Permit CITY OF TIGARD ELECTRICAL PERMIT
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Permit #: ELC2010 -00360
..,. COMMUNITY DEVELOPMENT
Date Issued: 07/16/2010
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 parcel: 1S135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 120
Subdivision: LINCOLN ONE Lot 0
Project: Genex
Project Description: (4) branch circuits for TI
Owner: FEES
LINCOLN CENTER LLC Quantity Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 4 crt Branch Circuits 07/16/2010 $78.44
CALIFORNIA ST 49TH FL wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 07/16/2010 $9.41
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 $87.85
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: l ' � Perrnittee Signature: a/t7 .191 .191 C-- fe
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.
07/14/2010 WED 15:08 FAX 5036242938 Willamettt C j002 /002
Electrical Permit Application � �� �� ' J roll of rlCL 11 o !-,Y City of Tigard � Datei13 . /6 /O Permit No.:��' / /O 't.0 G7 • 13125 SW flail Blvd., Tigard, Oil 97223 ��
lan Review
$ Phone: 503.639.4171 Fax: 503.598.1960 �s 1 P Data'B Y . Other Pcrm ee
i( up /w/0 _D /_5
, F
flGARb inspection Line: 503.639.4175 ,� , �kReady /By: Ltr lid See )'age2for
-
Internet w ww (igard or"gov 0 ' otified!Method � en
TYPE, OF WORI + a ` L
'AN Y
RE1EyV Supplemental Information
0 New construction 1Z Addition /alteration /t * 4 cement Please check all that apply (submit 2 sets of plans wtitems checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑Other:
where the available fault current ❑ Marinas and boatyards.
_CATEG(SRX O''- CONS` exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
1 d d 140
00 ❑Commercial -use agricultural
❑ 1- and 2- family dwelling fia Commercial/industrial ❑ Accessory building alnps for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JO$ . S1 i E TNFOILYIATION A ND LOCATION crgettcy system•
larger separately derive cm.
- .. :. .;. . Ad dition of new motor load of l -3 .
I d system.
Job site address: 10011P or more. occupancy.
Job no.:
39 _ 7 _ Job .2c, Sw �t G fyt
• ❑ Six or more residential units. 0 Recreational vehicle parks.
City / State/ZIP: ' �, h 1722-- ❑ Health-care facilities. ❑ Supply voltage for more than
cl ❑ Hazardous locations 600 volts nominal.
Suit 1dg" /apt. no.: /2„ Project name: / 1 , � ✓ ❑ Service or feeder 600 imps or more"
/ � `F.EESCHEUULE
;
Cross strcc1 /directions to Job site: Description i pty . I Fee. I 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
Tax snap /parcel nn.: Ea. add' 1 500 sq. 0. or portion 33.92 1
Limited residential
67.84 2
DESCRIPTION OF W.O12K (with above sq. )
�- „� n Limited energy multi - family
/ e ..1.4 � i /l , f .,�✓+t!rn,i �� res (with above sq. ft.) 67.84 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 100,70 2
O , PRO;PERT2 OWNER; ( ? ❑ TENANT 201 amps to 400 amps 133.56 2 •
Natnc: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 atnps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) 1 Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I 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
[j ;APPLICANT ❑ CONTACT„ J'ERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, / 56.18 5-4 / 2
first branch circuit
Address: Each add't branch circuit 3 7.42 ,0 7 . 2.. 74, 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
COISTRACTOR. 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 inspection 66.25
one: (503) 624 - 3631 I Fax: (503 - ) 624
_Investigation per hour (1 hr nun) 6G 25
CCB Lic.: 75059 Electrical Lic.: 34 -283C Suprv. Lic.: 422641,5, e / ' Industrial plant pct how 78.18
_— ...._ . .... ELECTitZCAL PERMIT. F EES < .
Suprv. Electrician signature, required, - -• Subtotal: 7 fr' --
Print name: David Fife Date: • Plan review (25% ofpennit fee):
7 / /�� State surcharge (12% of permit fee): 9 Y�
Authorized signature: TOTAL PERM IT FEE: 5(7 r....4.7-
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. //// ////���� (j�
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