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Permit
• n. CITY OF TIGARD ELECTRICAL PERMIT -: COMMUNITY DEVELOPMENT Permit #: ELC2012 -00557 :T t G A R D, 13125 SW Hall Blvd., Tigard OR 97223 503.718,2439 Date Issued: 09/25/2012 Parcel: 2S113AB00800 Jurisdiction: Tigard Site address: 16125 SW 72ND AVE Project: St. Jude Medical Center Subdivision: COUNCIL VIEW ACRES (LOTS 21 -44) Lot: 30 Project Description: (6) branch circuits for TI Contractor: LANPHERE CONSTRUCTION AND DEVELOPMENT L Owner: DUNCAN, JOHN ARTHUR & JANICE LEE 4160 SW 109TH AVENUE 9929 NW UPTON CT BEAVERTON, OR 97005 PORTLAND, OR 97229 PHONE: 503 - 718 -7934 PHONE: FAX: 503 - 718 -7935 FEES Quantity Description Date , Amount 6 crt Branch Circuit's wo /Purchase 09/25/2012 $93. Specifics: Service or Feeder 1 ea 12% State Surcharge - 09/25/2012 $11.19 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $104.47 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 OAR 52- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1 8800.33 Issued By: '1>;i.(/1X,('� t3ttC.bi. Permittee Signature: i t -Ppu ZE D 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. SEP /24/2012/M0N 12:08 PM FAX No. 503 P. 002 Electrical Permit Applicati °- t- - Cif of Tigard SEP 2 4 2012 Dat a �- a - vl9S.s7 n DateJBy: Permit No.: C 111, 13125 SW Hl Blvd.. Tigard, OR 9� Plaa Review Phone: 503.718.2439 Fax: 503.5 � � ! t� + a Other Permit: er(�Q/p — rO Inspection Line: 503.639.4175 ny �A°l� Date/By: r [GARD Q�[ f . r �r� a vows tlgard -or gov ` •* '-';!../i.!;,11.4,14 t ' Date R N r� S see Page for Internet '' Co Supplementalnformapoa s y Y. . - . t }T v F. s r . 1 ' : n r r 'Zr 1 .:: 9C"' ... I I f 1 %�,l •17f f 1 } 4 i. } 4y 1 T .... .. r k ..A� - �„ � jj 0 New construction ® AdditlOrl /alteratl0a/replacemcnl Please check ',•i!: ll that a (submit 2 sets o plans w /items checked b elow): ❑ Demolition ❑er: ❑ Service or feeder 400 amps or more ❑ Bnilding over three stories. K where the available fault current El Marinas and boatyards. y', � p } r r } "- ,1+,c� . ai Ta i. l � .. , 1 : .. rt , 1 , i „ I iii:Fi' exceeds 10,000 amps at 150 volts or ❑ Flo buildings. -� . , . � . ....... � . i. ;.w. i " " "' :' leas to ground, or exceeds 14,000 ❑ Commercial -us agricultural ❑ 1 - and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other inetallatioms. buildings. ❑ Multifamily ❑ Master builder C] Other: ❑ kne pump. ,r � 4rr �" - 1 Nw '7 n T 3 t 7 T ,.. la gee separately at 75 derived Or "1:. Y. , r {li ,1r� i t'r [� 4 P"'1 s r ,, ,m ❑ AMit 5 �. ? i t. „x 1.1, i�I z- --- 1 i ro + t} ion Yam• Inrgerseparatelyd SySlGn, .... _— ...::. _..._ . `r -Ja'j ❑ Add iti on of new motor load of ❑ °A", ••g••, �.1 -2 ". "1 d ". Job no.: 120009E Job site address: 16125 SW 72 ° Ave. J 10011Ror occupancy. in Six or mom residential unit& ❑ Recreational vehicle prim. City /State /ZIP: Portland, OR 97224 0Health -care facilities. (;J Supply voltage for more than _ ❑ Hazardous locations. 600 volts nominal, J Suite/bldg. /apt no.: Project name: • . ❑ Service or feeder 600 amps or more. Y Cross street/dircctions to job •:,-„ ..t•+ .. _. . : .0k: } r t . 1 3 , , d `, , `yi .t; .. - ••, 1 site: I/mailman _ m ori i,,.... Qtr. Fee. Total New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: 1,000 Lot no.: sq. ft or less 168.54 4 Tax map /parcel no.: Ea add') 500 sq. R, or portion 33,92 1 I t 7 r 7 � ., 7 h r y Limited energy. residontial P _ .