Permit t
r ip CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00112
13125 SW Hall Blvd , Tigard OR 97223 503.639.4171 Date Issued: 03/05/2009
TI.GARD Parcel: 1 S 135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 375
Subdivision: Lot: 0
Project: Mastercare
Project Description: Install (2) branch circuits.
Owner: FEES
LINCOLN CENTER LLC Quantity Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555
CALIFORNIA ST 49TH FL 2 crt Branch Circuits 03/05/2009 $53 50
wo /Purchase Service or
PHONE Feeder
1 ea 12% State Surcharge - 03/05/2009 $6.42
Electrical
Contractor:
CAPITOL ELECTRIC CO INC
11401 NE MARX STREET
PORTLAND, OR 97220
PHONE: 503 - 255 -9488
FAX: 503 - 257 -7121
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $59.92
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 -0100 You may obtain a copy of the rules or direct questions to OUNC by calling 503.246 6699 or 1 800.332.2344.
Issued By: � 1/� g 1 1 mil V) XA. ` / Permittee Si nature:
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 an inspection that business day.
This permit card shall he 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.
ECectrical Permit Application RECEIVED FOR OFFICE USE ONLY
Received
City of Tigard Date/By: . Permit no.: 2
MAR 0 3 2009 Date /B -Cfi `tom ZQ� 1114t0 12—
' 13125 SW Ball Blvd., Tigard, OR 97223 Plan Review
- C • Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit:
T I GA RD Inspection Line: 503.639 CITY OF11GARD Date Ready /By: See Page 2 for
Internet: Wnvw.tigard- or.gov BUILDING DIVISION
Notified /Method: Supplemental Information
.. � ��aA� �. _ Ya TwY�PL',OFWO� .�n>3'.,A,,. 3. �, ,..._ ,. . , � �w 'o VJ..�� ,��
� ❑ New construction U Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition ❑ Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories
where the available fault current Marinas and boatyards
:° . „ .a __.., ".CATEG01,2Y4OF�CO _STRUCTt5�i;<I.... °'.�v_ _, 9Y Y
• I- and 2- family dwelling 0 Commercial /industrial U Accessory building exceeds 10,000 amps at 150 volts or Floating buildings
❑ Multi - family ❑ Master Builder ❑ Other less to ground, or exceeds 14,000 Commercial -use agricultural
.., .t , t JOB SITE °INFORMATLWA D LO,CAT101 , * ,"gi s s v amps for all other installations. ❑ buildings
Job no.: 290404 Job site address: 10260 SW Greenberg ❑ Fire Pump ❑ Installation of 75 KVA or
❑ Emergency system larger separately derived system
City /State /ZIP: Tigard, OR ❑ Addition of new motor load of ❑ "A " "E " "1 -2 " "1 -3 "
100HP or more. ❑ occupancy
Suite- bldg./apt. no.. 375 Project name: Mastercare ❑ Six or more residential units II] 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
., - 5a < � :,i
Subdivision: Lot no.: e -_3 �'?'d' _ `.� FI E,SCHEDUL @a s.,. .-
Description I Qty. I Fee. I Total
Tax map /parcel no.: New residential - single or multi - family dwelling unit.
4. - ", =5 ,7 trj)E8QRltt:nR)::%0,FAORKVE.':Y Includes attached garage.
Relocated switches and lighting for tenant improvement 1000 sq. ft. or less $ 145 15 4
Ea. Add'l 500 sq. ft or portion $ 33.40 1
',❑ PROPERTY5OWNER; >> , t . .I , ", ,,„ ; _,'`�_'_a' ' ❑TENANT. a ; , i 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 $ 80.30 2
201 amps to 400 amps $ 106.85 2
Phone: Fax: 401 amps to 600 amps $ 160.60 2
k 601 amps to 1000 amps $ 240.60 2
Owner installation: This installation is being made on property that I own which is not Over 1000 amps or volts $ 454.65 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 $ 66.85 I
" k❑ APPLICANT' ";i.,.," g,,, „I. „y ' S,, '”. :. [J C®NTAGT;PERSON . , .._ 201 amps to 400 amps $ 100.30 2
Business Name: - 101 amps to 600 amps i 8 133.75 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 $ 6.65 2
B. Fee for branch circuits
without service or feeder fee,
City/State/ZIP: first branch circuit 1 $ 46.85 46.85 2
Phone: Fax: Each additional branch circuit: 1 $ 6.65 6.65 2
Miscellaneous (service or feeder not included)
E -mail: Each manufactured or modular
�� art z ; ' ,tea
,,; _ .:.�,� k �� a ,,��,C®NTRAC� : TORr �� � A ;.,', _..., MZ:, If dwelling, service and or feeder $ 90.90 2
. Business Name: CAPITOL ELECTRIC CO., INC. Reconnect only $ 66.85 2
Pump or irrigation circle $ 53.40 2
Contact name: Sign or outline lighting $ 53.40 2
Signal circuit(s) or limited -
Address: 11401 NE MARX ST. energy panel, alterations, or
extension. Describe: Page 2 2
City /State /ZIP: PORTLAND, OR 97220 -1041
Each additional inspection over allowable in any of the above
'Phone: 503 - 255 -9488 Fax: 503 - 257 -7121 Per inspection I $ 62.50
Investigation per hour (1 hr min) $ 62.50
CCR Lic.: 48748 lEleetrical Lie.: 26 -496C ISupry Lie.: 3 32 -S Industrial plant per hour $ 73.75
� f l / / ELECTRICAL`PERNFE
IIT "ES".; t't,1, . °: . .�,. _, -a e =� 1 ' ;,, _ .
Suprv. Electrician signature, required: t��
Subtotal $ 53.50
Print Name: DARRELL MCNEEL Date: 02/26/09 Plan review (25% of permit fee)
• ... Authorized signature: lfv �j t // State surcharge ( 12% of permit fee) $ 6.42
d TOTAL PERMIT FEE $ 59.92
I Print Name: DARRELL CNEEL This permit application expires if a permit is not obtained within 180
days after it bas been accepted as complete.
* Number of inspections per permit allowed.