Permit 114
* i CITY OF TIGARD
ELECTRICAL PERMIT
>: COMMUNITY DEVELOPMENT Permit #: ELC2010 -00313
k t Date Issued: 06/24/2010
A i GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
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Parcel: 1 S126DCO3300
Jurisdiction: Tigard
Site address: 9900 SW GREENBURG RD 245
Subdivision: Lot: 0
Project: State Farm Insurance
Project Description: (1) branch circuit for light switch.
Owner: FEES
ATHERTON REALTY PARTNERSHIP Quantity Description Date Amount
200 SW MARKET ST SUITE 200
PORTLAND, OR 97201 1 crt Branch Circuits 06/24/2010 $56.18
• wo /Purchase Service or
PHONE: 503 - 279 -1722 Feeder
1 ea 12% State Surcharge - 06/24/2010 $6.74
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 $62.92
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.
r
Issued By: _ _...r.C- _ —09,1r Permittee Signature: i
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.
CaII 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.
06/24/2010 THU 8:18 FAX 5036242938 Willamette Electric 1 j002 /00`2
Electrical Permit Applicati0 !Fr q /„ rOR OFFICGLSE ONLt
City of Tigard " ., Received �
M -`' DateB : & BIM= Permit No.: _ , r
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
s . Phone: 503.639.4171 Fax: 503.598.191 : p
•
�N 2 4 2010 llatc /B : Other Permit f I )10— OtO'3G
T 1 GAR D Inspection Line: 503.639.4175 Date Ready /By: Ju - ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: T 17 Supplemental lnformation
Tl' y CII T�° ( Gr- l' P'{' ' AN R E EI4 -
PiE Oi.$4 �R �1< , r ; {pr" a
n ,_. .PL .
t. 1 1 � 7 . ? Please .:
leas check all that apply (submit 2 sets of plans w items checked below):
❑ New construction RI Addition /alteration /replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition 0 Other:
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUC I'I0N exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
. Icss to ground, or exceeds 14,000 ❑ Commercial - use agricutturat
❑ 1- and 2- family dwelling L j Commercial/industrial ❑ Accessory building amps for all other installations, buildings.
❑ Multi- family ❑ Master builder ❑ other ❑ Piro pump. ❑ installation of 75 KVA or
. Emergency system. larger separately derived system.
T
,OB TE I
SINFORMATION AN LOCATION
... , . , . ❑ Addition of new motor load of ❑ "A" "L'^ - 1 - 2 - , "I 3"
Job no.: 5 j 9�/- p Job site address: 79 s- 300o 1' or a res. R occupancy. Recreational rM rr -rrt� �++� � /�. ❑ Six or more residential units. ❑Recreational vehicle parks.
City /State /ZiP: 71-/G..4, ❑ Health -care facilities. ❑ Supply voltage for more than
� , U 16 f ❑ Hazardous locations 600 volts nominal.
,ire/ 1dg.lapt. no.: 2 �5 Project name: ❑ Service or feeder 600 amps or more.
r ` _)E SCHEDUL ' ;,
Cross street /directions to job site: Description 1 Otw i Pee J Total 1 + -
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
DESCRIPTION OF . WOR K (with above sq. 0.) 67.84 2
/
� - Limited energy, multi - family
4,d / S < residential (with above sq. ft.) 67.84 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
.O PROPERT\' OwN ER,: : ' D TENANT 201 amps to 400 amps 133.56 2
Name: 401 amp 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 1
Owner installation: This installation is being made on property that i own which is not 20 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
(] "APPLICAAT D, CONTACT PERSON above service or feeder fee,
7A2 2
each branch circuit _
Business name: 13. Fee for branch circuits
without s ervice o f eeder fee, / 56.18 5L 2
Contact name: first branch circuit
-
Address: Each add', branch circuit 7.42 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/ZIP: Tigard, OR 97281 Each additional inspection over allowable in any of the above
Per
Phone. 03) 624 - 3631 Fax: (503 - ) 624 - 2938 inspection 66.25
Investigation on per hour (t hr mm) 66 .25
CB Lic.: 75059 lcctrical Lic.: 34 -283C Suprv, Lic.: 4226 -* ' Industrial plant per hour 78.18
ELECTRICAL_ PERMIT `FEES
Suprv. Electrician signature, rcquired ' -- --� _ _ _ _ Subtotal: 56.7 w
Print name: David Fife G — - - bate: 0/7
7
/ S tate surcharge (12% of pennit fee): ( 1
Authorized signature: TOTAL PERMIT FEE:
6 2- q1.
Print dame: 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.
1:11uildiugPcaniss CI .C- Pcrmi,App.doc 10'0109 440- 4615T(1 t r00. COMMEFI