Permit �t CITY OF TIGARD ELECTRICAL PERMIT
�'7 g COMMUNITY DEVELOPM Permit #: ELC2012 00630
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/05/2012
Parcel: 1 S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 210
Project: Advanced Wealth Subdivision: METZGER, TOWN OF Lot: 9
•
Project Description: (2) branch circuits for additional outlets
Contractor: CAPITOL ELECTRIC CO INC Owner: LINCOLN CENTER LLC
11401 NE MARX STREET BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97220 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 255 -9488 PHONE:
FAX: 503 - 257 -7121
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 11/05/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/05/2012 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
•
Total $71.23
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 thro 52- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 5,3 232.1987 or 1.800.332.2344. jj
Issued By: Permittee Signature: C�'�/ — �
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.
11/02/2012 12:56 5032577121 CAPITOL ELECTRIC PAGE 02/02
RECEIVED I') 0... „,t l•: (',tii• :(IN1.1
Electrical Permit Application a \R , 1 �' L Receive` / •
D ate/13y: / 6 i p Permit no.: �4G' 9_ Io, OO 4
IN City. of Tigard d`”
• 13125 SWI Hall Blvd.. Tigard, OR 97223 'NOV O ^^ P lan Review
gar U 1 Other Permit:
Phoite:'„303.639.4171 'Pax: 503.598:1960 Date/By:
T1i:i ;.f:.t, inspoctitinLhte: 501639,4475 CITYOFTIGARD DateRaady/By: Juris: ■ See Pap 2for
Internet•. www,tigard- or -gov Notificd/Method: sap .meltollnforinndan
BUILDING DIVISION
','- .-... ra. ,- N v �-n::, � iz7 `, 1 . :2E ii. � 5ptr- a �...:. -7 :.7:T ::: „
/ --war ,• - .-^.�_. 1..i �\ rr a'y -- J t`� . •.f,A.l i .3if�: �r .Jc '.
'. °. -.'1 - ... ate G '.. U
IN New construction 0 Addition/alteration/replacement please check an that apply (submit 2 nets of plena wlitt in checked belay ;
❑ Demolition U Other: ❑ Service or feeder 400 amps or more ❑ Building over throe stories
_ __ r q o-_ —. -- - - _ Marinas and boatyards
i �- ""' - _ . _ _: =;=�' -' ,a � � ' �- j,,;,l,j;,: WherethaeveAAble Taultcunenl Ma tY
:•�. .:�:: r _ ,,,._ -'.. _ -l.- �^ F'_.. t- :'i
. u:'w'S- '- �7:��i� �.`J:. .5 :�'!ti. . . - -. .. _,,..,�... •.r_ . }:.i -
■ I - and 2 -tinily dwelling 0 Commercial/industrial • Accessory building exceeds 10,000 amps at ISO volts or ❑ Floating buildings
❑ Multi -fami ❑ Master Builder El Other lase to ground, or exceeds 14.000 ❑ Commorctat-use agricultural
-.— • 7 ;;; _s••- "",�' , 1. � l u' "C' - -7 ::= I other Installations. buildings
.::ii55 _'wG it ,n.,71�e"�. ,�t�5�i ;n;a�n'o���ru��' ;c'T;r•;;: _ 1 7 Y -"• em for au
❑ Fire Pump ❑ Installation of 75 KVA or
Job no.: 130026 Job site adds: 10220 SW Greanburg Rd ❑ Emergency system larger aeperately derived system.
City /State/ZlP: Tigard OR ❑ Addition of new motor load of CI •A", "E", "1.2°, "1.3",
100HP or mare. El orxupancy
Suite/bldg, /apt. no.: 210 [Project Project name: Advanced Wealth Added Outlets ❑ six or more residential unite ❑ Recreational vehicle parks.
El Health-care facilities ❑ Supply voltage for more than
Cross Streel/i)irections to job site: W El Hazardous locations 600 volts nominal,
El service or feeder 600 em or more
Subdivision: ,Lot no.: Description ^ ` :.:_ . ` _ kale Total
'..-- ma. I. =el no.: - New residential - single or multi- fsmlly dwelling unit.
' - -. .c-a .ci:: -.7 .Z- �C Y I9 G!-1 : ,27y' Frcf .. - . - ` —. : 1 I ncludes attached garage.
