Permit CITY OF TIGARD ELECTRICAL PERMIT
111 ' COMMUNITY DEVELOPMENT Permit #: ELC2012 -00314
T [ G A D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/23/2012
Parcel: 1S135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 487
Project: Sperry Van Ness Subdivision: METZGER, TOWN OF Lot: 9
Project Description: (1) branch circuit for TI
Contractor: WILLAMETTE ELECTRIC INC Owner: LINCOLN CENTER LLC
PO BOX 230547 BY SHORENSTEIN PROPERTIES LLC
TIGARD, OR 97281 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 624 -3631 PHONE:
FAX: 503 - 624 -2938
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 05/23/2012 $56.18
Specifics: • Service or Feeder
1 ea 12% State Surcharge - 05/23/2012 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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: 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 52- 001 -0090. You ( m � ay � ob b tain a copy of the rules or direct questions to OUNC by calling 503.2322..1 987 or 1.800.332. 44.
Issued By: MAc.1C/� Permittee 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 she at the time of each Inspection.
Electrical Permit Application FOR OFFICE USE ONLY
74 Il City of Tigard R Fr I 14-4' °I Permit N6 . 1 /..... 003,
13125 SW Hall Blvd., Tigard, OR 97223 • P ` — :mew
C . Phone: 503.639.4171 Fax: 503.598.1960 I Rptg/BY; Other Permit: 8 te/' .700.,._ .700.,._ fig],,
Inspection Line: 503.639.4175 MAY 2 3 ®hfe Ready/By: lode 13 ® See Page 2 for
T I G A R D p N otified/Method: 4 ° Supplemental Internet: www.tigard or.gov � � pp emental Information
7'YPE' WORK !'' vI - 1' °, r 1 ; 1) - I141f, ;LL
El New construction Addition/alteration/replace @h '' "/ ' °�' r Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
' ' ,, _.. _.., C ATTGOR' tt`' 0E . C1'+bNSA ` RUCITON �.. _;. - • : ; ,;
. exceeds amps at volts Floating g ngs.
less to ground, or exceeds 14,000 ❑ Commercial -use
agricultural
❑ 1- and 2- family dwelling fLCommercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
anger separately derived system.
OB= 1`t ORMA IO ,: t A N D L O C A , ,9-$ ' _ , _ A
: :: : : ...,, : � : :' ; L.
,. � �..__ _.... ..:..�.,. -... , ... . , � .,. __.,.. ..... ... • •. - motor load of "A ", "E », "1 -2 », "1 -3 ",
_ ❑ Addition of new m ❑
/ 7 f� Job site address: 2 100HP or more. occupancy.
Job no.:
(p / le I t7 Z G 5 L � r r� z " eS l..� l s— ❑ Six or more residential units. ❑ Recreational vehicle parks.
City ( (/ r ❑ Health-care facilities. ❑ Supply voltage for more than
ty / U' v 0 , ` 9 7 �—� ['Hazardous locations. 600 volts nominal.
lilt ldg. /apt no.: ��' 7 1 Project name: -3 flan,,. 1/ a,A p./ t° SS Service or feeder 600 amps or more.
❑
, .,•''r:; PE- E1 4SC7#_DULE , -- ,:•; ■ Cross street/directions to job site: Description I Q tr. I Fee. I Total . I •
New residential single- or multi- family dwelling unit.
. Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
75.00 2
- D E S CR IPTION::•OF: :'WORK '' (with above sq. ft.)
; ... , . .._ �� Limited energy, multi-family 75.00 • 2
7:0..A..1 ' _ � /- It ✓'' M ��
Services or feeders installation, (with above s it
/ !� llation, alteration, and/or relocation
200 amps or less 100.70 2
Cl PROPERTY -OWNER . ®., 'EIVANT amps to mps
400 amps 133.56 2
• 401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary
City/ State/ZIP: relocation services or feeders installation, alteration, and/or
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 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
;:= ' (]..APPLICANT.:,: - � : ® C CT PERSON =: feeder fee„ 7.42 2
- -- each branch circuit
Business name: B. Fee for branch circuits withou
service or feeder fee, first i 56.18 sV / 2
Contact name: branch circuit
. Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
tY dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E ,
, Sign or outline lighting ._ hng
. . . _ . 67.84 2
. _. .: . - ''Uhl CX IV, ` � }i °''
- ., :. , -' '
.. - . .. ,,..�. � , +. ; 4 .:!::: , ` ,. Signal circuit(s) or
Business name: Willamette Electric Inc. panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: P.O. Box 230547 Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Tigard, OR 97281 Investigation (1 hr min) 66.25/ hr
-
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 624 -3631 I Fax: (503) 624 - 2938 Inspections for which no fee is 90.00 / hr
specifically listed (4 hr min)
CCB Lic.: 75059 Electrical Lic.: 34 -283C 1 Suprv. Lic.: 4226 - ELECTRICAL PE `PEES ":
Suprv. Electrician signature, requ• Subtotal: 56 ie
Plan review (25% of permit fee):
Print name: David Fife I Date: State surcharge (12a /o of permit fee): &
TOTAL PERMIT FEE: 4 2- ��
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: 1 Date days after it has been accepted as complete.
Number of inspections allowed per permit.
13.BuildingTenoits \ELC- PermitApp.doc 07/01/10 440- 4615T(11 /05 /COMNWEB
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