Permit CITY OF TIGARD ELECTRICAL PERMIT
0 COMMUNITY DEVELOPMENT Permit #: ELC2010 -00549
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/07/2010
Parcel: 2S101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 100
Subdivision: TRIANGLE CORPORATE PARK Lot: 2
Project: Lincoln Heritage
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 20 crt Branch Circuits 10/07/2010 $197.16
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 10/07/2010 $23.66
Electrical
Contractor:
HILLSBORO ELECTRIC LLC
21185 NW EVERGREEN PKWY #110
HILLSBORO, OR 97124
PHONE: 503 -439 -9666
FAX: 503 - 601 -3680
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $220.82
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: Arm. ��.�� 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.
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.
Oct 0410 08:22p p.1
Electrical Permit AnplicatioIRECEJVED FOR OFFICE: USE ONLY
III City of Tigard
Received
13125 SW Hall Blvd., Tigard, OR 9722 C T 5 2010 Oa1e /3 I
I Plan Review l./ alailiZEI:MIEMMIni
Phone: 503.639.4171 Fax: 503.598.1960
Date, Other Permit: ti 4 ► iu- 00 i
1' 1 C; A R 1) Inspection Line: 503.639.4175 CITY OF TIGARD Dater �� lu 21 See Page 2 for
Internet: wwnv.tigard- or.gov BUILDING DIVISION ' . j Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction Addition /alteration/replacement Please check all That apply (submit 2 sees of plans w:items checked below):
❑ Service or feeder 400 amps or more ❑ 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.
'Ea - less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
El - and 2- family dwelling Commercial /industrial Q Accessory building amps for all other installations. buildings
❑ Multi- family ❑ Master builder ❑ Other: 1 Fire pump. ❑ installation of75 KVA
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system,
. ❑ Addition of new motor load of ❑ `.4 ", "E ", "I -2 ", "1 -3 ",
-✓
Job no.: � Job site address: ] r � x t� 1001 occupancy.
` ` t ��w Y '� ❑ Six or more residcnlial units. ❑ Rearealional vehicle parks.
City!State/ZIP C3�} C�i� die ,�a �- 11 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
\
it Idg_laptno.: it i Project name: >�y -Y�1� �� -\-0 -. Z ❑ Service or feeder 600 amps crmore.
FEE SCHEDULE
Cross street/directions to job site: Ikscri lion
P I Qty, 1 Pea 1 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'I 500 sq. R. or portion 33.92 I
Tax map /parcel 110.:
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited mubfvs 7500 2
residential above (with above e sq. q. [l.)
S ervices or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER i ❑ 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 I 552.26 2
City /State /ZIP:
Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 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 zmps to 599 amps 165.54 j 2
Branch circuits - ncw, alteration. or extension, per panel _
Owner signature: Date: A. Fcc for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first
Contact name: branch circuit G6 ' 18 t I �U (
2
. Each add' 1 branch circuit t9 7.42 1I ( ,�D 2
I Address: Miscellaneous (service or feeder hot included)
Each manufactured or modular
Clty /StatcfZIP: dwelling. service and /or feeder 67.84 12
Phone: ( ) Fax:: ( ) Reconnect only 6 ?.84 2
E Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited -energy
Business name: Hillsboro Electric, LLC panel, alteration, or extension. page 2 _ 2
Each additional inspection over allowable in any of the abov
Address: 21185 NW Evergreen Pkwy #110 Additional inspection (I hr min) 66.25/hr
Ind l min) 66.25/ hr
City /State/ZIP: Hillsboro / OR / 97124
Indus:rialplant(I hr min) 78.18/hr
Phone: ( 503 439 -9666 1 Fax: (`03) 601 -3680 specifically listed hhrmin)ts 90.00/hr
CCB Lic.: 1 34481 Electrical Lic.: 34 -499C Suprv. Lic.:49 /I5 ELECTRICAL PERMIT FEES Tq-�
Suprv. Electrician signature, required: pl��
Subtotal: l: ! / J • 1 � D
Plan review (25 of permit fee �,,,
1 f •� /,�
Print name: To e� !'t 4 D ate: Y b _/ ��D Slate surcharge (12 °.0 of feel: a • �++
V �V TOTAL PERMIT FEI Oe V. Authorized signature:
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
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