SrS ': , ,::�: , :;'. :.:"�t:l~s.-.. • : �::sca� - �L'. _ .V_u�.. : ,�t.��,�... ��: �:: `.x� . .� _. . `. -
Install GP outlets - 10oo sq. ft, Or less $ 160,54 4
. Ea; Add? 500 sq. It or portion S 33.92 , 1
. _ _ ; — c
■ a.a-ir •i -t': ,. c;-`n la_l :l;i"G`.F'�+3 a ;. Y ' ����n� -- - ,-
:.....�� limited energy residential
' ' (with above 9. fl.) S 75.00 2 -
Name:
_ Limited energy, multifamily
' residential (with above sq. ft.) S 75.00 2
Address:
Service or ficdera Installation, alteration, and/or relocation
City /State/ZiP: 200 amps or less S 100.70 2
201 amps to 400 amps S 133.56 2
Phone: Fax: 401 amps to 600 amps S 200.34 2
601 amps to 1000 amps . S 301,04 2
Owner instnilatlan: This installation is being made on property that 1 own which is not Over 1000 amps or volts S 552,26 2 ,
intended for sale, lease, rent or exchange, according to ORS 447, 449, 670. and 701 Temporary services or feeders installation, alteration, aud/or
Owner signature: Date: relocation
• 200 amps or less l 4 5 9,36 1
■`17 ::.:• : ";rc c�•= 7,* " i 7 ■kIC n r` I'd - 201 am to 400am s J { 1 S 125.08 2
:.. [ " 4, l _ . ; rt, :,.. n ,k ql.- .l : a a. %F::�;:. PS _ P
Business Name: 40] amps to 599 amps S 168.4 2
Branch circuits - new, alteration, or extension, per panel .
A, Fee for branch circuits with '
Contact na service or feeder fee. each' '
branch circuit' 5 7,42 2
Address: .
B. Fee for branch circuits ,
_ without semvicc or feeder fee. •
City/Smtc/ZiP: first branch circwt . 1 S 50,18 68.18 2
Each additional branch circuit: • 1 S 7,42 7,42 _ 2 '
Phone: Fax: Mlacelleaeous (service or feeder not included) •
E -mail: Each manufbctured or modular .
dwelling, service rind or fader s 67.64 2
Business Name: CAPITOL ELECTRIC CO., INC. Reconnect only S 67,114 2
• Pump or irrigation circle S 67.84 2
Contact name: Gary Stolen Signal or outline Iighting , S 67.84 2
Signal circuits) or limited -
Address: 11401 NE MARX ST. energy panel, alterations, or
_ extension, Describe: S 75,00 2
' City/Statc/ZtP: PORTLAND, OR 97220 -1041 1 Page 2 - —
• Each additional Inspection over allowable In any of the above
Phone: 503.265.9488 Fax: 503 - 257.7121 Per inspection S 66.25
t tlon per hour (I hr min) $ 66.25
CCB Lie.: 46748 'Electrical Lie„ 26 -496C , Lie.; 3132-S industrial .lent er hour S 78.18
required: Electrician signature, , ' � ;i:;S:'= ='l : °:;i 24 ! 1 . .. cl , ..: -: _ -n
_ Subtotal $ 85.80
Print Name: Darrell M % .t : 1110 ., 2 Plan review (25% of permit fee)
l 7 T ate surc ( 12% of permit fee) ; 1.23
Authorized signature: Tp TOTAL PERMIT FEE S 71.23
Print Name: DarrflrMCN I This permit application replan Ira neemb I. not obtained a4thin ISO
drop Otte 11 hat meant aeenpted am complete.
• Number of inspections per permit allowed,
L• \Dut4,a\P, -„,ro .r- permlIApp.dnc 10/sbus 44046151111M520MIwsa
11/02/2012 12:56 5032577121 CAPITOL ELECTRIC PAGE 01/02
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Payment Authorization Form
13125 SW Hall. Blvd. • Tigard, Oregon 97223
Ti G A RD Building Division: 503.718.2439 • Planning/Engineering: 503.718.2421
Fax: 503.598.1960 • Internet: www.ti l and -.r. l ov
Permit No.:
Job Site Address: f 0 2.70� 1 Co JAL
Project Name: 1'4\10 J /,1LX.6 c A('T1-I A 9 0sr..0
Credit Card Information: Please printelearly.
21-VISA ❑ MasterCard _ 117 5 3 4SS — . 67 17 / o -
n Discover (credit card account number)
Expiration date: / /
Cardholder name on card: 1 -744,J / . ��--
Contact phone number: '7 7( 2t-7 <124-
Bilking address for this card: / Pi o (
Billing ZIP code: 17 2— -
rust A,cc unt I r matio : For permit fees to be paid from established trust account.
Trust account number:
Contractor /Business name:
Contact phone number:
I hereby give the City of Tigard permission to pay for the above referenced
permit with the credit card or trust account provided above.
Authorized Signature: AP
—
Name Printed f j 011-.J
Date.
Please FAX this completed and signed form to 503.598.1960.
* ** DO NOT EMAIL THIS FORM. x
For your protection, this form will be destroyed after your payment has been processed.
it \Building \ Fotrret\PaymentAurhciromtion_03 G 12.doc