� 4 , . - ... ..;, g. c [ q + 1t f l,.l + ti (with above sq 75.00 2 Add 1) new 20A circuit and receptacle. Relocate 4 branch ckt receptacles Limited resid energy, ieatial� with sq. 75.00 2 above sq. a ft,L Services or feeders installation, alteration, and/or relocation 200 amps or less 100,70 P •4 tv -::,g, :51 � % M[tl7 IN - I C` Z l c., a t � .. {� q , i { ". + 201 amps to400 amps 133,56 2 F : i++o ?' ........ � •`t`1:� - _. ` � .. � �.� 1- r ; ._,_e:.:•_ tel f 4J[ -' 1. 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 552,26 2 City/State/ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) p ax: ( ) 200 amps or less 59.36 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 sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Owner signature: Branch circuits — new, alteration, or extension, per panel Date: A, Fee for branch circuits with l .�,y , �hr� r i i . �W " "i'r t F + ;t , r 1 3 � abov stx or der fee, .. r�LT'.^1�e_,,. mac,. . �... .i 'w� _ui!7_ "r: �t 1 .LL y.3��'s:- t. �::r�§`� a : �f': ...a ° ea l'll branch ervi tirClli 7.42 2 Business name: B. Fee for branch circuits without service or feeder fee, first 1 56.18 B Contact name: branch circuit 56.18 2 Address; Each add•) branch circuit 5 742 37.10 2 Miscellaneous (service or feeder not included) City/State/ZIP: M}e Eachmanutacdormodular 67,84 2 dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 F42.441.1.7.41. E-mail: Pump or irrigation circle 67,24 2 (,7�� z: iT } 1 i ti - r Sign or outline lighting 67.84 2 f .i'.�:.i�N rlig :r..,. .i li 6 riS.C.3,'...1 i r Z y: f ", ,} :::', .c7. r h'. +i::. is Signal cirCuit(S) or limited-energy Business name.: Lanphere Construction and Development, LLC panel, alteration. or extension, Page 2 2 Each additional inspection over allowable in any of the above Address: 4160 SW 109 Ave. Additional inspection (1 hr min) 66,25/ hr City /St�ate/ZIP: Beaverton, OR 97005 Investigation (1 hr min) 66.251 hr - industrial plant (1 hr rain) 78.18/ llr Phone: (503) 718 -7934 Fax: (503) 718 -7935 N i l 3 Inspections for which no fee is f CCB Lie.: 197316 l l Electrical Lie.: C879 Q listed i5 hr min) 90 00/ hr -11111 Suprv. Lie :: 49315 1 n _ r lr r r N rF� 7 r f ,, . I?'. ' .r,;�I . Suprv. Electrician signature, required: ` Subtotal 93.28 — Plmr review (25% of permit fee): • Print name: Kent Zimmerman Daze: 09.24.12 State surcharge (12% of permit fee): 11.19 Authorized signature: TOTAL PERMIT FEE: 104.47 This permit application expires if a permit is not obtained within 180 Print name: Date: ` days after it has been accepted as complete. • Number of icspectionS allowed per permit. L:19uildingWermitslELC P rmitApp,dpc 07/01 /l0 440 1615T(11/05 /COMAWne • SEP /24/2012/MON 12:07 PM FAX No, 503 -718 -7935 P. 001 172 0. ) Construction & Development 4160 SW 109th Avenue • Beaverton, OR 97005 ,• P: 503.718.7934 • P. 503.718.7935 Fax To: City of Tigard - Electrical From: Ron Mann Fax: 503 -59 8-1960 Pages: 3 Phone: Data Monday, September 24, 2012 Re: Electrical Permit Application cc: ❑ Urgent 0 For Review ❑ Please Comment © Please Reply ❑ Please Recycle Comments: Please see the attached application and credit card information. • Thank you' Amber Floistad Construction & Facilities Administrator j Lanphere Construction & Development 4160 SW 109th Ave. I Beaverton, OR 97005 P.503.526.2151 I C:503.547.7946 I F:503.718.7935 afloistad@buybob.com I 'www.LanphereConstruction.com