLC #2
111 SW COLUMBIA ST BY PACIFIC NW PROP LTD PTNSP
STE 480 PO BOX 2206
PORTLAND, OR 97201 BEAVERTON, OR 97075
PHONE: 503 - 419 -3300 PHONE:
FAX: 503 - 419 -3695
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 06/08/2011 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/08/2011 $8.52
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 OAR 952- 001 -0090. You may obtain a copy of the rule • -ct questions to OUNC by calling 503 .2.1987 or 1.800.332.2344.
Issued By: AO" Permittee Signature: v — --- -
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.
JUN -08 -2011 WED 09:11 AM CHRISTENSON ELECTRIC, INC FAX NO, 95034193695 P. 01/02
Electrical Permit Application '
�p ica 4 FOR OFFICE SE ()NiA:
City of Tigard )' rt..i.1 . � �_
i ll/ Permit / 9
13 SW h all Blvd., Tigard 503,' QR.!_ r,
Date/13 : !iC JCJ
v1 ry �` Plan Review
2 . Phone: 503,639.4171 Fax: ili . - Date/By: Other Permit: It, 1 1/ "t;>C 5
FIG A l t3 Inspection Line; 503,639,4175 c) Date Rcady/By: htris' a See rage 2 for
Internet: www.tigard-ar.gov JAN GQ,� 0 . Not:frcd/lvlethod: / . • Supplemental Information
. J
��‘ r., .1...,... PLC:0,.0) E�': : ",'A" .:, .:' , --
❑ New construction Addition /alterationi eat Plcsso cheek all that apply (submit 2 sets of plans w /items checked below):
Q �, ID Service or feeder 400 amps or more In Building over three stogies,
Q Demolition Other: V — where the available fault currant ❑ Marinas and boatyards,
C a E. ,O, R'Y OF'. "' '' . ... s at 150 volts or
P exedea510,000 mops 0 Floating buildings.
Less to ground, or exceeds 14,000 ❑ Commercial - use agricultural
❑ 1- and 2- family dwe Commercial/industrial ❑ Accessory build amps for all other installations. buildings,
0 Multi - family Master builder ❑ Other: I:I Fire um
P P q.lnstallation of 75 KVA or
0 Emergency system. larger sepnr,,iely derived system,
JOB SITE:„ INFORMATION :AND LOCATION ❑ Addition of new motor load of
0 ..A., "F "1 -2 "1 -3
Job no, - 3 Job site address: ` 215 V V Y n 7 2 1001-11' or mare, occupancy.
` ❑ Six cr more residential units, is Recrestinnai vehicle parks.
City /State /ZIP: + \\ in f. — c' - .. - 3 is Health -tarn facilities. ❑ Supply voltage for more than
Qr ❑ Haka<dnns locations. 800 volts nominal,
Suite/bldg. /apt. no.: )-jyD Project name: , t r ❑ Service or feeder 600 amps or more.
'! FEE SCIIT DIlIa6 ;
Cross reet/dlrections to job site: - nrxcri �1ty_ I Fee. I, - _ Ybl:d
, a o , (f
N ew re ormn[ti- family dwelling unit.
A. U W n 1 t ` � 6 - `1 /, Includes attached garage.
Subdivision: f Lot no.: 1,000 sq, ft or less _ 168,54 4
Ltt. add'/ 500 sq. ft, or portion 33,92 1
Tax map /parcel no.:
, Limited energy, residential
..:DESCRIPTION OF WOR' ': • (with above sq. E.) 75,00 2
,�
� Limited energy, multi- family 75.00
,U b \ l_/l, \N) w \ nC\ /1
9 \�J p Y�ta �,e.., -_. residential (with above s ft.
2) OmtukL) 1� �1 Services a feeders insta Il atio n,,altcrntIon, rind /or relocation
200 amps or less 100,70 2 ,
❑ PROPERTY .OWNER' •- • ' : a TENANT 201 amps to 400 amps 133,5G
2
Name: 101 amps to 600 amps 200.34 2
—
--- 601 amps to 1,000 amps 301,04 2
-
Address _ Over 1,000 amps or volts 552,26 1
City/State / %1P: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 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. 1 amps l0 599 amps 168.54 2
Branch circuits - new, alteration, nr extension, per panel
Owner signature: _ Date; _
_ _ A. Fee for branch Circuits with
❑ ArI'LICANT:. :., . CONT ,CT ..PERSON abovc aery 01' feeder fee, 7.42 2
each branch circuit
Business name: A„ , , - B. Fee for branch circuits without
service al fee, first
Contact name; branch circuit 56.18�J t �� 2
Each ndd'1 bronchi circuit >s` a Address ��� 1 2
Miscellaneous (service or feeder not included)
City /State /Chia: loch manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67,84 2
E -mail:
Pump or irrigation circle 67,84 2
t CONTRACTOR Signor outline lighting 67.84 2
y Signal Circuit(s) or limited- energy --
t
Business name: 'Ili ,� poach alteration, or exten sion. Page 2 _. 2
V Each additional inspection over allowable in rinv of the above
Address: l \�, • 44 _ 1 ,1 t . Additional inspection (1 hr min) 66,2S/ hr _
City/State /ZIP; 1 • investigation (1 hr min) 66.25/ hr
LA a.. 7 Industrial slant (1 hr min) 78,18 / hr
Phone: ( al lot _'" , ; • — - _/ rats- Inspections fur which no foe is —
specifically his id 'l: hr min) 90.00 / hr
CCB Lic.: I �11 h i , Electrical Lic , � ; rv. I,ic. ;5 i 5 ELECTRICAI„..PERMIT FEES .
Suprv, Electrician signature, required: /� Subtotal: LI
- -- Plan review (25% of permit fee);
Print /lame: Date: « ( State surcharge (12% of permit fee)!
Authorized signature: � Tn'I'A.I. PERMIT pl:l : 1
This permit upplicatiou expires if a permit is nut obtained within 180
Print name: Date: days after it bus been accepted as Complete.
` Number of inspections allowed par permit.
I' Innil4irm'.PcrmiMU.LC. Nunn App 'k» n7 /tine -I40-4 6i MI 1ln5 ;c0M/won