Permit A CITY OF TIGARD ELECTRICAL PERMIT
a ' • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00565
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/27/2012
Parcel: 1 S 135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 350
Project: Softsource Subdivision: METZGER, TOWN OF Lot: 9
Project Description: (4) branch circuits 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
4 crt Branch Circuits wo /Purchase 09/27/2012 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 09/27/2012 $9.41
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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 -0090. You may obtain a •py of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: , L Permittee Signature: O k APPca efrn tJ
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.
09/27/2012 THU 13:34 FAX 5036242938 Willamette Electric lg1002/002
• - -
6)
Electrical Permit App . . . .
licat t CI - 1V-241)
,CE —.4 :':::,-',,, :: ;:.' :,.. :1 ...... I. OR OFFICE USE ONLY .::-..-:':..:.-.' :::-•'. ;•:-;:).:."''' ';',::
• - -
City of Tigard Received
Date/Bv: q ) 0 7 (3- sc Permit N -•
o.: 62...e. I,t). 005
II " 13125 SW Hall Blvd., Tigard, OR 972 . ., 3 2 7 2312 Plan Review Other Permit:
c Pe r
'' Phone: 503.639.4171 Fax: 503.598.1960 Date/By: .
TI GARD Inspection Line: 503.639A175 cm oF TIGARD Date Ready/By: TB See Page 2 for
Internet: vAim.li gard-or.gov
IlLMIG DIVISION Notified/Method: Supplemental 1n:formation
!!iy m. -:. ,. , : ,. .. : ,.. : :: . -, ., ‘ . ...:,., .,, , .., :., .., .: icr
Ej New construction 1E3 Addition/alteration/replacement Please check all that apply (submit a sets of plans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
.':tidEbbiiib:ettti)146Aildr4i*: : "T ":'• : : : ":' '. - : '''':-: exceeds 10,000 amps at 150 volts or 0 Flowing buildings.
, . . ... - , - less to ground, or exceeds 14,000 0 Commernial-iise agricultural
13 1- and 2-family dwelling 14 Commercial/industrial 0 Accessory building amps for all other installations. buildings. '......
o Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA Cir
.., 0 Emergency system. larger separately derived system.
po ::::::::::: 0 Addition of new motor load of 0 "A", V', "1-2", "1-3",
100HP or more. occupancy.
Job no.: 7 ) ;2-- I Job site address: /0;),?..e9 & re e" Az.er A/ 0 Six or more residential units. 0 Recreational vehicle parks.
0 Health-care facilities. 0 Supply voltage for more than
City/State/ZIP: 7 6.. v, e (7 4_ i .,_ ?- 0 Hazardous locations. 600 volts nominal.
0 Service or feeder 600 amps or more.
(t2))bit Idg./apt. no.: 3 s --0 Project name: _r . 7 ,--
'C- .:- . • . _.: .. ... :; '-:- 7 : - ';.:•:,::' -
Cross street/directions to job site: uts 1 lily. 1 its. I '... Totil . .:
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
75.00 2
' 'DESCRIPTION :15F WORK . . , , ': : . : : (with above sq. ft.)
Limited energy, multi-family
75.00 ' 2
residential (with above sq. ft.)
7 „.7.- fp& 1/ e ckt. rd., .7"
Services or feeders installation, alteration, and/or relocation
. . 200 amps or less 100.70 2
0 PH6P.BittV • I :. : • . - ..:0:Atrittist • • : ' • 201 amps to 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 services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59_36 I 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
401 t 599 am 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. amps o
Branch circui ps
ts - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
a . A P P L R A N T . - , : : . 1 i . . : ' ...0,0:ouern:ipisopr- above service or feeder fee,
each branch circuit 742 2
B. Fee for branch circuits without
Business name: _.. /V
service or feeder fee, first
/ 56.18 5 t - - - 2
Contact name: branch circuit
. Each add'l branch circuit 3 7.42 ?.... 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City/State/ZIP: 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 67.84 2 '
-'• ' :i 1.1 -. :-f; :. ::::E;: Vitin;: ''',;-.: .: .:.': '....::' :1 .: ;' :: ':, ,..-. Signal circuit(s) or limited
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) 6625/ hr
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: Tigard, OR 97281
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 624 .
I Fax: (503) 624 Inspections for which no fee is 90.00/hr
specifically listed %LT min) _ ..,..,_.....„.. ..
CCB Lic.: 75059 Electrical Lic.: 34 Suprv. Lic.: 4226 .... .... , ;:, !..1MOTATC`' :PEIWIT.1 , i
Subtotal: wagwAr
Suprv. Electrician signature, requi - • Plan review (25% of permit fbe):
47/
Print name: David Fife Date: --- //i 2___ State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE: 0 7
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
1:1BundimperriSMELC-PermitAppdoc 07/01/10 440.4615T(t Mt/COM/WEB