Permit ,, CITY OF TIGARD ELECTRICAL PERMIT
11111 • COMMUNITY DEVELOPMENT Permit #: ELC2011 -00335
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/21/2011
• Parcel: 1 S 135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 485
Project: Thorson Pacific Subdivision: ASHBROOK FARM Lot: PTS 1, 2
Project Description: Electrical for TI.
Contractor: WILLAMETTE ELECTRIC INC Owner: LINCOLN CENTER LLC
PO BOX 230547 BY SHORENSTEIN PROPERTIES LLC
TIGARD, OR 97281 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 624 -3631 PHONE:
FAX: 503 - 624 -2938
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 06/21/2011 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/21/2011 $9.41
Type of Use: COM Electrical
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 0 952- 001 -0090. You e a co ules or direct questions to OUNC by calling 503.23 1987 or 1.800.332.2344. c
Issued By: Permittee Signature: . 7
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.
06/17/2011 FRI 13:40 FAX 5036242938 Willamette Electric 0 002/002
Electrical Permit Application FOR OFFiCG t3SE ONL1'
City of Ti and Received -1 /
g �� �� DatcBy; l / II if Permit No.: �GL
't 13125 SW Mall Blvd., Tigard,0 v Ie �planReview
Phone: 503.639.4171 Fax: 503. •60 1 �Q bate/By: Other Permit: 4 13 17_ O /� ^�
Ti GARD Inspection Line: 503.639.4175 \` `'(). Date Ready/By: iUTiS: 0 See Page 2 for �!
Internet: ttww. tigard- or.gov Q� Notified/Method: Supplemental Information •
TYPE OF WORK * . ..I!LAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
1:: New construction Addition /alteration /r =•V ment )
v. ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current
❑ Marinas and boatyards.
.. . CATEGO RY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14 0 Commercial 6� dwellin f . C ommercial /industrial Accessory building 5 14,000 ❑ apiculture]
❑ 1 - and 2 g ❑ y g amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
.. , ❑ Emergency system. larger separately derived system.
.. MI SITE INFORMATION AN15:1.00ATI.ON • n of new motor load of ❑ "A•' "E" "1 -2" "1-3"
❑ Additi
.� pp // 1001-1P or more. occupancy.
Job no.: S Job site address: /C) 1P t (J'fe r .!� 1. r ,%L 2- El or mom residential units. ❑ Recreational vehicle parks.
City /State /ZIP: / U ❑ Health -care facilities. ❑ Supply voltage for more than
G •'/' (/! ` - ❑ Hazardous locations. 600 volts nominal.
uite ldg. /apt. no.: f ,2 ! % > ,, ' ,r ❑ Service or feeder 600 amps or more.
Vii Project name: / 0 5 6'.2/) G.c_�/ / (
y
. E SCI UIiE
rEED Cross street/directions to job site: Description - .I Qty. I Fee. I T otal J R
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential 75.00 2
DESCRIPTION WORK • ' • " (with above sq. ft)
_ _ Limited energy, multi- family
in ?' / " 7,- 404/e il'i t"f'1 >"--
residential (with above sq. f1.) 75.00 • 2
• Services or feeders installation, alteration, and /or relocation
200 amps or less 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
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner 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
❑ ,.APPLICANT above service or feeder fee, • CONTACT PERSON each branch circuit 7 2
Business name: 13. Fee for branch circuits without
service or feeder fee, first / 56.18 5 ! , 2
Contact name: branch circuit 5
Each add'l branch circuit .3 7.42 d l 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
tY dwelling, service and/or feeder
Phone: ( ) Fax:: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
;CONTRACTOR••• : _ . 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) 66251 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 (%z hr min)
CCB Lic.: 75059 Electrical Lic.: 34 -283C Suprv. Lic,: 4226 -S : . .. ..,BLECTRICAL: TEES . '
G Subtotal: 7 �f
Suprv. Electrician signature, requ' ` . / f '
Plan review (25% of permit fee): _
Print name: David Fife Date: (,(.fit /7k State surcharge (12% of permit fee): t '1 _
I TOTAL PERMIT FEE: 7 == " s
Authorized signature: -
This permit application expires if a permit is not obtained within ISO
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\ nuildinglPermits \ELC-PcrmitApp.doc 07/01/10 440.4et5T(11 /05 /COM/WEB