Permit CITY OF TIGARD ELECTRICAL PERMIT
;� ! COMMUNITY DEVELOPMENT Permit#: ELC2013-00539
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/11/2013
Parcel: 1 S135AB04500
Jurisdiction: Tigard
Site address: 10250 SW GREENBURG RD 110
Project: Family Health Subdivision: 1991-055 PARTITION PLAT Lot: 1
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
5 crt Branch Circuits wo/Purchase 09/11/2013 $85.86
Specifics: Service or Feeder
1 ea 12%State Surcharge- 09/11/2013 $10.30
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $96.16
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: • law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 thr' gh OAR 95 001-0090. You may obtain a copy of the rules or direct questions to OUNC by ca - .1987 or 1.800.332. 44.
Issued By: 4./m _.dr_( Permittee Signal ' ' �' L4," r f
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' `? _� a�i �! — Date: ' /
/ .
LICENSE NO. /6,265
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.
09/1042013._TUE 14:03 FAX 5036242938 Willamette
Electric 81002/002
Electrical Permit Applicati .IV FOR
OFI ICE USE ON1A'
City of Tigard Rem"� ' 2 q
g c DateB�: // �/ M. Permit No.: ��OtQy,j-ex)539
• 13125 SW Hall Blvd.,Tigard,OR 97223 EP 10 2013 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 Date/B Other Permit: l
i� �� aoa ,
TIGARIJ; inspection Line: 503.639.4175 Cep OF TIGARD DateReadyBy: • luris: ®ScePage 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
■ a � 1 I I
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:..2.,. .,4..,:y a.` f'r.'h t: � •� ..:, F` ' ..,4,,.i$5r:z ,t- `,, f. i r , � ?- i3.
va., .v c�d ..�.i 3�.r.S.t J s .. .. �:.: „..,,,.„,,v„-,,� .dd:�• >�Y-,o,.n�. A,. �Y'-x �.:. �r{� �1F;.s�`.�ri'/�e6.L.t;�i.✓�.'�i�''.i�'.
Please check all that apply(submit 2 sets of plans wlitems checked below
❑New construction �r]Addition/alteration/replaceirtertt below):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
nn a t_ . w ;'1'.1 u . a`o s, a,, `1016.5 1.' r�,::.. •;' ' exceeds 10,000 amps at 150 volts or ❑Floatin buildings.s.
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: 0 Fire pump. ❑Installation of 150 KVA or
:. �- -8"45. •,. k`. _ r- �_ : ' ❑Emergency system. larger separately derived system.
.-ywr ---s-s. u o s+a l a _e e e g $• a ••:=. 1;,. Addition of new motor load of "A","E"
-3 S,G?eic.., yBoF!i`-...:isi'. � r _ • N•, .-;$ . .r� .?c'.`.D'."` ..•w. ,:�n: ❑ ❑ u1-2s. .,1_3r.
100HP or more. occupancy.
3ob no.: Job site address: / o2 Sa S i,a c jfsp e'4 r�,iG
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: J l� `�7 ❑Health-care facilities. ❑Supply voltage for more than
r�/ r` 3 ❑Hazardous locations. 600 volts nominal.
uitelbldg./apt.no p Q Project name: N'r i. /��,�./r 2 ❑Service or feeder 600 amps or more.
/QCs / // "r: 4),„'', ? AI':a. ? I�'1');§.z-�rr '•_`` aitg u;`:
Cross street/directions to job site: Description Qty. Fee. Total •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq.ft.or less 168.54 4
Tax map/parcel no.: Ea.add'I 500 sq.ft.or portion 33.92 1
_ Limited energy,residential 75.00 2
<:°r
P.-' ,-t,•'.., '' �� e,d5`'ar oe o „0 : r,' F.. (wi�tflabove sq.fl`)
Limited energy,multi-family 75.00 2
_^ residential with above sq.ft.)
7---e".e..., 7- .../.--4-t /re-,Lie z,,, =R'eiiew9ble:'•Eiiei .:' ;.,,_,:
Services or feeders installation,alteration,and/or relocation
vit".. ,14 R iSi t; r �" '��,„T r� fYAVs3 j t t�j �t S "u
; 200 amps or less 100.70 2
,tcl!-:. u . •,^.�.»AU.wr� � tv°�Aa ;11ek:t3r4:n.s �'� �aty fc. �fP-"''3
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 I
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
. :',1 y, rlW �T,-1 t -27 `0.11, ,: 4/ f•' ,p)Y ;, A.Fee for branch circuits with
Y. i.' 'A, :it4.'di ,.. F`'�':..*: ' ` €,, 46...rw x%O1 i..a...� ,'0._ t�A� aA,:.4.
above service or feeder fee,
7A2 2
Business name: each branch circuit
B.Fee for branch circuits without
Contact name: service or feeder fee,first / 5618 S� 2
branch circuit
Address: Each add'I branch circuit ey 7.42 ;,G 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
kk .'. - ,9 . rait o i, :g°-'T r"ry�•` L. t . "I NS. Sign or outline lighting 67.84 2
Business name: I /,/ l. � Signal circuit(s)or limited-energy See
-<< .1 panel,alteration,or extension. _ Page 2 2
. Address: Each additional inspection over allowable in any of the above
/� / `� �� Additional inspection(1 hr min) 66.25/hr
p�V(/ City/State/ZIP: '� ( 7J /' Investigation(1 hr min) 66.25/hr
(((JJJ Phone: 0Z�;r!?� 0. Fax:( q G�' s t�� e Industrial plant(1 hr min) 78.18/hr
L / Inspections for which no fee is
CCB Lie.:7,5-0(..5-9'' Electrical Lic f�G Suprv.Lic.: ' s cificall listed 'G hr min 90.OD/hr
ii. AO P rrt ir!'� �F a a��i5i6�'u. (, r ;i 1 v;'r
Suprv.Electrician signature,required: �!< vt�sLS4"I n 3 t �x S Vie
p g , eq '` Subtotal:
Print names f)j 7-1`--Pe- Date: C��C)// Plan review(25%of permit fee):
State surcharge(I2%of permit fee): Ie,
Authorized signature: TOTAL PERMIT FEE: q 6, 40
Print name: Date: This permit application expires if a permit is not obtained within 080
days after it has been accepted as complete.
• Number of inspections allowed per permit. A/ ,
I:1Building\Permite\ELC PermizApp_Ei.R ERE.doc Rev05/21/2013 440.4615TOI/05/COMIVEB �V ('