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Permit CITY OF TIGARD ELECTRICAL PERMIT ;r1 g' COMMUNITY DEVELOPMENT Permit #: ELC2013 -00439 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/25/2013 Parcel: 1 S 135AB00900 Jurisdiction: Tigard Site address: 10200 SW GREENBURG RD 320 Project: Springwater Wealth Subdivision: METZGER, TOWN OF Lot: 9 Project Description: (3) branch circuits for TI Contractor: WILLAMETTE ELECTRIC INC Owner: LINCOLN CENTER LLC PO BOX 230547 BY SHORENSTEIN PROPERTIES LLC TIGARD, OR 97281 555 CALIFORNIA ST 49TH FL SAN FRANCISCO, CA 94104 PHONE: 503 - 624 -3631 PHONE: FAX: 503 - 624 -2938 FEES Quantity Description Date Amount 3 crt Branch Circuits wo /Purchase 07/25/2013 $71.02 Specifics: Service or Feeder 1 ea 12% State Surcharge - 07/25/2013 $8.52 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $79.54 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 accordance ' 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. • TTENTION: Oregon law -q i = you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -t 01- 0010th ough OAR 952 -I %1 -0091 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800 2. 4. Is ed By: 16 1 1 4--6- 1 1/i Permittee Signature: 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. Electrical Permit Application FOR OFFICE USE ONLY City of Tigard RECEIVED Date/B ea 7 A b AI Permit No.: f4C,,t /3— 00 3 74 • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ° ' Phone: 503.718.2439 Fax: 503.598 (0 , Date : Other Permit: T l G ARD Inspection Line: 503.639.4175 J UL. 5 L i 3 B Date Ready/By: luris: El See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information 91TIGARD TYPE REVIEW . ' D Please check e ase cec all that a I ❑ New construction El Addition /a era t on rep acement pp amps (submit j, sets of plans hams checked below): ❑ Service or feeder 400 a or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ", Job no.: {� Job site address / n / 100HP or more. occupancy. V n /L 2 0 0 S Lt/ LrJ- Pel h r-.fir /< I. ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: ........- ❑ Health -care facilities. ❑Supply voltage for more than ay- �f © I x ❑Hazardous locations. 600 volts nominal. Sui /bldg. /apt. no.: . 2_0 Project name: 5 v �� , m i 4 75, r ❑Service or feeder 600 amps or more. ✓ FEE SCHEDULE Cross street/directions to job site: Description I Qty. I Fee. I Total I • New residential single- or multi - family dwelling unit. Includes attached garage. _ Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'I 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 • J _ Limited energy, multi - family 75.00 2 to nGrn1 .,./- / i 'o v to ?V\ Y.7 residential (with above sq. ft.) Renewable Energy ❑ See Page 2 Services or feeders installation, alteration, and/or relocation _ ❑ PROPERTY OWNER I ❑ TENANT 200 amps or less 100.70 2 201 amps to 400 amps 133.56 2 Name: 401 amps to 600 amps 200.34 2 Address: 601 amps to 1,000 amps 301.04 2 Over 1,000 amps or volts 552,26 2 City/State /ZIP: Temporary services or feeders installation, alteration, and /or Phone: ( ) Fax: ( ) relocation 200 amps or less 59.36 l 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: Date: Branch circuits - new, alteration, or extension, per panel ❑ APPLICANT , • ' I ❑ CONTACT PERSON A. Fee for branch circuits with above service or feeder fee, 7.42 2 Business name: each branch circuit B. Fee for branch circuits without Contact name: service or feeder fee, first / 56.18 SG / e 2 branch circuit Address: Each add'l branch circuit ?.- 7.42 Jr �f ' 2 City/State /ZIP: Miscellaneous (service or feeder not included) Each manufactured or modular 67.84 2 Phone: ( ) Fax: : ( ) dwelling, service and/or feeder Reconnect only 67.84 2 E - mail: Pump or irrigation circle 67.84 2 . CONTRACTOR Sign or outline lighting 67.84 2 Business name: J -�� Signal circuit(s) or limited- energy See �� / / 'P . / ��t�l rr> panel, alteration, or extension. Page 2 2 Address: Po /30 7 a 5—y 7 Each additional inspection over allowable in any of the above � 7 / Additional inspection (1 hr min) 66.25/ hr City /State /ZIP: / / t- �4,,,, (./ 0 R. 9 / - 2 - 3 Investigation (1 hr min) 66.25/ hr Phone: $ o ) ‘ 2._ 7_, 36, 3 / Fax: (563 ) G;7 ; 9 3 Industrial plant (1 hr min) 78.18/ hr g Inspections for which no fee is 90.00 / hr CCB Lie.: d -7 Sys( Electrical Lie.: 3 L- 2 �D r Suprv. Lic.: ' 5 specifically listed (Y2 hr min) /' • . ELECTRICAL''.PERMIT FEES 4 `.. . • Suprv. Electrician signature, required: Subtotal: '47/ a) Print name: /) /'I f Date: Plan review (25% of permit fee): /�(!' �i 'e State surcharge (12% of permit fee): 0 4--' Authorized signature: TOTAL PERMIT FEE: 79 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 inspections allowed per permit. I:\ Building\ Permits \ELC_PermitApp_ELR_ERE.doc Rev 05 /21/2013 440- 4615T(l1/05 /COM/WER