Permit CITY OF TIGARD ELECTRICAL PERMIT
1 ii - . ' - COMMUNITY DEVELOPMENT Permit #: ELC2012 -00039
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/26/2012
Parcel: 1 S135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 340
Project: PNW Telco Subdivision: METZGER, TOWN OF Lot: 9
Project Description: (3) branch circuits for egress lighting /outlets.
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
3 crt Branch Circuits wo /Purchase 01/26/2012 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/26/2012 $8.52
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
Required Items and Reports (Conditions)
This permit ' . - • ubject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law All work will
be don= in accordance Withpproved 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 N. • - quires you to follow the rules adopted by the Oregon Utility Notific,gtiam Center. Those rules are set forth in OAR
952 101 -0010 through OAR 95 111-01'40. You may obtain a copy of the rules or direct questions to OUNC by calli6i 503.232.1987 or 1 800.332 '344.
il
Is ued By: P ermittee Signature: _ 6 i tie � •
I
• 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:
CONTRACTO' INSTALLATION,ONLY
SIGNATURE OF SUPR. ELEC' % i, 44 A'. 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.
01/24/2012 10:52 5032577121 CAPITOL ELECTRIC PAGE 02/02
Electrical Permit A pnlication �� l Received
City of Tigard e, v; 1 Datc/13y: /ay Permit: tin.: """ 6
rr 13125 SW Hall Blvd., Tigard, Q>: 97223 " �, 4 Plan Review Other Permit! QQ // ,1�
Phone: 503.639.4171 Pax: 503.59 ^ Daic/11y _ 4 L f At ,. 01��t�7
T tGn1t 17 T Internet: C. 50 .639 O�I, Hate Ready /13y;
kris: L. I One ram 2 an
Internet: wWW.tigarcl- or,SOV 1 = 14 6 r L Notified /Method: gupplcmontellnrnmmilan
TYPF, OF WORK - � `y PLAN REVIEW
L I New construction i Addition /alteration/replacement. r ® Please check all that apply (submit 2 sets of plane w /Items checked below):
[I Other G� t1�\v� ❑ Service or fender 400 amps or more ❑ Building over Three stories
El Demolition
CATEGORY OF CON STRUC !, where tiro available fault current [Ti Marinas and boatyards
1 and 2- Family dwelling LJ Commercial /industrial ` Accessory building exceeds 10,000 amps at 150 volts or ❑ Floating buildings
❑ Multi - family ❑ Master Builder ❑ Other loss to ground, or exceeds 14,000 ❑ Cotnmercial -use agricultural
JOB SITE INFORMATION AND LOCATION amps for all other Installations, buildings
❑ Fire Pump ❑ installation of 75 KVA or
Job no.: 120138 Job site address: 10200 SW Grflertburg Rd ❑ Emergency system larger separately derived system.
❑ Addition of new motor load of Li "A ", "E ", "1 - ", "1.3 ",
City /Stale /ZiP: Tigard Oregon _ 100HP or more. ❑ occupancy
- —
7 Six or more residential units n Recreational vehicle parks.
Suitc/bldg. /npl, not 340 Project name: PNW Telco Hcalth -care factlitics n suppl 1 voltage for more than
I - 1
Cross Street/Directions to .b site: Li Flrrardous locations 600 volts nominal.
—
U Service or Feeder 600 am es or more _
'� FBE SCFIIfDULE
Subdivision; Lot no,: Description � I Qty. I For. i Total I •"
Tax snap /parcel no.: New residential - single or multi- family dwelling unit.
- DESCRIPTION OF WORK _includes attached garslgo-
Install egress lighting/ outlets 1000 sq, ft, or leas $ 188.54 4
Ea. Add 500 s9. ft or portion $ 13.92 I ,
- - i. .PROPERTY OWNER J ❑ TENANT Limited energy residential
(with above sq, ft._ , $ 75.0n 2
Name Limited energy, multi - family
— —
residential with above sq, 0;) s 75.00 2
Address: Service or feeders installation, alteration, and /or relocation
" 200 amps or less 5 100.70 - 2
CitylStatc /ZIP: 201 amps to 400 amps $ 133.56 2
401 amps to 600 amps $ 200.24 2
Phone: Fax: 601 amps to 1000 amps $ 301.04 2
Owner installation: This installation is being made on property that 1 own which is not • Over 1000 amps or volts 1 $ 552.26 2
intended for sale, lense, rent or exchange. according to ORS 447, 449, 070, and 701 Temporary services or feeders Installation, alteration, and /or
Owner signature: Date , reloentiott
200 amps Or lean $ 50.74 ` I
APPLICANT LI CONTACT PERSON _ 201. amps to 400 amps $ 125.00 I r 2
401 amps to 599 amps 5 160.54 2
Business Name: Branch circuits - new, alteration, or extension, per panel
"— A. Fee for branch circuits with
Contact name;
service or feeder fee, each
- `— branch circuit S 7.42 2
Address 11, Fcc for branch circuits
without service or feeder fee,
City /State /ZIP: first branch circuit 1 S 56.10 56.18 2
Each additional branch Circuit 2 i 7,42 14.84 2
Phone: Fan; Miseelltlnenus (ervicc or Feeder not include[) "
E -mail: Bach manufactured or modular
CONTRACTOR dwelling, service and or feeder $ 07.04 2
Am_
Business Name: CAPITOL ELECTRIC CO., INC. W Reconnect irrigation $ 67.34 2
Pump or r irrtgOtinn circle $ 67,84 2
Si nor outline li•htin_ $ 67,84 2
Contact name:
Signal circuits) or hmitcd-
energy panel, alterations, or
Address: 11401 NE MARX ST, extension. Uoscribc: 5 75.00 2
City /State /ZiP: PORTLAND, OR 97220 -1041 — i Page 2
Each additional Ina. ection over allowable in an of the above MOM
MEI Phone; 503 -255 -9488 Fax; 503- 257 -7121 Fer ins Winn $ 66. 25
i.nvesti sl.ion cr hour 1 hr mm MEI fi 05,25
CCB Lk.: 48748 Electrical Lie.; 26 -496C Su.rv, Lie,: 3132 -S Industrial plan per hour $ 78,18 _ .
rv, Electrician signature, rc ai rs ELECTRICAL PERMIT PEPS'
gu
p q ,1- 1? /,, sal -total $ 71.02
• rrintName: DARRELL MC Date: 01/24112 Plan review (25% of permit fee) __
Authorized signature: �,� Stott surcharge! 12% of permit fee) $ 9.52
6 ,f -I ' �.<4 .,•:: . ` TOTAL PERMIT FitE $ 79.54
- Print Name: DARRELL - N - Tad permit npvlloarl. naptrm Irn permu h nor ohtnlueri within 180 /
diva rater It hna hear arenptrrt as complete. ti Number o I' itlipeoliona per permit allowed,
t:l rtuildiruureamiixt5l .C•Pore.:IApp.dnc 10/01'00 440.461571 I/05 /ct)M /WE}