Permit p CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00269
Date Issued: 05/09/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1S135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 110
Project: Terra Staffing Subdivision: METZGER, TOWN OF Lot: 9
Project Description: (8) branch circuits for 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: 513 - 619 -3200
FAX: 503 - 257 -7121
FEES
Quantity Description Date Amount
8 crt Branch Circuits wo /Purchase 05/09/2012 $108.12
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/09/2012 $12.97
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $121.09
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 0A- • •2 -1 • 0. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /
Issued By: ��t�� Permittee Signature: /1/(/ `9 / t./
0/
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 503.639.4176 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.
•
05/07/2012 08:03 5032577121 CAPITOL ELECTRIC PAGE 02/02
RECEIVED
Electrical Permit Application hOR01 FICE U,s►;°NI.Y
Received
City of Tigard MAY - 7 2012 Dntr/By: / 'Z Perin it no &GC,24i01. — 0o c,26, 9
83 125 SW Hull Blvd., Tigard, OR 97223 Plan Review
- Phone: 503.639.4171 Fax: 501598.1960 CITY OF TIGARD DatdlSY; Other Pcnnu
icPav2 Odd o
T , „ Inspection Line: 503.634.4175 BUILDING DIVISIO Date Ready /By: Ju hu / - f-_,.. f-_,.. s e. Pope 2car
Internet: vvww,tigard 11 - or,gOv Notified /Method: U enrolemenmllnnmmotian
TYPE OF WORK PLAN REVIEW
I_ I Ncw construction Li Adrlitinn/alteration/replaccment Please check an mat apply (submit 2 sets of plans wttems checked below);
[i Demolition ❑ Other: ❑ Service or feeder 400 amps or more U Building over three. ;dories
CATEGORY OF CONSTRUCTION where the available fault current I_ I Marinas and boatyards
I .1 I.- and 2- family dwelling L Cnntnlcrcial/industrial El Memory building exceeds 10.000 amps at 150 volts or ❑ Floating buildings
❑ Multi - family ❑ Master Builder Cl Other less to ground. or excnnds 14,000 U Commercial• use agricultural
JOB SITE INFORMATION A.ND LOCATION amps for all Other Installations. buildings
Joh nn.: 120523 Job site address: 10300 SW Greenburg Rd ❑Fins Pump ❑ Installation of 75 KVA or
Cl Emergency system larger separately derived system.
City /Staccl /.I P; Tigard OR 111 Addition of new motor loaf( of ❑ "A ". "E"."1-2", '1•3",
t00HP or move, LJ occupancy
$u;tc/hldp. /apt. no.: ' ruiect name: Terra Staffing 11 Six or mom residential units ❑ Roereatbnsl vehicle parka.
❑ Health -care facilities ❑ Supply voltage for more then
Cross Street/Directions tope! site: ❑ l laz lydo is locations 6(10 volts nominal.
1..1 Service or feeder 600 amps or more
FEB SCHEDULE
Subrlivisiun; Lot no.: Description I Qtr, I Fee. I Total 1 "
Tax mop /parcel lln.: New residential • single or multi- family dwelling unit.
DESCRIPTION OF WORK Includes attached garage. ,
Tenant ►mpmvenmcnt 1000 sq. 0. or Tess S 168.54 4
. Ea. Mull 500 sq. ft or portion $ _ 33.92 I
LI PROPERTY OWNER I U T Limited energy residential
Name `with above sq. fl.) S 75.00 f 2
Limited =era, multi-Amity
residential (with above sq. ft,) - 5 75,1)0 2
Address' Service or feeders inatatlatinn, alteration, and/or relocation
200 ants or Iris S 100.70 2
City/State/ZIP: 201 amps to 400 amps S 131,56 2 _
Phone Fax: 401 amps to 600 amps 5 200.34 2
001 amps t0 1000 amps S 301.04 2
Owner Installation: This installation is being made on property that t own which is not Over 1000 amps or volts 5 55216 2
intended for sale, lease, rent or exchange, according to ORS 447. 449, 670. and 701 Temporary services or feeders installation, alteration, and/or
Owner signature: Date: relocation
200 amps or less 5 59.36 I _
• APPLICANT _I CONTACT' PERSON _ 201 amps to 400 amps S 125.08 2
401 amps to 599 amps S 168,54 _ 2
Bustncas Name: Branch circuits • new, alteration, or extenslnn, per panel
A. Fee for branch circuits with
Contact name:
service or feeder fee. each
Address: branch circuit 5 7.42 2
B. Fee for branch circuits
without service or feeder fee,
City/StatrJZIP: first branch circuit 1 S 56.18 56.18 2
Phone: Fax: Each additional branch circuit: 7 _ 5 7.42 51.84 2
_ Miscellaneous (service or feeder not Included)
E -mail; Each manuMCturcd or modular
CONTRACTOR dwelling, service and or feeder $ 67.54 2
Business Name; CAPITOL ELECTRIC CO„ INC. Reconnect only $ 67,84 2
Pump or irrigation circle S 67.84 2
Contact name: Gary Stelert Sign or outline lighting S 67.84 2
Signal cireail(s) or limited -
Addrettct 11401 NE MARX ST. energy pane, alterations, or
_ extension. Describe; 5 75.00 2
City/Slate/ZIP: PORTLAND, OR 97220 -1041 - Page
2
Each additional Inspection over allowable In any o_f the above
hone: 503.255.9488 / Fax: 257.7121 Per inspection S w; 25
-
S 61.25
Investigation per hour (1 hr min)
C (B Lie.; 48748 ✓ lF,leetrieal Lie.: 26-496C Suprv. Lic,; 3132$ Industrial plant per hour S 78.18
Suprv. Electrician signature. required / S ub ✓ o aRtCAL PERMIT FEES•
Subtotal S 108,12
Print Name: Darrell M . - �0 12 Plan review (25 %ofpcmtil fee)
4, Authorised signature: r% State surcharge ( 12% of permit fee) E 12.97 i /
TOTAL. PERMIT FEF. $ 121.09
mint Name: Parrs cNeel Thi, pr rm rtnpplkaaon *viral Ifaarrmit not aeta •oed within 100
Om aflrr II hnn h.r„ ace.p tad as complete.
. Ntunber of Inapeetirma per permit allowed.
eWuildineWrr. r ioARir.Pem,nnpp.dne 10/61/00 440- 4615T(II/05 /COA