Permit CITY OF TIGARD ELECTRICAL PERMIT
Al
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00093
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/08/2012
TIGARD g Parcel: 1S 135AB00900
Jurisdiction: Tigard
Site address: 10260 SW GREEN BURG RD 1160
Project: Spec Space 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
3 crt Branch Circuits wo /Purchase 02/08/2012 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/08/2012 $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 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 OA 952 - 001 -0090. You obtain a co. of the ru - or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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Issued Byv - - Perm ittee 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.
02/07/2012 10:13 5032577121 CAPITOL ELECTRIC PAGE 02/02
Electrical Permit Application 1 FOR (Fl WE USE ONLY
J Received
City of Tigard, C Date /By:W
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'� 1 3123 SW Hail Blvd., Tigerd, 97223 �� Plan Review
Phone: 503,639.4171 Fax; 503.598:19 G0 `L� Date/By; Other Permit:
I . It lz z '
in6pectinn Tine: 50.3A 30,4175\ '
P bale Ready/By: /B
Internet wwvot,llgtltd -4r -gt v c� \ y y' 3 «Pnro2lbr
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'000\ Notified /Method: 5u Iemenlni Information
r cr _v`1\
_ TYPE OF WORK \"(mot, ",(^„v` PLAN REVASw. ..--,
U New construction l.',1 A ddition /alteration /rep }t�iccn'�cni � Please shock all that apply
�`�� � y (sUbmit 2 sets of plans wfitema checked below):
❑ Demolition I._i Other ❑ Service or loader 400 amps or more El Bulming over three stories
CATEGORY OF CONSTRUCTION where the available fault current Li Marinas and boatyards
I- and 2- family dwelling -d Commercial /industrial L_ Accessory building exceeds 10,000 amps at 150 volts or ❑ Floating buildings
❑ Multi.famil ❑ Hasler Budder ❑ Other less to round, or oxceeds 14,00D
9 ❑ Commerctal.u. ^,.o agricultural
JOB SITE INFORMATION AND LOCATION amps for all other installations. buildings
Job no,: 120134 ,lob Rite address: 1D26D SW Greenburg Rd n Fire Pump ❑installation 01 75 KVA or
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L..1 Emergency system Larger separately derivod s y stem.
Cily/5tntc /Z].P: Tigard OR C I Addition of new motor load of ❑ -A". V. ^1 -2 ^. "1 -9
•
V• 100HP or more, ❑ occupancy
Suite /hid({, /apl. no.: 1 160 Project name; q ❑ Six or more residential units ❑ Recreational vehicle parks.
❑ Flealth - core facilities ❑ Supply voltage for more than
Cross Strcetlgircctions to jot) sits: ❑ Hazardous locations 000 volts nominal.
❑ Scrvicc or feeder 600 am rs or more
SubdiviRinn: Lot no.: FEE SCHEDULE
I)oel•iptiorl I Qty. I Fee, I 'Total I "
Tax map /parcel no,: New residential - single nr multi-family dwelling unit.
DESCRiPTION OF WORK Includes attached garage,
Add (3) dedicated cutlets 1000 s q, n'. or less $ 109.54 4
Fa, .Add'! 500 sq. fl nr portion I 33,92 1
L PROPERTY OWNER U TENANT — Limited energy residential
Name; (with above sq, ft s 75,00 2
Limited energy, multi - family
Address; residential (with above.. , ft.) • .$ 7500 2
Service or feeders Installation, alteration, and /or relocation
City /State2fP:
240 amps amps nr less 0 100,70 2
20] amps to 400 snips S 133.56 2
Phnnc Fax; 401 atnys to 600 amps S 200.34 2
601 amps to 1000 amps 1 301.04 2
Owner Installation: This ing(nllation is being made on property that I own which is not Over 1001000 amps or volts $ 552,2!,
intended for sale, least, rent or escllnnge, according In ORS 447, 449, 670, and 701 2
Temporary services or feeders installation, alteratioo n, and /nr
Owner signature: Date:
rclneatinn!
200 amps or less $ 59.36
LI APPLICANT i LJ CONTACT PERSON 201 amps to 400 amps I 125.08 2
Business Namc: 401 am 5)f�lo 599 amps S I68.54 2
Branch circuits - new, alteration, or ektensien, per `ane[ —
Contact name A. Feu for branch circuits with
- service or feeder rce, each
Address: branch circuit s 7,42 2
B. Foe for branch circu
City /StatcJ71P; without Scrvicc or feeder fix.
first branch circuit 1 s 56,18 56.18 2
Phone: Fax: Each additional branch circuit: 2 + 7,42 14.84 _ 2
E-mail:
Miscellaneous (service nr feeder n ot included
Each manufactured or modular
CONTRACTOR dwelling, service and or feeder $ 67,84 2
Business Name: CAPITOL ELECTRIC CO„ INC. Reconnect only 6 67.84 2
Pump or irrigation circle 1 67.84 2
Contact name; Sign c r outline iighting 5 67.84 2
Signal circuit(s) or limiled-
Address: 11401 NE MARX ST, energy panel. alterations, or
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extension. Describe: 5 75.00 2
City/Stale /ZiP; PORTLAND, OR 97220.1041 Page 2
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Each additional i6d Lion over allowable in any of the above
Phone: 503.255 -9488 Fax: 503 - 257-7121 Per inspection S 6625
Investigation pet hour (I hr min) 5 66.25
CC L ic.: 4$748 Electrical Lie.: 26 -496C Suprv. Lie 3132 -S .industrial plant per hour
5 78,18
Suprv. Lleetrieian signature. require. : ELECTRICAL PERMIT FEES*
Subtotal $ 71.02
Print Name: DARRHLI t, T L Date; 0210 r (25%
i . Plan review (25 /n ofEcrmit fee)
Authorized signature: > f dr , 'State surcharge t _ 12% nfpemtit fee) $ 8.52
TOTAL PERMIT FEE $ 79.54
Print. Name; DARK Its CN L —��-
- Thin permit npprtrnunq expires tf o permit is 501 nbmhtrrt within tan
days after II hoe hrcn aceeptcd as enamel%
' Number of inspetaiuns per permit s 110 Wed.
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