Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00411
T f CARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/09/2010
Parcel: 25101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 200
Subdivision: TRIANGLE CORPORATE PARK Lot: 2
Project: HealthNet
Project Description: Electrical 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 6 crt Branch Circuits 08/09/2010 $93.28
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 08/09/2010 $11.19
Electrical
Contractor:
HILLSBORO ELECTRIC LLC
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 $104.47
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 • 952- 001 -0100. You may obtain a copy •lib's: les or direct questions to OUNC by calling 503.246.6699 or 1
Issued By: _ — Permittee Signature:
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.
From:Hillsboro Electric,LLC 5036013680 08/05/2010 23:27 #747 P.001/002
Electrical Permit A licatio �
(� `�, F 7 r FOFtOFFI( F "I�tiF O \r.l
d City of Tigard }� t T p P
Receive
III '°' ; Date/13 . �,! i/ f <)� Permit No.. `C
� � 1 3125 SW Hall Blvd., Tigar. • tt Plan Review
7223 010 _ --VU
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Phone: 503.639.4171 Fax: 503.5 0 6 L Date/B : Other Permit:
- 1:1) Inspection Line: 503.639.4175 `^ • ,� r Date Ready/By: kris: 65 ee Page 2 for �
=sari' Internet www.tigard- or.gov r „ , ' t� id I Notified/Method: TT , Supplemental Information
"V • 1 .�' rvhl " i✓
TYPE o ls►i ! �S `'- `
J > �f� rl. PLAN REVIEW
❑ New construction p Addition )'(� Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition ❑Other: ❑ Service or feeder 400 amps or more ❑ Budding over three stories.
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
1- and 2-family dwelling Commercial /industrial less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
El y g ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A "E ", "1 -2 "1 -3 ^,
Job no.: ` nl Job site address: nJ ^L /` In �j } h 100HPormore. occupancy.
• "" � °� \ '^ (/� ) W rl `" .1 Y/ \ ❑ S ix or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: / i Gtr ` Dk t <1 .7 2 7 ❑ Health -care facilities. ❑ Supply voltage for more than
a i _ ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: ✓ W Project name: /7L /.1L1, r/i o } ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:
Description 1 Qry. 1 F. 1 Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1 . 0 0 0 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 WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family
C O� -� 6f//t. � .S' �'� residential (with above sq. ft.) _ 75.00 2
_
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133 56
2
Name:
401 amps to 600 amps 200.34 2
60) 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
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not -
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
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first 1
Contact name: branch circuit J 56.18 sl J� 2
Each add') branch circuit "" 7.42 3 7, JO 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City /Slate /ZIP: dwelling, service and/or feeder 67 2
Phone: ( ) Fax: : ( ) Reconnect onl 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited-energy '
Business name: Hillsboro Electric, LLC panel, alteration, or extension. Paget 2
Each additional inspection over allowable in any of the above
Address: 21 1 8 5 NW Evergreen Pkwy #110 Additional inspection (1 hr min) 66.25/ hr
Investigation tipant (1 mm) 66.25/ hr
City / State/ZIP: Hillsboro / OR / 971 24
Industrial plant (1 hr min) 78.18/ hr
Phone:( 503 439 -96 Fax: (503 ) 601 -3680 Inspections for which no fee is
u specifically liste VA hr min) 90.00/ hr
CCB Lic.: 134481 Electrical Lic.: 34-499C Suprv. Lic.: -1 / c y / S ELECTRICAL PERMIT FEES
� / ./1 / � Subtotal: S ti 3. �
Suprv. Electrician signature, required: Pit 1
Plan review (25% of permit fee): ,---
Print name: i �� U � t, LuU Date: _ _ /v State surcharge (12% of permit fee): r t' (.. (
Authorized signature: TOTAL PERMIT FEE: 6f ( l ()I -I • y 1
This permit application expires if a permit is not o within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
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