Permit p CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2013 -00199
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/02/2013
Parcel: 1 S135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 600
Project: Axium Subdivision: METZGER, TOWN OF Lot: 9
Project Description: (1) branch circuit
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
1 crt Branch Circuits wo /Purchase 04 /02/2013 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/02/2013 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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. ATTEN + •: • :.•n law requires you to follow the rules adopted by the Oregon Utility N• " - i• Center. Those rules are set forth in OAR
952- 001 -001 through OAR • • • 00• •. You may obtain a copy of the rules or direct questions to OUNC bb 1987 or 1.800.332.2344
Issued B • / - / iIL •4 _ _ Permittee Signatu � /
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' C 04—e[ 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.
04/01/2013 11:25 5032577121 CAPITOL ELECTRIC PAGE 02/02
Electrical Permit Application -EC ETVED i flu ui'i i h: l yi1'; ()NIA'
eeetvc•
City of Tigard Date/Ay. 'C // 3 j, Permit no.: b..e X0/3 -QO / F'
• 13125 SW Hit Blvd., Tigard, OR 97223 ANA 1 2013 Plan Review Other Permit:
V' Phone; 503,639,4171 Fax: 503.598.196 Datc/By.
TI , ; n n Errspection Li he' 50 '1lGA Datc Rcady /By: Juris: ❑ S ee ' oar 2 for
Internet: www.tlgard- or.gov (ititarraCONLSION Notified/Method: _ siippiornisnini lnfor 0iiori
,.... , - _ ~Y-:.. Val, iiiiMidirMINME
New construction O Addition /alteration /replacement Please check ell that apply (submit S sets of plans w /items checked below)'
❑ Demolition 0 Other; ❑ Service or tocdcr 400 amps or more ❑ Building over three stories
- • 17 1 : ' t ;. d +t r � k -:,4 • 1;, ,;yf,, • ,,,. where the available fault current Marinas and boatyards
❑ Y 1 - and 2- family dwelling 0 Commercial/industrial ❑ Accessory building exceeds 10,000 amps at 150 volts or ❑ Floating buildings
❑ Multi - family ❑ Master Builder ❑ Other less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
*, t, % ". ,''r r �r : fi 3."
.�.,, �. r 1 Amps all o
„ � "q ;ti�.�,, A •'p� r' . �1���. ,t,_... A;,;fn � am p other Installations buildings
Job no.; 130754 1 Job site address: 10200 SW Greenburg Rd ❑ Fite rump ❑ Inste9Plfon Or 75 KVA or
❑ Emergency system larger separately derived system.
❑ AOSit+on or new motor load of ❑ "A ". "E "1.2', "'-3',
City/State /ZIP Tigard OR
100HP or snore, ❑ occupancy
0
Suite/bldg. /apt. Co. Suite 600 'Project name Axium Base Food Six or more residential units ❑ Recreational vonide parks.
❑ Health -care Facilities ❑ Supply voltage for more than
Cross Street /Directions to job site: ❑ Hanardous locations 600 volts nominal,
❑ Service or feeder 600 am. • or more _ _
Subdivision Lot n0. '. „.,,,rs' i, S 51,y OM:ri�:iw. ice: ;y( ^a :' .."r._:! :.._.'ic ~`'- "”. '4:+t:'t.�•::',_._t.'s... .
Description Q. Fee. 7044 "
Tax map /parse: no New residential - single or multi - family dwelling unit.
tin •,t: . .9rat =TZ SC' a ,T ONCIE-W,ORK?sSAaw & _ ; . ;:?.;s " -"= ' '! ': Includes attached garage.
Install (I) i 20 20a base feed _ 1000 sq, ft, or less S 138.54 4
Ea. Add'I 500 sq. (I or portion S 33.62 1
OWN ,y " ji1 �e itt* 4 ; i r; n ;ig Limited energy residential
Name: (with above sq R.) $ 75.00 2
Limited energy, multi - family
Address' residential (with above sq. R) $ 75 00 2
Scrvicc or feeders Installation, alteration, and /or rel ocation
City/State/ZIP 200 amps or less S 100.70 • 2
201 amps to 400 amps S 133.56 2 -
Phone pa;, 401 amps to 600 amps $ 200,34 2
601 snips to 1000 amps S 301.04 2
Owner Installation: This installation is being made un property that 1 own which is not Over 1000 amps or volts S 552.26 2
intended for vile, lease. rent or exchange. according to ORS 447. 449. 670, and 701 Temporary services or feeders installnti0n, alteration, and /or
Owner Signature' Date: relocation
200 amps or Ices S 59,36 1
s,,._ r.:: . •'.PJS.G� N ;
yet ._ ;, _"4 . ,- •. „ �a,1. ".a . <, "' 201 amps to 400 amps S 125.08 2
401 amps to 599 amps $ 168,54 2
Business T>,3mr_. Branch circuits - new, Alteration, or extension, per panel
Contact name: A. Fee for branch Circuits with
service or feeder fee, each
branch circuit $ 7.42 2
Address.
B Fee for branch circuity
without service or feeder fee,
CirylStatdZiP first branch circuit 1 5 56.18 66.18 2
Each additional branch circuit $ 7 2
Phone Fax -
Miscellaneous (service or feeder not included)
E -mail: Each menu@aured or modular
s Mf$tRiiNt C rA+ y"f, w r 5eileattieu dwelling, service end or feeder S 67.84 2
Business Name. CAPITOL ELECTRIC CO., INC. Reconnect only S 67.64 2
Pump or irrigation circle S 67.84 2
Contact name Gary Stelvrt Sign or outline lighting $ 67.84 2
Signal circuit(s) or limited.
Address' 11401 NE MARX ST. energy panel, alterations, or
extension. Describe. $ 75 no 2
City /State /ZIP. PORTLAND, OR 972 20 - 1 041 i Page 2
Each additional inspection over allowable in any of t above
Phone 503- 255 -9488 Fay 503- 257.7121 Per inspection S 66.25
investigation per hour (I Or min) S 66.25
CCI3 Lie,, 48748 1Electric41.1.4c.., 26-496C ISuprv.Lic.. 3132 -S Industrial .lant.erhour S 7s. is
•
Suprv, Electrician signature. required. 1 114 . 9u r7 r "` M f "' p � ... .. ' /rG .•• "'""a;'F'
�/�� btotni S 66.18
Print Name: Darrell McNe atb e: 04/01/13 Plan review (25% of permit fcc)
w 1144- ,M n- State surcharge ( 12% of permit fee) 6.74
Authorized signature
�f�% lj7, TOTAL PERMIT FEE $ 62.92
Print Name. Darrell MC NOB. Thb permil npplicnllen expires ire swell it not °Wined wiiein ten
0 Ry, •acr it has been neceeted al Coln Mete. tti./'
" Number of inspections per permit allowed.
t:' , iild instromiliv.C•POrmiiAlpr.5ox Inmt/oo 440.1615T( II/05/CoM/uEy