Permit „ CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2013 -00399 •
Date issued: 07/16/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1S135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 375
Project: Master Care Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Install door bell.
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 07/16/2013 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/16/2013 $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. 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 9 090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ”— Permittee Signature: OA/ ,q"/ / 77 dz■i
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 603.639.4176 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.
07/11/2013 15:21 5032577121 CAPITOL ELECTRIC PAGE 02/02
, . I t ill (11 �t ; 11 1 t 1Nl •
Electrical Permit Application RECEIVE, . cc crv - h I .'
City of Tigard Date/B / /4/3 4N Pcrrrtit no E[C�o /3 -110399
• 13125 SW Hall Blvd., Tigard, OR 97223 JUL P lan Review 1 2013 Other Permit:
Phone: 501639.4171 Fax: 503.598.1960 Date/By:
Inspection Litre, 503.639.4175 CITY TIGA�D Date Ready /By; ❑ Sim Pnte 211.
f (_ I'+ D omen mint ioromunen
Internet www.tigard-or.gov Not
- BUILD ► 1 LI 1 +
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�". ti :".xis � � ti 5.1:,'�:t. � 7e . ,h t.,.� i � _. ,.t .'._. , r v. , -:� s �3
!.:r�'rN rs: t ri,:. -:J4;• _ .ate -. �,. r.,�� =..
❑ Ne construction ❑ Addition/alteration/replacement pisses cheek all that apply (submit 2 gels of plena wntems checked below):
❑ Demolition ❑ Other; ❑ Service or feeder 400 amps or more f❑ Building over three' stories
Y
,..c� �':,,,-r�.� .� . �'r'l`ti`� "��;rJ,:�: {n��L' ,.'— :- 1- ?�.'- r !?i `� s „i s�. �•;� where the avallebl0 faun current Manilas and boatyards
E� I. and 2- family dwelling ❑ Commerelal /industrial ❑ Accessory building exceeds 10,000 amps at is0 volts or ❑ Floating buildings
❑ Multi Tamil ❑ Master Builder ❑ Other less to ground, or exceeds 14,000 0 Commercial -use agricultural
4 .,.., i,a c a � •I;T ,,, i l.4 ;kii : lit }' L, ^. .
�.'�•� Law% 4 amps for all other Installations. buildings
,. , � ❑ Fire Pump ❑ installation of 75 KVA or
Job no 131208 lob site address: 10260 SW Greenburg Rd ❑ Emergency system
larger separately derived system.
` � ,I ❑ Addition of new molar toad of ❑ "A" "E" "1 -2 ", "1.3 ",
—
/1" ity /Statc/ZIP: Tigard OR 10011P or more ❑ occupancy
��(VVV/// "'""" Meeter Care 1� d Six or more residential units ❑ Recreational vehicle perks.
5uitclbldg. /apt no.: 375 Project nam ❑ Health -care facilities ❑ Supply voltage for more than
Cross Street/Directions to ob site:
❑ Has trdous locutions 600 volts nominal,
� ❑ service or feeder 600 am s or more
Subdivision: [Lot no.: Description leal Pea Total
Tax ma 1 arcel no.: New residential • single or multi- family dwelling unit
G 47, 4` 4 i•. :a 7 l x�a:w 4�4, r'nj Inc d
0� attached
--• ;, �.,, �.�:...r�..i_. — be dgarage.
In . r r 1000 sq, or less T S 168,54 4
Install Doorbell ,
Ea, Add'I 500 sq. ft or portion S 33.92 1
r:' - 4. 1, ''_!�' zA• ", 7 *_.n Limited energy residential
''' .� rM:ft ?� tuttpTfive�iW ■,
(with above sq. It,) 5 75,00 2
Nome; Limitcd ener(ty, multifamily
residential (with above sq. ft.) $ 75.0D 2
Address: Service or feeders Installation, alteration, and/or relocation
200 am : or less $ 100.70 2
City/Statc/ZIP; 201 am. to 400 em. i! S 133.56 2
_ 401 amps to 600 amps III 5 200.34 2
Phone: Fax: 601 am•s to 1000 am•s S 301,04 2
Owner Installation: This installation is being made on property that i own which is not Over 1000 am.. or volts — $ 552.26 3
intended for sale, least, rent or exchange, according to ORS 447, 449, 670, and 701 Temporary services or feeders installation, alteration, and /or
relocation
Owner signature; Date: 200 amps or less $ 5 9.36
. + ! ■ ;t:. P :twat;F l E l .`.14 ?)2a , Ci t91 x.,1 . J. "J±, :Li:;' c3fl 201 amps to 400 amps $ 175,05 2
401 amps to 599 amps $ 168.54 2 ,
9usinms Name Branch c ircuits - ne w, alteration, or extension per panel
A. Fcc for branch circuits with
Contact name: service or feeder fee. each
branch circuit $ 7.42 •2_
Address: B, Fcc for branch circuits
without service or feeder fee.
Clry /Statel7.1P: first branch circuit t $ 56,15 66.18 2
— —
Each additional branch circuit: $ 7.42 2
Phone: Fax' Miseellancolts (service or feeder not intinde
E moil: Each manufactured or modular
Sri„^�� - , y ,. ti ,. 5 "s ^`?�' w „•,I ;. dwelling, service and or fhcdcr S 67.84 2
r . ! .;SAiStT� _ns 5,. x 11 , 1•,_. : tom. t°7U: ,
Reconnect on $ 67.84 2
Business Name; CAPITOL ELECTRIC CO., INC. Pam • or irn • anon circle S 67.54 2
4Iti Sign or outline lighting 5 67,84 2
Contact name: Signal circuit(s) or limited - energy sec
panel, alterations, or extension. 1 Page 2 2
Address: 11401 NE MARX ST. Cacti additional ins. action over allowable in an of the above
Additional ins.ectiOn 1 hr min ME 66.25 /hr
City/State/ZIP: PORTLAND, OR 97220 -1041 Investi :'tian 1 hr min 6625/ hr r
Industrial slant 1 hr min NM 78.18 / lrr
Phone: 603- 256.9488 Fax: 503.267.7121 inspections for which no fee is 11.1 on oat ht
CCB Lic.: 48748 Electrical Lie.: 26.49110 lSuprv, Lie.: 3132-s s.ecificall listed 1/2 hr min
'T4 ,' r�L t.- ��iEt�!ltl ,.J l� } d�.il' -0Se fI.IL •,, t,:til....
$uprv. Electrician signature. require `J . Subtotal. $ 56.18
Print Name: CNeel Date: 07/11/13 Plan review (25% of permit lee);
I AZ ,� State surcharge (12% ofpermit fee): 5 6.74
Authorized signature: ”. �L/� TOTAL PERMIT FEE: $ 62.92 1/
Print Name: I McNeal This permit appacethm elpltn Ire permit a not°Mnreed within 140
dun seer it tuts been Mrepted at comp41o,
• • Number of in9pecHnnx par Permit cllewed.
1:V3mldiny\Prrmlra \eLC_r iiApp 10/01/(10 440461$1(1I /OS/COM/WEB