Permit CITY OF TIGARD ELECTRICAL PERMIT
" . 8 COMMUNITY DEVELOPMENT Permit #: ELC2013 00120
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/27/2013
Parcel: 1 S134BC00300
Jurisdiction: Tigard
Site address: 12220 SW SCHOLLS FERRY RD
Project: Greenway Town Center Subdivision: GREENWOOD TERRACE CONDO Lot: 17
Project Description: (6) branch circuits to install new 320w PS MH fixture heads and remove 400w MH pole light heads
Contractor: SYLVANIA LIGHTING SERVICES INC Owner: FW OR- GREENWAY TOWN CENTER LLC
12535 NE MARX ST PO BOX 790830
PORTLAND, OR 97230 SAN ANTONIO, TX 78279
PHONE: 503 - 262 -8177 PHONE:
FAX: 503 - 262 -8401
FEES
Quantity Description Date Amount
6 crt Branch Circuits wo /Purchase 02/27/2013 $93.28
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/27/2013 $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 OA 52 -001- 090. You or
1� may obttaain copy of the rules or direct questions to OUNC by calling 503.2332.1987 or 1.800.332.2344.
Issued By: ty t 'L-Kit Permittee Signature: Vk! ' t f P` CA—
(/ 0
/ 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.
2013 - Feb -19 03:39 PM Portland SLS Office (503) 262 -8401 1/
Electrical Permit Application 1, fat 0141(.1.; I.iSI; ()NI.,Y
City of Tigard RECEIVED Re6 Femur N o.: ,
tY Daten3y: a I j D I Sf Clt (9.0 3 -- op l g._
N 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review
Nri Phone: 503.718.2439 Fax: 503.598 960, Date/BY: Other Permit:
T I C. A It U Inspection Lino: 503.639.4175 C D 1 9 7 7,1 Data Raady/By: torte' I El See Pap 2 hr
Internet: www•tigard- or,gov Notified/Method: 1 1 SupplamontelInformation
_ 'ME o iCITIOF TIGARD PLAN REVIEW
❑ New construction 2g ION Please check all that apply (submit y seta of plans w /items checked below):
❑ Service a feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available (bolt current ❑ Mauna, and boatyards.
CATEGORY OF CONSTRUCTION a exceeds 10,000 amps at 150 volts or ❑ Floating buildings,
lase to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling mercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family Master builder ❑ Other: ❑ Fire ptunp. ❑ installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergenoys�em. larger separately derived system.
❑ Addition of new motor lead of ❑ "A ". "B".' 1 - 2 ". "1.3 ".
Job no.: Job site address: qq 1001W or morn. occupancy.
/4 2 . Q , W S et MD/S ❑ Six or more residential units, L I Recreational vehicle patio.
City /State/ZIP: 77 ope A p , � * '�a�, 3 ❑ Health -care facilities. ❑ Supply voltage lbr more then
❑ Hamrdaua locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or fader 600 amps or more.
Cross street/directions to FEE SCHEDULE
Job site:
J Dered • rion .I. 1 Total
•
C New residential single- or multi family dwelling unit,
C`7 i2 Elw. Y i d w , Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. R or less 168.54 4
Tax map/parcel no.: Ea. add'I 500 sq. ft. orponlon 33.92 1
Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above Q. R)
Limited energy. multi -family 7500 2
Q 61/9 ( l(W Lk/ m. -h pg/ Ltd ter A0'71 -o s t tN4T/4-/( residential (with above se. R.)
Services or feeders installation alteration, and /or relocation
IVt L4J $cSLO W 0 5 f'tt H' ft Zi It S • 200 amps or leis _ 100.70 2
{'PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 6 ! w 72 w"/ C 1 � 401 amps to 1, 0 amps amps 30.04 2
601 amps to 1,000 amps 3011.04 2
Address: /2_azp Sec/ cd ad i ii t;s 2 l 2 •y Over 1,000 amps or volts 552.26 2
Temporary services or feeders Installation, alteration, and /or
City/State/ZIP:
f p s i BD , Va relocation
Phone: ( ) Fax: ( ) 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 166,54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
APPLICANT I ❑ CONTACT PERSON above service or fender fee, 7 42 2
each branch circuit
Business name: 6°y /1/4.0 (1 4„ ,L 16 *r, 5-ego t',w- B. Fee for branch circuits without
`7 service or fbeder Ibe, first
Contact name: 77,- C8 4 branch circuit I 56.18 9� 2
Each inlet branch circuit 5 7.42 57 .- 2
Address:
/.25 - 3.s /Va- fy) i9.2,4C „:if" Miscellaneous (service or feeder not Included)
�y _ _ G� Each manufactured or modular
City/State/ZIP:
AR Zteu l) � T 7 3 a dwenbhp, service and/or feeder 6734 2
Phone: (gD3) a _ei 9- Pax:: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: OS S 41 o(A a .S /✓iN p .. Cc WI
CONTRACTOR ` Sign or audios lighting 67.84 2
Signal circuit(s) or limited - energy
Business name: 5,9"Ih A.114vb-- panel, alteration, or MUM ion. Page 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (I hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City/State/ZIP: - - Industrial plant (I hr min) 78,18/hr
Phone: ( ) *2,5 Ii 3 I Fax: ( ) Inspections for which no Poo is 90.00/ hr
speelfleally listed OS hr min)
CCB Lia.: . 0 2 Electrical LW.: V Suprv. Lic.45 -r ° a t, S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: - 7 11 1 i C I I Subtotal: q$ . air
Plan review (25% of permit fee): --
Print name: m ere, ill 7—E 41 of Date: State eurcharga (12% of permit fee): //
TOTAL PERMIT PEE / Q 4/ �,�
Authorized signature: Tbb permit application expires Ifa permit is not obtained within 180
d ays after it has been accepted as complete.
Print name: I ^�� �� Date: ��� 0 Number of ins pection, allowed per permit.
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