Permit � ,, CITY OF TIGARD ELECTRICAL PERMIT
;'� � COMMUNITY DEVELOPMENT Permit #: ELC2012 -00136
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date issued: 03/09/2012
Parcel: 2S101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 460
Project: State Farm Subdivision: VARNS ACRES Lot: 9
Project Description: (30) branch circuits
Contractor: HILLSBORO ELECTRIC LLC Owner: GK TRIANGLE CORPORATE PARK III L
21185 NW EVERGREEN PKWY #110 BY THOMSON REUTERS INC
HILLSBORO, OR 97124 ATTN: MEGAN DOWLING
PO BOX 130174
CARLSBAD, CA 92013
PHONE: 503 -439 -9666 PHONE: 503 - 221 -1900
FAX: 503 - 601 -3680
FEES
Quantity Description Date Amount
Specifics:
30 crt Branch Circuits wo /Purchase 03/09/2012 $271.36
Service or Feeder
1 ea 12% State Surcharge - 03/09/2012 $32.56
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $303.92
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: O on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 throug A 952- - 90. ou may obtain a copy of the rules or direct questions to OUNC by calling � 5 f 03.232.1198 , 7or 1.800.332.234.4.
Issued By: Permittee Signature: f/A/ // o / e7v•
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 603.639.4176 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.
Mar 08 12 05:40p p.1
. Electrical Permit Application \ti ... : - - - ..f o+i ul- vier USE ONL►
• City of Tigard `Ni% ,O 0s ef W y /S- / Pernrit No:: ex_eo?CY2 --G?:y.50
I 13125 SW Flail Blvd., Tigard, a t 2, '.i : ^) \O\ Plan Review T
Phone: 503.718.2439 Fax: 'Ti.,?.:,./.. Thin ,`V &\`-0 DateBy: Other Permit :��(P� /A - �d6/t:J
T I G A R D Inspection Litre: 503.639.4175 • . .- \ Date ReadyBy: saw ' El See Page 2 for
Internet www.tigard or.gov O �. .VO Notified,'Method: en
Method:
' ' • " : IT:-E OF WORK .o \� I I PLAN -REVIEW 1
i
❑ New construction ® Addition/alteration/
r eejement Please check all that apply (submit 2 sets of plans w,'iteus checked below)
❑ Service or feeder 400 amps or more . ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyard'.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ floating buildings.
less to grotmd, or exceeds 14,000 ❑ Commercial-um agicullural
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder 0 Other: ❑ rise pump. ❑ I4stallation ot'75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ system.
Emergency system. Larger separately derived syste
❑ Addition of new motor load of
Job no.: 7976 I Job site address: 13221 SW 68 Parkway t00HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /StateIZIP: 97223 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominaL
sit bldg. /apL no.: 460 I Project name: State Farm 0 Service or feeder (mOO amps or more.
Cross street/directions to job site: FEE SCHEDULE n. I
� pecokptlon { gen. Fee. I Tact I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less t 168.54 4
Ea. add' i 500 sq. ft. or portion l 33.92 i
Tax map/parcel no.: Limited energy, residential
75.00 1 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
T1 residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 1 100.70 I 2
❑ "PROPERTY OWNER I ❑ TENANT 201 amps to 4C0 amps 13356 2
401 amps to 600 amps 20034 2 •
Name: I 601 amps to 1,000 amps 301.04 2
Address: Ova 1,000 amps•ar volts 55226 • 1 2
CitylStatelL1P: Temporary services or feeders installation, alteration, and /or
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 aittp, to 599 amps 168.54 2
intended for sale, tease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits - new, alteration, or extension, er panel
Owner signature: Date: A. Fee for branch circuits with I
❑ APPLICANT I 0 CONTAC f PERSON above smite-or feeder fee, I I 7.42 , 1 2
each branch circuit
Business n ame: 13. Fee for branch circuits without
service or feeder fee, first I 56.18 ,
Contact name: branch circuit 56.18
Each add't branch circuit 29 7.42 215.18 2
Address: Miscellaneous (service or feeder not included)
City /State/ZIP: Eadl ma tufactmal or rrtextular 67.84 ' '
dwelling, service and/or feeder 2
Phone: ( ) • Fax: • ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: • '
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: Hillsboro Electric LLC panel, altem lion, or =tension.. , Page 2 , 2
Each additional inspection over allowable in any of the above
Address: 21185 NW Evergreen Parkway Suite #110 Additional inspection (1 hr mm) 6621 hr
Investigation (1 hr min) 662i hr
City/State/21P: Hillsboro, 011.97124 Industrial picot (l hr min) 78.18/ hr
Phone: (503) 439 - 9666. I Fax: (503) 601 - 3680 Inspections for which no fee is 90.00/ hr •
specifically listed (15 hr min) •
CCB Lie.: 134481 Electrical Lic.: 34 - 499C Suprv. Lic.: 4941S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 271.36
Plan review (25% of permit fee):
- . Print name: Joey Vitacco Date: 3-8-12 State surcharge (12% of permit fee): 32.56
Authorized signature: TOTAL PERMIT FEE: 303.92
This permitapplcatmn expires if a permit is not obtained within 1&1
• Print nano' days after it has been accepted as complete p f//
1 Date: • Number of inspections allowed pee permit.
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