Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00209
IIGRI 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/30/2010
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Parcel: 25101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 500
Subdivision: TRIANGLE CORPORATE PARK Lot: 2
Project: University of Phoenix
Project Description: (1) 200 amp service and (28) branch circuits for TI.
Owner: FEES
GK TRIANGLE CORPORATE PARK III L Quantity Description Date Amount
BB# 73- 1771- GK1130, CBRE, PO BOX 2096
WARREN, MI 48090 1 ea Services or Feeders - 200 04/30/2010 $100.70
amps or less
PHONE: 28 crt Branch Circuits 04/30/2010 $256.52
wo /Purchase Service or
Feeder
Contractor: 1 ea 12% State Surcharge - 04/30/2010 $42.87
HILLSBORO ELECTRIC LLC Electrical
21185 NW EVERGREEN PKWY #110
HILLSBORO, OR 97124
PHONE: 503 -439 -9666
FAX: 503- 601 -3680
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $400.09
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.
i
Issued By: r / -- Permittee Signature: (fA/• /97 iC•� r �D ' �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 603.639.4175 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.
From:Hillsboro Electric,LLC 5036013680 04/29/2010 07:00 #562 P.002/002 17
Electrical Permit ApplicatiREiCEIVE I o f oi l rl t s i Oil 1
.
. City of Tigard Received Y / / A Ir Permit 1.4°'' � - Q0
13125 SW Hall Blvd., Tigard, OR 972 PR 3 0 2010 Plan Review
- � , 9
Phone: 503.639.4171 Fax: 503.598.10 D Other Permir,4 (()/ t) 0 0O i /r
Jns ection Line: 503.639.4175
:;T1 C, A R ''''''.l..-*::: .' p O TIGA Date Ready/By: 61 See Page 2 for
rm
lntemeInternet: www.tigard or.gov '' DIVISION lit. Supplemental Information •
TYPE OI WfJRt( PLAN REVIEW
❑ New construction Addition/a lteration/r e placement Please check all that apply (submit 2 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.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -ase agricultural
❑ 1- and 2- family dwelling l„Commercial/industrial ❑ Accessory building amps for all other installations. buildings,
❑ Multi- family ❑ Master builder ❑ Other: ['Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1.2 ", "1 - ",
Job no.: ?��'4, Job site address: 13�, .G ( `p�W9 100HP or more. occupancy.
❑
/ ❑Six or more residential units. Recreational vehicle parks.
City /State/ZIP: ` ` -� / bV? r t�`�,"") Z ❑ Health -care facilities. ❑ Supply voltage for more than
` L. J p
El Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: t/P
Project name: On /I'5i h o/ r 1l o ebl , y ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:
Description 1 Qty. 1 F. 1 Tool 1
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi- family 75.00 2
. 's__ . residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 1 80.30 Bo .30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
•
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits -new, alteration, or e: tension, Qer panel
Owner signature: Dale: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee,
Business name: each branch circuit 6.65 IBE,?p 2
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
City /State/ZIP:
Miscellaneous hanufactured (service or feeder not included)
Phone: dwelling, service and/or feeder 90.90 2
( ) Fax::( )
Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: 1 1.1 v D 1 .\..�� LI Signal circuit(s) or limited -
q t energy panel, alteration, or
Address: ^ \VD Fve�,� � erGr- \L 4 �1 1 s� `� extension. Describe: Page 2 2
Zb� 0
City/State /ZIP: ..k.. 0 102 t i, - 4.• t - 1 1 Each additional inspection over allowable in any of the above
L ' Per inspection 62.50
Phone: 1� .. e
�) ` Fax: O ! ♦ II Investigation per hour (I hr min) 62.50
CCB Lic.: 3," 7 .niectrical Lic.: 3 C uprv. Lic.: 0 ( 0 5 Industrial plant per hour 73.75
ELECTRICAL PERMIT p O MIT FEES n2
Suprv. Electrician signature, required: / t"'`^�( 4 . to r ' Subtotal: 2 (r(... cep .5 • r 0"
Print name: Pz71 a .....A Date: l .l a l �. Plan review (25% of permit fee): — d
State surcharge (12% of permit fee): , l 8 ; / ,g I
Authorized signature: 7
TOTAL PERMIT FEE: .' j Ei . 4 / 8
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. ' / [ 0 �j
C \BuildimtWermits∎ELC- PermitApp.d " 5¢3/06 440- 0/5T(1 I /OS /COM/WEB Ll i D/
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