Permit CITY OF TIGARD ELECTRICAL PERMIT
Per
a COMMUNITY DEVELOPMENT
Permit #: ELC2012 -00207
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/10/2012
Parcel: 2S 101 DA00102
Jurisdiction:
Site address: 13221 SW 68th PKWY 450
Project: Spec Space Subdivision: VARNS ACRES Lot: 9
Project Description: Electrical for TI.
Contractor: HILLSBORO ELECTRIC LLC Owner: GK TRIANGLE CORPORATE PARK III
21185 NW EVERGREEN PKWY #110 P.O. BOX 130174 •
HILLSBORO, OR 97124 CARLSBAD, CA 92013
PHONE: 503 -439 -9666
PHONE: 503 - 221 -1900
FAX: 503 - 601 -3680
FEES
Quantity Description Date Amount
7 crt Branch Circuits wo /Purchase 04/10/2012 $100.70
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/10/2012 $12.08
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
•
Total $112.78
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 95 - 001 -0090, You may obtain a copy of the r • - ct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. .
Issued By: 1 . ` ■ Permittee Signature: • _� ! ..soy
�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.
From:Hi I lsboro Electric,LLC 5036013680 04/06/2012 15:06 #835 P.001/002
:
. RECEIVE,,
Electrical Permit Application FOR OFFICE USE ONLY
•
City of Tigard 6 R , NI ,
1 - • 13125 SW Han Blvd., Tigard, OR 97223 APR 2012 Emez
Plan Review
• Il
Phone: 503.718.2439 Fax: 503.598.1 OF TIGARD Datela ' Other Pennit: 47 / I
1 1(i A R D
• Inspection Line: 503.639.4175 Date Ready/By: -rt ....el 0 See Page 2 for
-
• Internet: www.tigard BUILDING DIVISIO ,. Notified/Method: Supplemental Information
KatOtafiIrte.A0VEM.W9f - 140.01tid:firMagialt i tg r aft Wag; i reakEt. 3 4/40 1 .1 : eatalMtatat
0 New construction Addition/alteration/replacement Please check all that apply (submit 1 sets of plans a//items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition Other: where the available fault current 0 Marinas and boatyards.
''':'i30:;14;1P/V-Al:ig.:P7r7-04-'4-ifi'AVVEAfilik:014k4r7cti*fiejirakliti'Sgtritek,!/$44.0:1:4;q4, exceeds 10.000 amps at 150 volts or 0 Floating buildings.
z4 "'''''''"''' - ' 4- '"' - ' t '''''' I '''''''" less to ground. or exceeds 14.000 13 Commercial-use agricultural
0 1- and 2-family dwelling Commercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family Master builder 0 Other: 0 Fire pump, 0 Installation of 75 KVA or
0 Emergency system.
load of larger separately derived system .
13
,
Job no.: - 77 (p Job site address: 1 3 9,1 6 co L016--p 1..,bC11 10011P or more.
13 Six Or more residential units. occupancy.
13 Recreational vehicle parks.
City/State/ZIP: 71 cr \
6 L, i - i-e LIED 0 Health-care facilities.
0 Hazardous locations. 0 Supply voltage for more than
600 volts nominal.
Suite/bldg./apt. no.: I Project name: lOct..C.- Prr,i') ['Service or feeder 600 amps or more.
MA-3/AfgliStr.
Cross street/directions to job site: Destrtgaloo 1 Qty. 1 Fee. 1 Total 1 •
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. fl. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: , Limited energy, residential
)g,a;,:;i14140kin.S9W-SW:.:R:SOIN::01.41,011-401014FASSINIMAZ* (with above 84 ' ft') 75.00 / 2
Limited energy, multi-faintly
-11-- residential (with above sq. ft.) 75.00 / 2
Services or feeders installation and/or relocation
200 amps or less 100.70 2
:i.,,t'V'v:.,'Atl'zfitiiiikiifr'ro 201 amps to 400 amps 133.56 2
. ':' , : , :::"'i.. - •,-*=.-"::-:. , ..--.ik-.... -, -2■..... -,Sx .t.:...i..., , n..-.....': r t .- i , t* 1.3= , , , :-.....,t, ,
N 401 amps to 600 amps 200.34 2
ame:
601 amps to I,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) I Fax; ( ) 200 amps or less 5936 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 _
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. amps to 599 amps _ 168.54 2
Branch circuits - new, alteration, or extension, er panel
Owner signature: Date: A. Fee for branch circuits with _
..,:-;.':,:r--k..e.P.V-9-411,',501;4064.' r '714 . 4714 ,- *Taltar40311946-irtiardMite04#4 above serviceor feeder fee,
742 2 1;4..-ige.V.1-..,_,..,,, ,.... eac b ranc h circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first
Contact name: branch circuit j 56.18 Sto 2
Each add'I branch circuit 7.42 L44 2
Address: Miscellaneous (service or feeder not Included)
Each manufactured or modular
City/State/ZIP:
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E
Sign or outline lighting 67.84 2
4 . , Signal circuit(s) or limited-energy
Business name: Hillsboro Electric, LLC panel, alteration, or extension. Page 2 _ 2
Each additional inspecdon over allowable In any of the above
Address: 21185 NW Evergreen Parkway #110 Additional inspection (I hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: Tigard
Industrial plant (I hr min) 78.18/ hr
Phone: (503) 439-9666 Fax: (503) 601-3680 Inspections for which no fee is
90.00/ hr
ifical listed 'A br min,
CCB Lic.: 134481 Electrical Lic.: 34-499C 1 Suprv. Lic.: 4 19 Li i s
: 1 - 7
Suprv. Electrician signature, required: V Subtotal: 1(90 0
ti7thzees
Plan review (25% of permit fee): .,-------
t
Print name: To c U 1 Crt (- C. 0 Date: 9 ... State surcharge (12% of pennit fee): 4 og
TOTAL PERMIT FEE: "I 4\---1 bl,
i., 1
Authorized signature:
This permit application expires If a permit Is not obaned within I
days after It has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
lAnuilding■PcrmIts 07 440-461ST(I 1(05/COMPNEB