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Permit CITY OF TIGARD ELECTRICAL PERMIT °. COMMUNITY DEVELOPMENT Permit #: ELC2012 00377 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/21/2012 TIC; ;1. R. C} 9 Parcel: 1 S135AB01006 Jurisdiction: Tigard Site address: 10500 SW GREENBURG RD 200 Project: The Mutual Fund Store Subdivision: ASHBROOK FARM Lot: 6 Project Description: Sign or outline lighting Contractor: MICHAEL DAVID PAGINTON Owner: LINCOLN CENTER LLC BY SHORENSTEIN PROPERTIES LLC 555 CALIFORNIA ST 49TH FL SAN FRANCISCO, CA 94104 PHONE: PHONE: FAX: FEES Quantity Description Date Amount Specifics: 1 ea Sign or Outline Lighting 06/21/2012 $67.84 1 ea 12% State Surcharge - 06/21/2012 $8.14 • Electrical Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $75.98 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 •2 -001- X90. You ma obtain a copy of the rules or direct questions to OUNC by calling 503:232.1987 or 1.800.332.2344. A / OM, 4 0 e,4 flo LL Issued By: 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 site at the time of each Inspection. • (071 110( Electrical Permit Application FOR OFFICE I;SE ONIN Rece ived -, 03 7 Ci of Tigard ' ' Permit No � 5 g RECEIVE Plan Review : 0 . a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review C Phone: 503.718.2439 Fax: 503.598.1960 DateB : Other Permit: r I G A R D Inspection Line: 503.639 JUN 2 1 2012 Date Ready/By: IMII RI See Page 2 for Internet: www.tigard- or.gov Notified/Method: TYPE OF woerry0FTIGARD PLAN REVIEW ❑ New construction ❑ Addition/altergtiftewsION 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 J Other: 6( 4 14 -(, P where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", Job no.: Job site address: 0 600 5�, GIEw o vs I Six or or more. ❑ R c eation. ❑ Six or more residential units. Recreational vehicle parks. City/State /ZIP: 0� Q � 2.2 3 ❑ Health facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: 7/4E M t aDAL, v i 5-zge ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description J 1 11h• 1 Fee. I Total I • New residential single- or multi family dwelling unit. An ¢ &a tvulwe le Includes attached garage. Subdivision: 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 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi - family 75.00 2 5 /6 (/' f/_ ci P residential (with above sq. ft.) _ / Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 X PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: $/7 iere /A) /{ &A/i'fk ' 3 601 amps to 1,000 amps 301.04 2 Address: /0 Z40 j 554. (-,q),14'• Over 1,000 amps or volts 552.26 2 City/State /ZIP: pp,„ Ol�. 7 7 7- relocation services or feeders installation, alteration, and/or relocation Phone: (5i3 ) 5/?- 3 //o Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits - new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with r RI APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7.42 2 O each branch circuit ... Business name: BEAVEVTOn Si S I Mol.w►Avt Litir�tL.p x!, 1.1$ B. Fee for branch circuits without 7 service or feeder fee, first 56.18 2 .. Contact name: MI ckl iNtk k-ko L M vi branch circuit {� Each add'l branch circuit 7.42 2 1 Address: 3 $ 3 (- Apt I V L V p Miscellaneous (service or feeder not included) S. tA Each manufactured or modular City/State /ZIP: Q V ra-Tb © 1Z Si S COS dwelling, service and/or feeder 67.84 2 Phone: (503) 4: 72- 96 3-7 Fax: : (503 c7 y- 1/71// Reconnect only 67.84 2 �/� Pump or irrigation circle 67.84 2 /4 E -mail: , l!t if b V e - poi 6/1,n5 y 5 i Co f r r Sign or outline lighting 67.84 2 CONTRACTOR _ Signal circuit(s) or limited energy Business name: �'��ptD t Ses panel, alteration, or extension. Page 2 _ 2 1 F 1 Each additional inspection over allowable in any of the above Address: e3$9 9 S p II aL V Additional inspection (1 hr min) 66.25/ hr Investigation (1 hr min) 66.25/ hr cit Q L e. n , oa 9 7 0 6 3 Industrial plant (1 hr min) 78.18/ hr Phone: (163 ) 472_9a 7 Fax: (5 93 ) S w-111•41/ 4h/ Inspections for which no fee is 90.00/ hr .41 (9 specifically listed (%x hr min) CCB Lic.:W :) lectt a lc.: r Suprv. Lic.: 4(1 SIG ELECTRICAL PERMIT FEES �i '411 ■ ea: ® 01 � 1 1 � Subtotal: Suprv. Elec t st rue, requtr L ° Plan review (25% of permit fee): Print name: V may\ Rwb`te�6 -� /� Date: �� 1� �� State surcharge (12% of permit fee): Authorized signature _� : �+�,J" TOTAL PERMIT FEE: ///��� This permit application expires if a permit is not obtained within 180 Print name: rh ,_/' , %4 Date 6-2 /.._ /� • days do s it has been accepted as complete. /', Number of inspections allowed per permit.