Permit CITY OF TIGARD ELECTRICAL PERMIT
11 1 - - COMMUNITY DEVELOPME Permit #: ELC2011 -00367
•
T!GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/01/2011
Parcel: 1 S 135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 610
Project: New York Life Subdivision: METZGER, TOWN OF Lot: PTS 7 -8
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
24 crt Branch Circuits wo /Purchase 07/01/2011 $226.84
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/01/2011 $27.22
Type of Use: Electrical
Class of Work:
Type of Const:
Occupancy Grp:
Total $254.06
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. u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.23i4.
Issued By: i � _ Permittee Signature: ! _ _ /._ / - - /A. .�
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.
07/01/2011 FRI 8:29 FAX 5036242938 Willamette Electric [3] 002/002
Electrical Permit Application FOR OFFICE USE ONLY
. City of Tigard Received. gi77-- Permit No.: r)-? 20 r 1 ,1 '•
t I a I3125 SW /tall Blvd., Tigard, OR 972 Plan Review '�
Phone: 503.639.4171 Fax: 503.598.1960 Date /B L t Other Permit: ` I , �_ •
T I G AR D Inspection Line: 503.639.4175 JUL 0 1 �Q�� Date Ready/By: ions: ' 1 See Page 2 for
Internet: www.tigard- or_gov 1 Notitied/Method: ' Cf' Supplemental Information
i
TYPE' Ox p vt� 'OFT[GARn PLAN acvtrW;;
❑ New construction ,Addition /a11q *I WISION Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ID Other:
where the available fault current 0 Marinas and boatyards.
CATEGO
less to ground, or exceeds 14,000 ❑ Commercial - use agricultural ' OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ID Floating buildings.
❑ 1 and 2 family dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ installation of 75 KVA or
. y
Emergency system larger separately derived system.
I013 SII E INFORMATION AND LOCATION , ❑ Addition of new motor load of ❑ "A ". "E ", "1 -2 ", "t -3 ", •
Job no.: ,.5 Job site address: / 0 e 6 0 -f C .- � ,, c to j a� ,4�, 100111 or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
Clt /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
y T : S e. J, 5 ?z z3
❑ Hazardous locations. 600 volts nominal.
Suite/bidg. /apt. no.: 670 Project name: / ❑ Service or feeder 600 amps or more.
ly . G ; Y t .. . FEE SCHEDULE .
Cross street/directions to job site: oeaeriptien I Qty. I Fec. i rota) ] •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRT:PTXON OE WORK (with above sq. ft.)
Limited energy, multi- family 75.00 2
7 7t residential (with above sq. ft.)
.L Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER , 0 :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 59.3 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
above service or feeder fec,
.APPLICANT ❑ 'CONTACT 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first '
Contact name: br anch circuit
1 56.18 '- 2
Each add'1 branch circuit 2.3 7.42 / ?t t� 2
Address: Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:
Signor outline lighting 67.84 2
. COIsITI ACi'OR _ , ,r _. . 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 abov
Address: P.O. Box 230547 Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: Tigard, OR 97281 Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 624 - 3631 Fax: (503) 624 Inspections for which no fee is 90,00/ hr
Specifically listed V, hr min
CCB Lie.: 75059 Electrical Lie.: 34-283C Suprv. Lic.: 4226 -S
Suprv. Electrician signature, requ' _
Plan review (25% of permit fee):
Print name: David Fife Date: d - 3 0 t/ State surcharge (12% of penult fee): 27 02
OTAL
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
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