Permit Er CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00006
. 1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/07/2010
TIGARD Parcel: 2S113AB01201
Jurisdiction: TIGARD
Site address: 16505 SW 72ND AVE
Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project: Safeco
Project Description: Add /alter (15) branch circuits.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 15 crt Branch Circuits 01/07/2010 $160.06
wo /Purchase Service or
PHONE: 503 - 624 -6300 Feeder
• 1 ea 12% State Surcharge - 01/07/2010 $19.21
Electrical
Contractor:
TIMBERLINE ELECTRICAL CONTRACTORS
PO BOX 918
LAKE OSWEGO, OR 97034
PHONE: 503 - 459 -4089
FAX: 503 - 254 -4227
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $179.27
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: 1 Permittee Signature: /I A7 /91)/e) LPL 7 "
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.
! Permit Applicatioi CE
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4 k y . 23225 SW He12: B1td, Tigard; OR 97223 JAN Daze/By: J E �` ?oil ). coca (,s
Fe' al ti . Phone: 503.639:4171 Fax: 503.598.1960 DateBy: Other Permit:
' 1 ''' ' \ Inspection Line: 503.639:4175 CITY OF TIGARD Dare Read 0 see Page Z file
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0 New construction • • ® Addition/alteration/replacement Please check all that apply (submit a sets of plans w /items checked below):
❑ Demolition ❑ Service or feeder 400 amps or more ❑ Building over three stories -
• where the available fault current ❑ Marinas and boatyards:
CAT'LGO):tI},'.01t LUIVSTRUCI'1OIy exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
❑ 1 - and 2- family dwelling ® Commercial/industrial 0 Accessory building a to ground or exceeds ons. ❑ buildings. t -use agricultural
taps for an other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
:108 SITE INFORMATION” AM LOCATKlN ❑ Addition o s larger separately derived system.
,
";` ...:. . , �, ., ': . , dition of new motor load of ❑
❑Ad
Job no.: Job site address: 16505 SW 72" Ave 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, Or, 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: Liberty Mutual Expansion ❑ Service or feeder 600: amps or more.
P1111 C00#4 r .
Cross street/directions to lob site: m ay- [ ,. d rea. • 1 f
New residential single- or multi - family dwelling. wit.
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 gy rDII meted ener residential
6 2 SCIUPTIO,N Op W 0R ...! (with above sq. 51 ) id
;: � 7:84
Limited energy, multi- family
Expanding existing space residential (with above sq. 1t.) 67.84 2
Services or feeders installation, alteration, and/or amps t�ektcation
200 or less • 100.70 � 2
,;s, *'! ,F I"i' t�W ` y :' . -: 0 '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 1
Owner installation: This installation is being made on property that I own which is not 20 r amps to 400 am ps 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
►' APP ICANT -_ " C(3NTAC'T P.ER.90Pr above service or feeder fee,
7A2 2
- . each. branch circuit
Business name: Timberline Electrical Contractors B. Fee for branch circuits '
Contact name: Paul Hutson without service or feeder fee, 1 56.18 56.18 2
first':branch 'circuit
Address: Same as below • . Each add'! branch circuit 14 7.42 103.88 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular •
dwelling service and/or feeder 67.84 • 2
Phone: ( ) Fax:: ( ) ' Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
' „ , 7 , -. ,. CONT1YAG"1'Olt . , Sign' or'oulime'lighting 67.84 2 ,
Business name: Timberline Electrical Contractors signal c;rcuit(s) or limited -
energy panel, alteration, or
Address: PO Box 918 extension. Describe: Page 2 2
City(StateILIP'. Lake Oswego, Or. 97034 Each additional htspectinn, over allowable in any of the above
Phone: (503) 459 - 4089 Fax: (503) 254 - 4227 P ectton 66.25
F Investigation per hour (1 hr min) 66.25
CCB Lic.: 160037 Electri .. i t.: l' 6- 1 /] Suprv. Lic.: 4957S Industrial plans per hour 78.18
Su rv- Electrician si .S.t , CF ICAL P'ERMU' t ..
p ' + g Subtotal: 160.06
Plan review (25% of permit fee):
Punt name: Patrick Ai h e Date: 1.5.2010 / (q p I
State surcharge (12% of permit fee): 0
Authorized signature: r it • , a TOTAL PERMIT FEE: 1 . 6
Print flame: Paul Hutson Date: 1.5.2010 T'hlspennit application expires if a permit is not obtained within 180
days alter it has been accepted as comp
Bng\Penultl\ELC- PenvitApp.doc 10/01/09 440- 461sr(01/o5/COM/WEB
• Number of inspections allowed per permit.
1: \ui li p.7
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£OO /Z06 rA YVd 60•TO OTOZ /50 /TO
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