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Permit ' ... 1r • _1; ' ELECTRICAL PERMIT CITY OF TIGARD 1, =1 • COMMUNITY DEVELOPMENT Permit #: ELC2009-00646 1 Date Issued: 12/04/2009 T (G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S101 DA00102 Jurisdiction: Tigard Site address: 13221 SW 68TH PKWY 200 Subdivision: TRIANGLE CORPORATE PARK Lot: 2 Project: HealthNet Project Description: Add /alter (3) branch circuits for TI. Owner: FEES GK TRIANGLE CORPORATE PARK III L Quantity Description Date Amount PO BOX 2096 WARREN, MI 48090 3 crt Branch Circuits 12/04/2009 $71.02 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 12/04/2009 $8.52 Electrical Contractor: PHOENIX ELECTRIC CO PO BOX 14037 PORTLAND, OR 97293 PHONE: 503 - 231 -8006 FAX: 503 - 235 -4300 Type of Use: COM 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 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: �.�`l6\ CIAj U 0,8 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' Q Q a `, ., y) Date: LICENSE NO. T' Call 503.639.4175 by 7:00 a.m. for an inspection that business day. 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. ec 04 09 10:36a Terry Koch 503 - 266 -8394 P.1 el RECEIVED Electrical Permit Application , - a " Fort oP USF ONLt 1' r DEC 0 4 2009 R ec ei ve v s� + tom „tt, kiii n 4 _.� ; --� . : City of Tigard > eBy: Permit No.. O.∎ ' V_ .e •. - ° Other Permit: ' q ►, t 13125 SW Hall Blvd., Tigard, OR 9]� ��.� Phone: 503.639.4171 Fax: 503.598.10 OF TIGARD Date/B Plan Review �' '� `i ? Inspection Line: 503.6 BUILDING DI VISION Date Ready/By: , : M See Page 2 ror { Notifed/Method: `1 Supplemental Information f#s!:r Internet: wvvw.tigard- or.gov " 3V OF WORK PLAN REVIEW ❑ New construction Addition /alteration/replacement Please check all that apply (submit 2 sets a fplans w /items checked below): ��---tt ❑ Service or feeder 400 amps or more 0 Building over three stories. LI ❑ Demolition Other: where the available fault current 0 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 L1J2'ommercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or ❑ Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION CI Addition of new motor load of ❑ "A", "E "1 - ", "1 - ", I OOHP or mo occupancy. Job no.: 355-7 Job site address: /3,2,A / ,s( 6 8- rgyelt ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State/ZIP: 774 hQb OR 7 7o J ❑ Health-cr douse l oc o n s . ❑ Supply voltage for more than ❑ Hazdauu octins. 600 volts nominal. Suite/bldg. /apt. no.: 2O0 Project name: pl f it,(, Aje j ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: oeae_triou •t • Fre. ii ' 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'l 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential p DESCRIPTION OF WORK (with above sq. ft.) 67.84 2 1 !/ t , j J Limited energy, multi - family 67.84 2 &g.4,Je f7 i I z_/ s f-E71z ,3 •3u` f.. ^h()jk. 7 residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER ! ❑ TENANT 201 amps to 400 amps 133.56 2 Name: 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 City/State/ZIP: Temporary services or feeders installation, alteration, and/or ty relocation Phone: ( ) Fax: ( ) 200 amps or Tess 59.36 1 Owner installation: This installation is being made on property that 1 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 Branch circuits — new, alteration, or extension, per panel Owner signature: Date: — A. Fee for branch circuits with . - 0 APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7.42 2 each branch circuit I Business name: B. Fee for branch circuits without service or feeder fee, % 56.18 c4 ,it 2 Contact name: first branch circuit _ Address: Each add'l branch circuit � a 7.42 / 4 .b4 2 Miscellaneous (service or feeder not included) City /State/ZIP: Each manufactured or modular 67.84 2 dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 E -mail: Pump or irrigation circle 67.84 2 1 CONTRACTOR Sift or outline lighting 67.84 2 ,� f Signal circuit(s) or limited - Business name: 0ti jg L /e-E-G j Q/'e_.. energy panel, alteration, or Address: extension. Describe: Pagc 2 2 p. 0.x X4 3J C ity/State /ZIP: A kaki. ii) o k - /If 93 Each additional inspection over allowable in an of the above Per inspection 66.25 Phonc: (56$ ) oz31.- Fa x: (5o ) ©e� Co 335 = 1-30c) investigation per hour(1 hr min) 66.25 l CCB Lic.: lh:275' 3 Electrical Lic.: e 5? Suprv. Lic.: ,57o., Industrial plant per hour 78.18 , ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: .// ...1 Subtotal: 71.4042 _- Plan review (25 %ofpermit fee): Print name: f �{ f J - ! ` } p er Date: l� � -�j State surcharge (12% of permit fee): fr 5", Authorized signature:, )? it / TOTAL PERMIT FEE: 79.5 4 r < This permit application expires if a permit is not obtained within 180 m Print nae: ri Date: days after it has been accepted as complete. IL