Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2013 00499
T f GARO 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/21/2013
Parcel: 1 S135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 360
Project: DiLorenzo&Company Subdivision: METZGER,TOWN OF Lot: 9
Project Description: 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
4 crt Branch Circuits wo/Purchase 08/21/2013 $78.44
Specifics: Service or Feeder
1 ea 12%State Surcharge- 08/21/2013 $9.41
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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 952-001-0090. You may o• -'• = •. of the -. • •• =ct questions toOUNCby calling 503.232.1987or1.800.332.2344./�
Issued By: _ _ 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.
, • .
08/20/2013 TUE 16.:25._..FAX 50362429 .11' :gin.- itil ic Z1002/002
Electrical Permit Application AUG 2 0 2013 . %FOR OFFICE USE ONLY . ' ' •
Received
111 City of Tigard CITY OF �r A �+ Permit No.: —' _d��/
• 13125 SW Hall Blvd.,Tigard,OR 97223 CITY OFTIGAR if Date/B : D �L� i1/ 2oi
Phone: 503.7182439 Fax: 503.598.19BUILDING DIVISIIITIIIIImilm� Other Permit:
TIGARD Inspection Line: 503.639.4175 ratcReadyBy: ® See Page 2for
Internet: www.tigard-or.gov Notified/Method: AIIIII, Supplemental Information
R�M-w §rS iaik $ S n' it R #5 §Ma i L , 4 Y& ' s , -. S tl v y;, : a.'- -i �7.a *
,v.,'4.
,.,v,,,,,,.r ,,.,m,,,. ... 4 .. ._2 .14:5,f. w 71ZrT%kit fa,; •: . 3� .'" .:''' : wsh - ' , ,.,S:ifi,i0„ '1- r. ,,„
0 New construction X Addition/alteration/replacement Please cheek all that apply(submit/sets of plans w/items checked below):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
}in t y OZAT b I x T 4T(U y Y V4 �
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 2 Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
j:�� '' '#;3 """''?�%".V"�'ss; y a'rr r•aYY" :a:s•:w. •r 'r•y.s.,<rc r sw,�/yN y ydfr:#yz r�? ❑Emergency system. larger separately derived system.
S.; ;A'lWQ. k i$ -,4-,;g'4:2',4. r '1 .0',,,,... 4;*,..S^?'� .„Qv f si`r ' ; a n'4 ❑Addition of new motor load of ❑
Job no.: Job site address: �} 0 1001IP or more. occupancy.
S�� I �G 3C�il (r rC'e∎-∎,� ,.-U•- yLG,4 ❑Six or more residential units. ❑Recreational vehicle parks.
✓ r� 0 /f A ❑Health-care facilities. ❑Supply voltage for more than
City/State/ZIP: r / C 0`
� �`l* ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: )i ,r 11 Project name: < ❑Service or feeder 600 amps or more.
`J " ,, tston rf, r I:.:�ci r ,tom..,. ;A ,,..•�E:.'i_Fr �SV? �`}•�•` -x'��.. ..•� 1',1':+''J..lt`�.fS'� i'ly�l. �,. .F„
Cross street/directions to job site: ne,erintion Qty. Fee. Total •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq.il.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.:
Orr N Limited energy,residential
';lf1 m^ v4?t:fiats h�' ,�fitt;; x�am�'t g 3 ri }f:eM e rojp ,• 75.00 2
u.'m,- il. -,. , .riE 8,. + U�t m:)':. ..e .'sfg;sd-4•.`+?,:,,'a,:t,q (with above sq.RI
„i^ { �, ,rt... h }?...h, h 'lr�' .iii: >:af9."dzn�<'SEo e.,s�^
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
ter'" iRetiiwaiileliiePgy+"'tVA'ti.sT.- .'A
,.
Services or feeders installation,alteration,and/or relocation
x's `Y C..;}R4 S"El O BR g c z� � u. `a r��i �k-',13.A'
=?r �4� 200 amps or less 100.70
2
.,?`'F -,"?•a.,...a.n.,. �. y � •%s:°i•'Rv .}, �y5 4Q• 4"i rs. c.�§ ..E` .,Ro-. s .5 ' :� i!v:r<`t:1
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:( ) I Fax:( ) relocation
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 168.54 2
Owner signature: Date: Branch circuits-new,alteration,or extension, er panel
S fi• '¢i1 Tr•a�°`��x A.Fee for branch circuits with
"�' "= above service or feeder fee,
Business name: each branch circuit 7'42 2
B.Fee for branch circuits without
Contact name: service or feeder fee,first / 56.18 Cl?5- 2
branch circuit
Address: Each add'l branch circuit 7 7.42 029 2
City/State/ZIP:
Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:( ) I Fax::( ) dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
,f: x,{:.Zc;Y'1 4'�;g,4 a +r- •'•^�:�•^ Jr N•::�c;y::.+••f, �_..�x. F(';
!P ;a: ;,3 gi <i p ,t#l.�c'• ,iii: :.�r?t' r IM .'�€k: ,s~ salt Sign or outline lighting 67.84 2
Business name: f I /� Signal circuit(s)or limited-energy See
f�/I . 72 C-r� • panel,alteration,or extension. Page 2 2
Address: FL,r_,i. :301e.-5z/7 Each additional inspection over allowable in any of the above
_ Additional inspection(I hr min) 66.25/hr
City/State/ZIP:
�'; / {� �t—�/ Investigation(1 hr min) 66.25/hr
Phone: k,i!/_3,L.,/ Fax:(t ?)1 2y -2 ( Industrial plant(1 hr min) 78.181 hr
7 Inspections for which no fee is 90.00/hr
CCB Lie.:7'3 r7 I Electrical Lic.3./f 2 4Suprv.Lie.: / 2i ,,S s. ificall listed %a hr min G
Suprv.Electrician signature,required: a) a o a t il: Z a'•.'�/r %ZM:
Subtotal: `,h
Print name: `�, it
?i"I e Date: ' I//'2 Plan review(25%of permit fee):
State surcharge(12%of permit fee): ? , '..!-
Authorized signature: TOTAL PERMIT FEE: f•7 c
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\Beitdingu'ermats'ELC PermitApp E1.R_ERE.doe Rev 05/21/2013 440-4615T(11/05/COM/WE13