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Permit CITY OF TIGARD ELECTRICAL PERMIT c,2 COMMUNITY DEVELOPMENT Permit #: ELC2009-00475 BOARD 13125 SW Hat Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/10/2009 _:.. Parcel: 1 S 135 D D04400 Jurisdiction: Tigard Site address: 11900 SW GREENBURG RD Subdivision: Lot: 0 Project: Southwest Family Physicians Project Description: (4) branch circuits to rewire lab. Job No. 09 -450 Owner: FEES BC ASSOCIATES LLC Quantity Description Date Amount 1128 SW ENGLEWOOD DR LAKE OSWEGO, OR 97034 4 crt Branch Circuits 09/10/2009 $66.80 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 09/10/2009 $8.02 Electrical Contractor: DEKORTE ELECTRIC INC. 4115 SE CLINTON ST #1 PORTLAND, OR 97202 PHONE: 503 - 288 -2211 FAX: 503 - 288 -2231 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $74 82 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 accordance •• 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. TENTION: Oregon I- re. you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 1 -0010 through OAR 9 ■01 -01 r You may obtain a copy of the rules or direct questions to OUNC by callin .246.6699 or 1.800.332.23. . I sued By: Permittee Signat � _!_' " _ 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' � L •�-�,_ ` �• Date: � v LICENSE NO. /7S • 5 Call 503.639.4175 by 7:00 a.m. for an inspection that business day. 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. r ' i 09/09/2009 13:28 50328822 C IV D DEKORTE ELECTRIC PAGE 02/02 • 1e ctrical Permit Application FOR Ufii=t[ E LSf. f11L1' ` City of Tigard S E P 0 9 2009 deceive - 13125 SW i u Hlvd , 'rig.* OR 97223 '' - :: f IIe / Prrouit No.:E' �� —� , Phone: 503.639A 171 Fax 503_598.19ffry OF TIGARD Plt tt TIE :i :'ji D Impaction Lime: 503.639 175 - Other • 0 P"m"; Wane: �,y.u�r br -gav BUIL DIVISIO 1 Rauty'rey H see e z� r s , q., :,,. i : >'>': t 4: _ Noril"tzdJMahod: # Sap entai Information :r �. , :a,' � .• ;:r�+��;t4•i4':7.i'p'�i'�1`,.w, f;tir.); ":�, 1�:H ::i`� ^'' ^t�': i�'(:¢ MA ;a ^. ls 0 New construction / :' Addititxiladtrniiont ::s•:,r,. ... ? < r : a fpl a os I te es checked ; eim);y,,% replaartrritaa[ � tdudt all etas apply ohtnic 2 sets of p3aos tictiiKt Q Demolition Q Other © Service orte4tla iaa Orops ar WOW Building ov three itcries. % 1 : o t ;:�;: .' r � :! ;i. rit a i: - , where the ainibine fault current ❑ Marinas 5 i , " ;Y ( *. %: ,(QQt�' *' . i a ' ti r rseceds 10 0DD C Flcctii bud linE' rd '• i '' t ; �f .; ',: , � Amps at fSOvdlsor ag baald.' " ID l- and lhueily dwelling t Conzn'terciabindustriat ❑ Accessory building `� � lCrtds 1< q C ; a1, aezics.kurat Q Multi family + f aratS rasaattatwns • b wld a •: ,,.,::. rhea- or ,� �, r: i.� ;� ,;�, } >• "'s pxoop. ❑ t asi�i 7$ $vA Master O � & fau"on uF ;::. " , : ' , e QP. , '$ :: O �� Q . :i.