Permit CITY OF TIGARD ELECTRICAL PERMIT
!'! = ;;. COMMUNITY DEVELOPMENT Permit #: ELC2011 -00665
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/30/2011
IIGAAD Parcel: 1 S 135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 150
Project: Sleep Medicine Network Subdivision: METZGER, TOWN OF Lot: 9
Project Description: (4) branch circuits 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 11/30/2011 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/30/2011 $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 95 0 90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: .0"' 1 / P1-- / C t'51-770"/
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 503.639.4176 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.
11/29/2011 TUE 9 : 13 FAX 5036242938 Willamette Electric Z1002/002
El ectrical Permit Application :-...: -•:, ;':-.::. - FOR•OFFICE USE ONilt. ••,•••••• • Y'''-:: -- ...•."-•-:',:. ..
." -•' -.. City of Tigard RECEIVED Received
Dp ew / --gd •
4.;;; . ' * ' ' ' -NoZZ-ea ora 6 6 .3
, . . 13125 SW Hall Blvd., Tigard,OR 97223
IN
I 2 . Phone: 503.639.4171 Fax: 503.59V6V 2 9 2 rrnit;at W .....ora y
Inspection Line: 503,639.4175 Date Ready/By: / UriS' .
TIGARD , ,...- ...." Ed See Page 2 for
Internet: www.tigard-or.gov Notified/Method: 17 Supplemental Information
.
. .
•
0NeW constru Additio i
P lerallion/Gre Please cheek all that apply (submit 2 sets of plans w/items checked below):
p p a p i m i e S n i t 0 N - • . - . . ' . . . 1441.,,i i tt * ,.. .104i. ... ,,._:.....,..: . .. .., .,: .. :... 7
0 Service or feeder 400 amps or more 0 Building over three stories,
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
- '' • '
. . . - ..... : .. ..;c .coNsuwatoN• ' . . -. . ,. exceeds 10,000 amps at 150 volts or 0 Floating buildings.
. . ......., • ,,. .. . .. .,..„ . ,,•• • . . . . . .. , , teas to ground, or exceeds 14,000 0 Commercial-use agricultural
0 I- and 2-family dwelling 2 Commercial/industrial 0 Accessory building amps for all other installations, buildings.
O Multi 0 Master builder 0 Other: 0 Fire pump. 0 installation of 75 KVA or
larger separately derived system. ... El Emergency system,
.. • .. 40.8 SITE.1100gIVIATION. 'AND - LOCATION ' . ' 0 Addition of new motor load of
Job no.: 6 / 7 1 Job site address: /2_
d„:,9.-c;. ,5 .t.,../ Lt. r e 4-\ x 0 100HP or more.
Six or more residential units. 0 occupancy.
Recreational vehicle parks.
C 4/State/ZIP: .7 „ " a le__ 1:Health-care facilities, U Supply voltage for more than
/ / .37 - 0 Hazardous locations. 600 volts nominal.
/guild/bldg./apt. n•.:/"_Y'e Project name: j -i e ..H ty) ele,„..,(>, 0 Service or feeder 600 amps or more.
Cross street/dircc ' • • • ••• site: Description I Qty, I Fee, I Total I
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. fl. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: , Limited energy, residential 75 00 2
• - . • . . DESCR1PTXON OP. WORK ... . • .. • .. . (with above sq. ft.)
Limited energy, multi-family
0
-
—. - residential (with above sq. ft.) 75.0 2
ep,, ,
, Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
0 PROPERTV •ONVNER. I . • .O 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
. . above service or feeder fee,
7A2 2
El APPLICIOTI : - I . . . CONTACT Fitx ON - each branch circuit .
Business name:
B Fee for branch circuits without
service or feeder fee, first / - .., r'i
5 . -
Contact name: branch circuit 56.18 -- 2
Each add'l branch circuit ,3 , 7.42 k 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67,84 2
City/State/ZIP: dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E . ...
Sign or outline lighting 67.84 2
. .
'COWRACT " ' '.. . .: . - :. - ... - . .. 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 mitt) . 66.25/ hr I
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: Tigard, OR 97281
Industrial plant (1 hr min) 78.18/hr
i
P one: (503) 624
.
v h
CCB Lie.: 75059 / Electrical Lie.: 34F-ax28 C
:503) 624-2938
./
.,.,„,—....,.........___ --.:--------.– Inspections for which no fee is 00/
hr
, r s cificall listed '/a hr min 90.
Suprv. Lie.: 4226-S ' .,- .:ELECTRICAL PERM1T..:FEES • •-, ...
Subtotal: ' Y '
Suprv. Electrician signature, requirect.-- _.
Plan review (25% of permit fee):
Print name: David Fife Date: 1/ z_1// — State surcharge (12% of permit fee): 7 ....-4/(
TOTAL PERMIT FEE: T' ! —
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.
I: \ Building‘Permits\ELC-FromitAppoloc 07/01/10 440-4615TO 1/05/COM/WEB