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Permit • CITY OF TIGARD ELECTRICAL PERMIT Per COMMUNITY DEVELOPMENT Permit #: ELC2012 -00172 T II G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/27/2012 Parcel: 1S126DB02800 Jurisdiction: Tigard Site address: 9370 SW GREENBURG RD 412 Project: Oregon Fertility Clinic Subdivision: 1991 -018 PARTITION PLAT Lot: 1 Project Description: TI Contractor: STEELE ELECTRIC LLC Owner: FRANKLIN COMMONS ASSOCIATES, LLC 716 ROXE DR BY NORRIS & STEVENS FOREST GROVE, OR 97116 621 SW MORRISON STE 800 PORTLAND, OR 97205 PHONE: 503 - 332 -1280 PHONE: FAX: 503 - 372 -6448 FEES Quantity Description Date Amount 3 crt Branch Circuits wo /Purchase 03/27/2012 $71.02 Specifics: Service or Feeder 1 ea 12% State Surcharge - 03/27/2012 $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 OAR 952- 001 -0090. cop le s or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. . � Issued = . — Permittee Signature: r 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: 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. 03/27/2012 08:04 5033726448 RE0FivEfi Electric #0681 P.001/002 ( ' � Electrical Permit Application OFFICE :S O \ �_, City of Tigard MAR 2 6 2012 Received mime's, �� m, , _ 13125 SW Hatt Blvd, Tigard, Olt 97223 Plan Review .; Phone: 503.639.4(71 Fax: 503.598.1960c OF TIGR iD Other p�(llO ' � T_C A .J 'n81)656311 ww 503.639.4175 L, LDING DIV101 . N a; ' Supplemental Informatioa Internet: ww /_ „,„w.. 7 �l 777 - 7- 7iii ' t . ',•. ; ' r1.,X• - - ^t ' f _ - ;. �,,.�^gt� T s,�, ? ,- -- -. •..'^'+� "' '' . ......... ,'.- ,:• :.w_ : : :. r- .x. -..�..,•..Ti�;rmx va flu., u - ,,s .7:11• • a",fi• " l .D ! : KC Y. . . ❑ New oonsiruction ddition/atteration/replaeement Mate stele an that arch (intuit secs ofptsas wrnrms checked below): 0 Demolition ❑ Other: : ❑ where the available fault eat ❑ tiarild as over three stories. Q Marinas and boatyards. 4 1 ,. - "u"� .,k, , ter°. i wA cc 10.000 ampG ra 150 volts or D Flown budmats. .:•,. : r •r , .. � :.co i : +! : lei to ground, a acoxds 14,000 ❑ Cammercral -use erg is 1u J ❑ 1 and 2 family dwelling IR Commercial/industrial .❑ Acpes oty I I ding amps for all other instalbrioas. Wangs. ❑ Multi - family 0 Master builder : ❑ Doren. 0 Fie pump. Q Installation of 75 KVA or • F A r. ...�✓ . I '':','.:".7 , I , ts _ � E magea ..� s s qua ely derived swam _ .. .,, . - j._ _ _ _ , ' ,1 111..,. ,.7 1 11 :. .,..,.w:.._:.�.t_. _ :., . . . . I 'rY tt s ❑ Addiliou of m w motor load of CI "A", "E", ° I-2 " 1 . 3 " �c Job site address: ea 7 0 Su • t00HPor err aocy. Job no. ` �'` -'I 1 O Si„ ,,,,,„„„,, „; esal assts. Q Rear-atonal vehicle perks. Supply voltage for c;iy/staterz�: 02 al 2 3 0 © more than Suite/bleigiapt no.: Project name: or p,,, - { CI Service or feeder 600 amps a mote. l '"d` `ter 4, r i a Cross sueet/dircetions to job site �[ � :._ - r 1 ' l ra ©�to I New residential single or multi - family dwelling oaf Includes attached garage. Subdivision Lot 1.000 sq. ft or less 168.54 4 Ea. e41'1500 sq. ft. or portion 33.92 1 Tax map/parcel no.: Limited energy, - v tnC a yrk G x • _ ` (•4111 above sq. ft et'se •)emra! 75.00 2 �_.. _ _ _ canned energy, main -fermi y 7500 CGR- 1, ale ri,v -D IA t.. with above ••. ft 2 �. Services or feeders instals alteration, and/or relocation 200 amps or Ines 100.70 2 C:".• > y <.sj � . ,, ,� ,-4 r : � RA :'w, 201 amps to deo amps 133.56 2 40 am ps to 600 neaps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 Address: I Over 1,000 ads or volts 552.26 2 City /Staze/ZIl': I Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) I Fax: ( ) 200 amps or less 5936 I 1 Owner installation: This installation is bang made on property that I o wn M ich i s not 201 amps to 400 amps 125.08 2 intended for sale, l ease, rent, or exchange, according to ORS 447,449,670 ad 701. 401 to 599 amps (68.54 2 Braucbf . wl5 - U ew. alteration, err , , . ' Panel Owner signamre: babe: _ , I A. Foe for un blanch cit �drits w ins • c 3 '' ^ K above 5.2'Ice er feeder fee, ¢b 4 t '� t. 4s� �c�:,, , ..,1,.... � , •ra:,Yt� C3r'11 branch circuit 2 Business name: B. Fee for branch circuits waked , 56.18 r ' (� 2 service or feeder fee, first Contact name: branch circuit Each add'I blanch circa 7.42 , q' 2 Address: I Misodlaneoas (service or feeder not included) City/State/ZIP: I ' or " � 67.84 2 dwell _ service and/or feeds • Phone: ( ) Fax:: ( ) I Recora>ec� only II 67.84 E-mail E I or utigoer circle 67.84 � � } Sign or olaline lighting 67.84 Ei • .., ut.- 'MSS Yr 5181 circuit(s) Or titltlteQ-GQQ$y Business name: S T Si j e, L C.(' ,2l te I P. n , or aeasiou. Pane 2 2 Each Address: ") ?� - t additional inspection over allowable in any of the above {� v,i ( 0 r %Ni ( Additional inspection (1 hr min) 6625/ hr City/State/ZIP! R c k- 6 d'lsvg. U x'1"1 ti (j investigation (1 hr min) 6625) hr Industrial plant (I hr tin) 78.18/12r Mon= 6 3 3 2 t 2 D3 TO Fax: (5") 1 "2. t, Li I I I % inssettxions for which no fee is ■ �� 1lstea(Y�hr vita 9000/br CCB Lic.:171 ( O Electrical Lie.. C 41 ° i Sups. Lin : 19 11 . S '1:;a a ___ . ,11. Suprv. Electrician signature; required I Subtotal: - '7 l . 0 Plan review (25% of permit fee): P r i n t name: 0 c . . . , , . . . S o f 1 l2 < I2 State surcharge (12% of pe mit see): it . 2 TOTAL PERMIT FEE: Authorized signature: 9 . $` 'Tis Permit apprresdoi a xpa® if a permit is not obtained within me Print name: p I days atter It has ban accepted as acmptete. • Number ofaRpvcp®s allowed per pamit. 1 L °8 PpdoO 07/01/10 1 441)46. p i WS/COMl4E$