Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00381
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/25/2012
TIGARD Parcel: 25101 DA00104
Jurisdiction: TIGARD
Site address: 13333 SW 68TH PKWY, STE# 010
Project: National American University Subdivision: VARNS ACRES Lot: 9
Project Description: (23) branch circuits for TI
Contractor: E C COMPANY Owner: TRIANGLE POINTE LLC
PO BOX 10286 901 NE GLISAN ST, #100
PORTLAND, OR 97296 PORTLAND, OR 97232
PHONE: 503 - 224 -3511 PHONE: 503 - 297 -8791
FAX: 503 - 295 -3012
FEES
Quantity Description Date Amount
23 crt Branch Circuits wo /Purchase 06/25/2012 $219.42
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/25/2012 $26.33
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $245.75
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 9 2 -001- 090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: DM A f 1. PU Cl4/ [rf
i9A1
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.
Jun. 25. 201210:48AM No. 0743 P. 1
Electrical Permit ApplicationRE sort orr,f:l: USE ONLY
Ci of Tigard
D Receiv
City Permit N a.:
Date/B . E1- �.er10Ja -DD
13125 SW Hall Blvd.,1'igard, OR 97223 �
u
Plan r eview
• Phone: 503.7181439 Fait: 503.598.19 UN 2 5 2012 Date/Oy. Other Permit: tcf PJO a- 00 t(
Inspection Line: 503.639.4175 Date Rea
t' l t_i A It U Ready lug 21 See Page 2 for
Internet www.ligard or.gov • CITY OF Tic; • Na t ilied/Method: •T� 0, I Supplemental lnformadon
=- $.''''''''''''-.. "__ 4L.:---'"',0?-6-'1=-Viii, _ - 'a s s - ; w PDT`. -- . ._.. -- i�:= 1 -
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit z sets of plans whims checked below):
❑ Demolition ❑Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current Cl Marinas and boatyards.
�� - 6 teal' i l ce: {• i exceeds ❑ buildings,
AYE', aa..__ � _. - . _� - , nom _ �'' _= pS et 150 tolls or F7 oating • - - - "�'` .. - less to ground, or exceeds 14,000 ❑ Commercial - use agriculnual
❑ 1 - and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps far all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Inclallation of 75 KVA or
'-_ -sq' _ : �; 9.11-'IN t tea �?, . • : - ❑ Emergency system, larger separately derived system, • _._, = ❑ Addison of new motor load of ❑ °A ", "E "1 - 2", "1 -
Job no.: 74620 Job site address: 13333 SW 68 Parkway 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks,
City/State/211 Tigard OR 97223 ❑Health -care faciiitiee. ❑ Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt, no.: 0 ( l7 I Project name: National American lJ fl J.e¢S � -_ ❑Service or fee 600 amps or more.
Cross street/directions to job site: i >_ 4. •r- Ir. B
besctrptbn -•,•ti =.`_".'.- = -'iii= :( -:=
1 tr, I Pre. I Tout i .
New residential single- or multi - family dwelling unit,
Includes attached garage,
Subdivision: I Lot no.: 1,000 sq. R. or less 168.54 4
Tax map /parcel no.:
Ea add'/ 500 sq. ft. or portion 33.92 1
�� - _: Limited energy, residential
. 3k ti ' a.,z — : :. __ t –4 "a - o ".NCO ; _-- 1 ;+ _ tee (with above sq. ft.) 75,00 2
F - - =_ u : -: r_ • -- '' -= - "•` ; ,,gi g
Limited energy, multi- lbntily 75.00 1 2
Tenant improvement Including new lighting and receptacles in a 12000 sf space. residential (with above sq. R)
Services or feeders instaltation, alteration, and/or relocation
200 amps or less 100.70 2
,, • = T " 1 :::- z i . . ;r, ass . I� ,� " �, ?� •., 201 amps to 400 amps 13156 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 55226 2
City/Slate /ZIP: Temporary services or feeders installation, alteration, and/or
relg calim !
Phone: ( ) rFax: ( ) 200 amps or less I 59.36 1 1
Owner Installation: This installation is being made on property that I own which is not 201 amps to 400 amps --- 125.08 2
intended for salt, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps ( 168.54 2
Branch circuits -new. alteration, or extension, per panel
Owner signature: Date: A. Fee lbr branch circuits with
`r;:> "ONO ° 4 ; w 2 4 = ' -- T_ - above servicemrfeeder
7
s:. x� .' ' ' ti=- ®° .:c , (L�1 -=3 ,42
- each bmnch circuit 2
Business name: EC Company B. Fee for branch circuits wrirhoru
service or feeder fee, first 1 56.18 56 2
Contact name: Kathy Keley branch circuit
-
Each add'I branch circuit 22 7.42 163.24 2
Address: PO Box 10286
Miscellaneous (service or feeder not included) -
City /State/Z1P: Portland OR 97296 -
Each manufactured or modular 67.84 2
dwelling service and/or feeder
Phone: (S03) 224 -3511 I Pax: : (503) 248 -6353 Reconnect only 67.84 2
E- mail: kethylc@e- c- c0.com Pump or inigelion circle 67.84 2
_ - -� —y : , .., _ _ _ Sign or outline lighting 67.84 2
r b' Gti -_• : --•, 41 . Signal ells—snip) or limited-energy
Business name: EC Company panel, alteration, or extension. Pope 2 2
Each additional inspection over allowable In any of the abov
Address: PO Box 10286 Additional inspection (I hr min) 66.25/ hr
City /State/ZJP: Portland OR 97296 investigation (1 hr min) 6625 /h r
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 224 - 3511 J Fax: (503) 248 inspections for which no fee is III 90.00 / hr
s , > Meal listed (Vs hr min
CCB Lic.: 49737 Electrical Lie.: 26 -45C Suprv, Lie.: 2345-S - ' t , , :_ ; by ;•.,_ _
Suprv. Electrician signature, required: Subtotal: 219.42
Pion review (25% of permit fee):
Print name: Ron Coffman / �- • Date: 6 -25 -2012 Stale surcharg ( 12 % ofpermit fee): 26.33
AM
,� o f A TOTAL PERMIT FEE: 245.75
Authorized signature: a, � C t pp
This permit alica expires If a permit is not obtained within 180
Print name: Anna Hat Da e: 6 -25 -2012 • days after it has been accepted as complete.
• Number of inspections allowed per permit.
L• 1Boeding1Perrnhat- C- PcrmrApp.doe 07/01/10 4904615Tt11/05!COM/WED