Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00634
T 1GAR.L3 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/09/2011
Parcel: 1 S135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 710
Project: Axiom Subdivision: METZGER, TOWN OF Lot: 9
Project Description: 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
2 crt Branch Circuits wo /Purchase 11/09/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/09/2011 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 throug�52- 001 -0090. You may obtain a copy of the ales or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ,
Issued By: - s 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:
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.
11/08/2011 14:50 5032577121 CAPITOL ELECTRIC PAGE 02/02
CEIV ED
lai:)li t )1 I #(` #3 IIti1C e)N1.5' —
Electrical Permit .A►p�I tc) — —
Received
Permit no,; ^ • - CO �
City of Tigard. p 8 2011 Date./B r ,
53125 V SW Hall Blvd., Tigard, OR 972 Plan R ev i e w
Permit:
Other Pe:
III M. ' phone; 503,639.4171 Tax: 503.598,1960 Datc /15y;
T I; ;l Ie 1) Ingpccti0S Line: 503,1539,4175 CITY' OF TIGARD Date Ready /By; I Sea Paso 2 oar
.. www-tig6rd- or.gOv BU1LDING DIVISION Notified /Melh<xl1 Sen•Icmcninl Inlhnnmwn
TYPE, OF WORK PLAN REVIEW
New construction ' Addition/ahem l.ion /rcpiaccment Please chock all that apply (submit 2 sets of plan, wdteme checked bellow):
rJ Demolition ❑ Other: _ ❑ Service or feodor 400 amps or mom 0 Building over three stories
— CATEGORY OF CONSTRUCTION where tho 4va1able fault current L] Marinas and boatyards
❑ I .anti 2- family dwelling 1:' Cummcrcial /industrial IL Accessory building exceeds 10,000 amps at 150 volts or El Floating buildings
❑ Multi -famil Li Master Builder LJ Other less to ground, or exceeds 14,000 ❑ Commerciakise agricultural
JOB SITE INFORMATION AND LOCATION amps for all other installations, buildings
1: Fire Pump ❑ Inslallatiotl of 75 KVA or
Joh no.: 111681 Job Site address: 10260 SW Greanburg Rd
n Emergency aysiem larger separately derived system.
1.-3 Addition of new motor load of i_i "A ", "E ", "1 -2 ", "1 -3 ",
City /Statc /'7fJP; Tigard Oregon 100Ho or more.
occupancy
Suite /h1dg. /apt. no,; 710 Project name: Axiom 30a Outlets ❑Six or more residential units n Recreational vehidC parka.
❑ I- icalth -care fecililies ❑ Supply voltage for more than
Cross Strect/Directions to job :QV _ ❑ i-fazardous locations 600 volts nominal.
❑ Service ur feeder 600 antes or more .
_ _ _ PEE SCHEDULE
Subdivisiav Lot nn.: p I Qty, I roc, i Total I _
Tax rung/ . and no.: New residential - single or mn #tl- fomlly dwelling unit.
DESCRIPTION . Includes attached_ara:c.
_
install (2) dedicated 30a outlets _ 1000 sA. 0, or less $ 166.54 4
Ea. Add'I 500 sq. 0 or op rtidl7 $ 37.92 I
1.1 PROPERTY OWNER .. I Li TENANT Limited energy residential
, (with above so, ft.) $ ; 75,00 2
Na Limited energy. multi-family
_residential (with above sq $ 75,00 , 2
Address Service or feeders Installation, alteration, and /or relocation
200 amps or less $ 100,70 2
City /Store /7.IP; 201 amps to 400 amps $ I33 2.
—� 401 amps to 600 amps 8 210.34 2
Phone: Fax:
601 amps to 1000 amps 5 701.04 2
Owner installation: This installation is being made on property that 'l own which is not. Over 1600 amps or volts , S 5 52.26 ' , 7
intended for sale. lance, rent or exchange, according to ORS 447, 449. 670, and 701 Temporary services or feeders inAt:nllatlnn, alteration, and/or
Owner signature: — Date: _relocation
200 amps or leSS S 55.30 1 t 1
j l APPLICANT L I CONTACT PERSON 201 amps to 400 amps $ 125,08 2
401 amps to 599 amps $ 168,54 2
Business Namc: + Branch circuits • new, alteration, or extension, per and
— A. Fee for branch circuits with
Contact name;
service or feeder Ice. each
Adtlrccs; branch circuit $ 7.42 2
B, Fee for branch circuits
without service or feeder fee.
City /State /ZiP' first branch circuit 1 S 56.18 56.18 2
Phone: pax:
Each additional branch circuit; 1 $ 7,42 7.42 2
Miscellaneous (service or feeder not lnelnded)
E -mail: Each mnnuftctured or modular
—
CONTRACTOR, dwelling, service and or feeder $ 47,04 2
Business Name: CAPITOL ELECTRIC CO., INC. Reconnect only 5 67.04 2
pump or irrigation circle — S 67.04 2
Contact. name: Sign or outline lighting $ 67.34 2
Signal circuits) or limited -
Address: 11401 NE MARX ST, energy panel. alterations, or
extension. Describe: 5 75.011 2
City /State/ZiP: PORTLAND, OR 97220 -1041 Page 2
Ench additional inspection over allowable in any of the above
Phone: 503- 255.9488 Fax: 503-257-7121 Per inspection $ 66.25
investiption per hoar (I lir mint x 5625
CCi3 Lie.: 48740 El trical Lie.: 26.4960 Su . rv. Lie.: 3132 -5 Industrial plant per hour $ 78.18
g � f /
ELECTRICAL Subtotal
PERMrT FEES*
Suprv. Electrician signature, req - d: �/7AY�� /lgj
Subtotal $ 63.60
Print Name: DAR E L MCN L Date: 11 /J/ Plan review (25 nf�ICmtit fee) _
Authorized signature' /f Stale surcharge ( 12% of permit fcc) $ 7.63
_ / J — /I / p - TOTAL PERMIT FEE $ 71.23
L-
Print Name: DARRE . N .r L - ' Thle permit epplIcaiton explrca it n permIc Ir CM oblelned within lee
dpye ener lc line seen accepted n• ccnmpinlo.
Numbut of inspecrinnc per permit allowed.
I:1 Duildi" a4PCrmlta \Ei.C:•pormilApp,t1p In/al/no 445- 4515TtI1/n5ttY1M /WILD