Permit i _ ._. r CITY OF TIGARD ELECTRICAL PERMIT
• _ 2 < COMMUNITY DEVELOPMENT Permit #: ELC2010 -00163
TIGARD! 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/09/2010
Parcel: 1 S 135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 380
Subdivision: LINCOLN CENTER/TWO LINCOLN Lot: 0
Project: Waldron Co.
Project Description: (5) branch circuits for TI
Owner: FEES
LINCOLN CENTER LLC Quantity Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555
CALIFORNIA ST 49TH FL 5 crt Branch Circuits 04/09/2010 $85.86
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 04/09/2010 $10.30
Electrical
Contractor:
WILLAMETTE ELECTRIC INC
PO BOX 230547
TIGARD, OR 97281
PHONE: 503 - 624 -3631
FAX: 503 - 624 -2938
Type of Use: COM
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: 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: V , .APi w, . Permittee Signature: ON `i - PG l 77
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 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.
04/08/2010 THU 16:01 FAX 5036242938 Willamette Electric 1j002/002
Electrical Permit Application RECEW 1 - 6 ,. ;L J f
� " . FOR O GSE ONL
• Received � ' : ,, . .. �. , . .-
City of Tigard Q q .n. i cams No.:
® 1 3 1 2 2 5 S W Hall Blvd., Tigard, OR 97223 APR 0 21 1 at ctE3v: 1I � EL 0 2 0 / 0 -10 . 2
r c an Review
—
1 cw Other Permit:
" 11 Phone: 503.6314171 Fax: 503.598.1960 � Dat p c ,Re By:
T I GAR D' inspection Line: 503.639.4175 CITY OF TIC r' l a d y,! t3 y : Jrvis: ^ / Ea See Page 2 for
Internet: www.tigard- or.gov r V k r tMcthod: / l (� Supplemental information • TYPE OF • WORK : PLAN .12EV
❑ New construction M Addition/alteration/replacement
Please check all that apply (submit 2 sets of plans wfitenu clocked below):
0 Service or feeder 400 amps or more Q 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.
..: ..:.:` ....,.,..� le to ground, ore exceeds 14,000 C I 1
less t- x 0 � Commercial-use agricultural
❑ 1- and 2- family dwelling Ki Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: 0 Fire pump. 0 installation of 75 KVA or
`
JOB' S IT E INFORM . AV12 L OCATI O N 0 Emergency system. larger separately derived system.
. ,.,.: ... , . ',.' ❑ Addition of new motor load of 0 "A" "E", "1 -2" "1-3".
Job no.: f_/? Job site address: /G �l� S 1 Js y fr ,� rj 1001 {I' or more. occupancy,
/ d ' ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/Z1P: / ,' , "26,, ' �% 5s' :- e. ❑ Health -care facilities. 0 Suppl voltage for more than
❑Hazardous locations. 600 volts nominal.
a ❑ Service or feeder 600 amps or more.
Suite /bidglapt. no.: j ;n, Project nam ,, , ;
e: ,, ,-:.-1,,,(,.. ‘,
Cross street /directions to job site: W4Lb /� C O _ Description EEE SC Q Qty. 1 Fee 1 1
J r' Description on q. ( 'Total
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'1500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 67.84 2
DI' SCRIPTION OF WORK (with above sq. n.)
Limited energy, multi- family
' 67.84 2
r . / ? ,,-, li. ; t tr ; ,,r , residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
: ❑ PROPERTY';O'fYNER :' ' ❑ 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
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
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
�;t1PPL CANT " I [) CONTACT,PLRSON above service or feeder fee,
each branch circuit 7A2 2
Business name: B. Fee for branch circuits
without service or feeder fee, / 1
first branch circuit 56.18 2
Contact name:
Address: Each add'I branch circuit 2r4 7.42 .. i, f' }-' 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
CONTRACTOR Sign or outline lighting 67.84 2
Business name: Willamette Electric inc Signal circuit(s) or limited -
energy panel, alteration, or
Address: P.O. Box 230547 extension. Describe: Page 2 2
City /State /Z1P: Tigard, OR 97281 Each additional inspection over allowable in any of the above
Per Phone: (503) 624 -3631 Fax: (503 - 624 - 2938 Investigation 66.25 o nn nvestiUghon per hour (1 hr mm) 66.25
V CCB Lic.: 75059 ,./ Electrical Lic.: 34 -283C t� Suprv. Lic.: 4226 - S Industrial plant per tom 78.18
ELEC.TRIGAL , P.ERMIT F
Suprv. Electrician signature, required. `^
P b 9 Subtotal
Print name: David Fife Date: / / / /�� Plan review (25 %ofpennit fee):
1 //( State surcharge (12% of permit fee): / f.+ �•
Authorized signature: TOTAL PERM FEE: j
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. V
1:13uilding'Pcnnits'ELC.PermitApp doc 10'01109 440- 4615T( t 1.05.COM 01013 % / /