% 4 COAT,, , „ : ',t ;",! <:`) ^`:., ' ': , ` 8 :=: : �tortoadof D`A ^, 1 - 2', - 1 - 3 - }sem. Iabrto_ • +•j"' �Additinmofoetrm L,`1- 2',`t3' Job site address: • it. l t0OtdPorran b -- t . -- OS er ma re - City /Stater21P=� �7 [ d lic a . l tines. O Rarr)pionst a par ks. f� / - ❑ rr�lrFicarc r idea D Sappi uolw f uw[c than Suite/bldg./apt too.: 1 Project name: D 0liatatdt� [Demons, boa wits mom eat, J i t:.tO k„,..14 I A t L f i t F D sen,ii= oc fad boa amps or mete.. Crass streetidirectiions to job site; ; i "• 1 < E ; _ ( " , C"3d New residential le or ennui- fxnail_v dwelling unit. Includes attached garage. Subdivision: Tax map/parcc .; Lat no.: ,Ilsq - or Less 145 _15 In o ! X00 sq - ft_ or portion all 3140 3- 40 = <:p;',;; -,. '; s,� 1 iON' . Limited cttc< residential `,:, ,.,Iffy;;",.. �,'?:;, :... r,•.';:. °" s.', ... , i+rirh 'buy' . tt 75.00 "Ma III (.(„ � (J • • , , $ j , _ Limited corm: multi - family ,r t rrsidemisl (wits above sq. 0_ 75_ 2 Sersiees or Feeders i;nstadlati , alteration, and/or relocation °, ';t, �`QP. ,I , � s F ' p , M1 '' , . �n ,,,:',,;; 200 rot s or tri ' _ (,+ �',� . ?�,.',i't� .' , r j . K t.,• ; �Ol amps w 400 s �p l ob.a5 �5 SOC 1 ii- S /--L� rut stops to 600 amps 16(3.6° � Name: la Address: 601 amps 001,000 amps =Ma 240.60 a Over 1.000 amps or volts MI 454.65 !Min Cit} dStatr JP: Temporary arrvices or feeders lnsialta alteration, tan, aaddar relocation Phanc: (5 ,) (p Q - 5 5 5-(Z1 Fax: ( ) 200 amps or less Owner tnxtatllaj This ins is being ode on tot 66.88 � intended for Sale, I g >a property that I own wh ich is not "1 dtk3 am 10030 lease, rem or exchange, according to ORS 447, 449, 670, and 701_ 40) amps to 599 amps 133.7'5 II Owner signature:, Date. Brandt circuits - Hew, alteration, or extension r • el . r :; b - . '+ - kl fCtforbryrchCirCila ( ., ..:.n:' -.:'✓r : J „ +�'� ' L!� ,' � , ^. [5 with ' r ° , � `. above serv ar feed" ice, $itsineSS name: each b ranch circuit 6 - Contact name; B. Foe for branch circuits without sercioe or feeder frc, list branch circuit 46 n 0. 85 Address': Facts add 1 branch circuit 6.65 City/State/ZIP: 1ltis ellatoons (service or feeder notitachukd) Each ruamafaconx:d or modular Phone; ( ) dtvcth rtrr service and/o feeder 90.90 2 Fax-. : ( ) E Reconnect only 66.85 El r ; i .} ''; ; ,,� �y� im Pump or irrigation circle 53.40 SI Y '' � :'' tf ? ,. i ;..' i sign or outline fighting 53A4 2 Business name_ Del/Corte Elecpric, tam Sigtral counts) or loaned- Address: 4115 SE Clinton St. WI energy per, alteration, or _ e. temsiatt` 11e: - Poor 2 2 City /State/ZIP: Portland, OR 97202. Each additional Inspection over allowable IA Any or the above Phone; (313) m-2211 Far: (503)288-2231 Investigation per hoar (1 in- min) Pa inspection 6250 MO 62 - 50 CCB Lic_: 159954 Electrical L 34-541C S MI / / ltprV_ Lac_ 4075S Industrial plant per hour Sum. Patrician signature, required: t r / �! ,..•r `' ':', " " .,:�Ei.E UtjC8I;'.:PI RiV(b1`:; ;.�r>:; ', .' '; Print name: leer )eKottc 1 Date: R 0� Plat, review %ofpermitfee): Authorized signature: Starr surcharge (12% of fee): g permit fee TOTAL. PERMIT FEE: - 7 4,8.a. Print name: Date: -.J. it implicating evpiren if a permit is not obtained %Maio UM . days att r it 163 been =cared as twrdeytrte //0 t Li/