Permit (25) CITY OF TIGARD ELECTRICAL PERMIT
III $; COMMUNITY DEVELOPMENT Permit#: ELC2016-00201
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/15/2016
Parcel: 1 S135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 270
Project: Silverado Funding 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 235 MONTGOMERY ST, 16TH FLOOR
SAN FRANCISCO, CA 94104
PHONE: 503-624-3631 PHONE:
FAX: 503-624-2938
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 03/15/2016 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 03/15/2016 $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 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==.= ••y of the rules or -ct questions to OUNC by calling 503.232.1987• 1 80/•32.2 •
Issued By: /�iL-t- - - • '•nature: �L�
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.
1
Electrical Permit Application FOR OFFICE USE ONLY
Received ,
City of Tigard Date/13 : !..1 f� _ �.a
illi - ' 13125 SW Hall Blvd.,Tigard •' '7�Z� Plan Review i
7[ Related Permit#:
Phone: 503.718.2439 F 960 \S3 Date/13 : J Co r 7
Inspection Line: 503.639 11> Ready Date/By: 7A See Page 2 for
TIGARP, Internet: www.tigard-or.gov' ',� ` Notified/Method: "MISupplemental Information
;*,.' .4 ,11-114.14;:4::1-:4,E 'k E?Q ,+'<p:•s :',;a.y -.'''lik''= 4,04'0"--:: ., :%s z ,z : ,...,._: Rl',�r�. 7.e;. ;4 ''t `r,r <z•.'..:.
❑New construction 121.Addition/alte al g \ t Please check all that apply(submit 2 sets of plans w/items checked):
1' ��y��
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other: w% N� where the available fault current 0 Marinas and boatyards.
,�;4jV c, «,, � lCATEGOR QF ,NT,' CTIO ,g��?' ._->, �}'F�,��i exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ 1-and 2-family dwelling [Commercial ndustrial 0 Accessory building amps for all other installations, buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
�� ,11- P * .° =.r` 0 Emergency system. larger separately derived
s: ..�, JOS�SLr. IN1;ORMeTION w.a L O( TION . - , ..r... ..
p ❑Addition of new motor load of system.
Job#: 9 Job site address: /0,3 GC)stti Ljr f_e,ro,,!7L��_.6/ 100HP or more. ❑"A","E","1-2","1-3",
0 Six or more residential units. occupancy.
Ci State/ZIP: '
/ f 4 1" 0 Health-care facilities. 0 Recreational vehicle parks.
uite/ ldg./apt.#: 7U Project name: Si >U er_z pV ��h �� ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: aa..7: ; h e 1,-, FE SCHED'tjt ,. ' . `
Description I Qty. 1 Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1
.."' y Z '. e , ,b ESSCRI�,TION OE WORT . ;tt `e;,"e„ ..' .N4p;..7.4.1 Limited energy,residential 75.00 2
t2p (with above sq.ft.)
I r L •./ �irt^ /\04,AO YI soil I Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy ❑ See Page 2
�,r EA PROPERTYYY;OWNER Vit,724! "f':.-e:1:11',;:13, t r IENANT,. ' .t! Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
, , 0 s tiro Branch circuits—new,alteration,or extension,per panel
❑'APPLICAN ; "� .,, ,❑ CONTACT`PERSON A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
service or feeder fee,first / 56.18 .57, /i 2
Address: branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 /y."..2._2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
67.84 2
' dwelling,service and/or feeder
Email: Reconnect only 67.84 2.
•
# ,, „ .-iCONTRACTOR,,` r Pump or irrigation circle 67.84 2
Business name: G✓h "/ Sign or outline lighting 67.84 2
iit� t"r Tl�a✓ i_ rr
Signal circuit(s)or limited-energy 0 See Page 2 2
Address: pa 6 c'� g 3 0 --y,, panel,alteration,or extension.
( Each additional inspection over allowable in any of the above
City/State/ZIP:ty -
/ l fiy_c,/ U 1` Y,,-,9; / Additional inspection(I hr min) 66.25/hr
Phone:( ) Fax: Investigation( C3 )
(1 hr min 90.00/
hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 9$"iy5-2 Electrical Lic.: 3 t�"2g3c, Suprv.Lic.: K���,�` specifically listed(/z hr min)
;:,.,):N,• -,.,
J ` ELECTRICAL,PERMLT;)TEES r• ' j
Suprv.Electrician signature,required: Subtotal: 7/ _es1-
Print name: Da tv/t ,,----7,v-t, Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): v S
Authorized signature: TOTAL PERMIT FEE: 177 ✓`�
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 06/17/2015 440-4615T(1t/05/COM/WEB
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10300 SW GREENBURG RD 270, TIGARD, OR,
97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00201
Jeff Grove
Violation Summary:
Inspector Contractor