Permit CITY OF TIGARD ELECTRICAL PERMIT
11 4 , ' COMMUNITY DEVELOPMENT Permit #: ELC2011 -00549
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 Date Issued: 10/05/2011
Parcel: 1S135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 440
Project: Tristar Risk Management Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Electrical for TI.
Contractor: CAPITOL ELECTRIC CO INC Owner: LINCOLN CENTER LLC
11401 NE MARX STREET BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97220 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE 503 - 255 -9488 PHONE
FAX 503 - 257 -7121
FEES
Quantity Description Date Amount
7 crt Branch Circuits wo /Purchase 10/05/2011 $100.70
Specifics: Service or Feeder
1 ea 12% State Surcharge - 10/05/2011 $12.08
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112 78
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 met forth in OAR
952- 001 -0010 through OAR 952- 001 -0090 You ma ,.obtain- a- copyrot - t - = l: or •ire t • uestions to OUNC by calling 503 232 1987 or 1 800 332 2344
IIP ..
Issued By: Permittee Signature: ! f/ _
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.
can 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.
Electrical Permit Application FoR oFF�cE usE ONLY
Received
1 of Ti aril Date /By j ` f� It Permit no : ` ` / , _ O 5z J rl
g - L
rif
• 13125 SW Hall Blvd., Tigard, OR - ^?. ` 1 Plan Review
Other Permit:
Phone: 503.639.4171 Fax: 503.5`J,,' 0 h `L�� Date/By ( 1,1 /� (—
TIGARD Inspection Line: 503.639.4175 V Date Ready /By. See Page 2 for
or.
Internet: www.ti and - ov C� t \®
g O" � S \(�.���" � R\ Notified /Method: ' Supplemental Information 10 :1\5�
TYPE OF'WORK 6C \ 'l 4J PLAN REVIEW
• ❑ New construction ❑ Addnton alteration /replacement \ \ Please check all that apply (submit 2 sets of plans w /items checked below)
❑ Demolition ID Other: �J ❑ Service or feeder 400 amps or more ❑ Building over three stories
_ CATEGORY OF CONSTRUCTION where the available fault current ❑ Marinas and boatyards
❑ I- and 2- family dwelling I❑ Commercial /industrial ❑ Accessory building exceeds 10,000 amps at 150 volts or ❑ Floating buildings
❑ Multi - family ❑ Master Builder Clothe, less to ground, or exceeds 14,000 ❑ Commercial - use agricultural
JOB SITE INFORMATION AND LOCATION amps for all other installations buildings
Job no • 111268 Job site address: 10300 SW Greenburg Rd El Fire Pump ❑ Installation of 75 KVA or
❑ Emergency system larger separately derived system
City/State/ZIP. Tigard, Oregon 97224 CI Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
100HP or more ❑ occupancy
Suite /b!dg /apt no. 430/440 Project name TriStar ❑ Six or more residential units ❑ Recreational vehicle parks.
❑ Health -care facilities ❑ Supply voltage for more than
Cross Street/Directions to job site ❑ Hazardous locations 600 volts nominal.
❑ Service or feeder 600 amps or more
FEE SCHEDULE
Subdivision. Lot no •
Description I Qty. I Fee. I Total
Tax map /parcel no. New residential - single or multi - family dwelling unit.
DESCRIPTION OF WORK Includes attached garage.
Tenant Improvement 1000 sq ft or less $ 168 54 4
Ea Add'I 500 sq ft or portion 5 33 92 1
❑ PROPERTY OWNER I ❑ TENANT Limited energy residential
Name (with above sq. ft.) $ 75 00 2
Limited energy, multi -family
Address residential (with above sq. ft.) $ 75 00 2
Service or feeders installation, alteration, and /or relocation
City/State/ZIP: 200 amps or less $ 100 70 2
201 amps to 400 amps $ 133 56 2
Phone. Fax 401 amps to 600 amps S 200 34 2
601 amps to 1000 amps $ 301 04 2
Owner installation: This installation is being made on property that I own which is not Over 1000 amps or volts $ 552 26 2
intended for sale, lease, rent or exchange, according to ORS 447, 449, 670, and 701 Temporary services or feeders installation, alteration, and /or
Owner signature. Date relocation
200 amps or less $ 59 36 1
❑ APPLICANT I ❑ CONTACT PERSON 201 amps to 400 amps $ 125 08 2
Business Name 401 amps to 599 amps $ 168 54 2
Branch circuits - new, alteration, or extension, per panel
Contact name A. Fee for branch circuits with
service or feeder fee, each
Address. branch circuit $ 7 42 2
B. Fee for branch circuits
City /StatelZ[P without service or feeder fee,
first branch circuit 1 5 56 18 56.18 2
Phone: Fax Each additional branch circuit' 6 $ 7 42 44.52 2
Miscellaneous (service or feeder not included)
E - mail: Each manufactured or modular
CONTRACTOR dwelling, service and or feeder $ 67.84 2
Business Name. CAPITOL ELECTRIC CO., INC. Reconnect only 5 67 84 2
Pump or irrigation circle $ 67.84 2
Contact name John McNeel
Sign or outline lighting $ 67 84 2
-
Signal circuit(s) or limited -
Address 11401 NE MARX ST. energy panel, alterations, or
extension Describe: $ 75 00 2
City /State /ZIP: PORTLAND, OR 97220 -1041 Page 2
Each additional inspection over allowable in any of the above
Phone 503- 255 -9488 Fax. 503 - 257 -7121 Per inspection $ 6625
,) Investigation per hour (1 hr min) $ 66 25
CCB Lie.. 48748 (Electrical - Lic. 26 - 496C ISupry Lic : 3132 -S 1 Industrial plant per hour $ 78 18
Suprv. Electrician signature, required. ; r #{ I SLECTRICAL PERMIT FEES*
Ue9 �f/ f / Subtotal $ 100.70
Print Name: DARRELL MCNEEL "- l'e 1100/ 4 1 Plan review (25% of permit fee)
Authorized signature 4 a y� hied /( State surcharg 12% of permit fee) $ 12.08
'"'�cj �j�cccjjj %C21, TOTAL PERMIT FEE $ 112.78
Print Name: DARRELL C E L This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
* Number of inspections per permit allowed.
I\ Building \Pemnts \ELC- PernuiApp doe 10/01/09 440- 4615T( II /05 /COM /WEB