Permit //// a 1E- ) ,,, Ad /el.
CITY OF TIG ELECTRICAL PERMIT
III ii
I: COMMUNITY DEV LOPMENT Permit #: ELC2010 -00527
T I G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/30/2010
Parcel: 2S101 DA00104
Jurisdiction: Tigard
Site address: 13333 SW 68TH PKWY
Subdivision: FARMERS INSURANCE Lot: 0
Project: ACS
Project Description: Work is for TI on first floor, 1/3 of second floor and 2nd floor lobby. Low voltage is for fire alarm.
10/19/10, adding (6) 200 amp or less svc/fdr, (1) 401 -600 amp svc/fdr, (20) branch circuits & (1)
low voltage for HVAC.
Owner: FEES
TRIANGLE POINTE LLC Quantity Description Date Amount
901 NE GLISAN ST #100
PORTLAND, OR 97232 205 crt Branch Circuits 09/30/2010 $1,569.86
wo /Purchase Service or
PHONE: Feeder
1 ea Signal circuit or Limited 09/30/2010 $75.00
Energy Panel
Contractor: 1 ea 12% State Surcharge - 09/30/2010 $197.38
ROSENDIN ELECTRIC INC Electrical
2925 NW ALOCLEK DR #170 1 ea Plan Review Electricial 09/30/2010 $411.22
HILLSBORO, OR 97124 6 ea Services or Feeders - 200 10/19/2010 $604.20
PHONE: 503 -615 -8189 amps or less
FAX 503 - 615 0689 1 ea Services or Feeders - 401 to 10/19/2010 $200.34
600 amps
20 crt Branch Circuits w /Purchase 10/19/2010 $148.40
Service or Feeder
Type of Use: COM 1 ea Signal circuit or Limited 10/19/2010 $75.00
Energy Panel
Class of Work: ALT Type of Const: 123 da 12% State Surcharge - 10/19/2010 $123.35
Occupancy Grp: Electrical (manual)
Total $3,404.75
Required Items and Reports (Conditions)
This permit is iss = - • •• > 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 - •rdance with approved pia . This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. A • NTION: Oregon law reel ' es y •u • follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -• 110 throu h OAR 952 -001 -0 • • You • ,- ob - in a copy of the rules or direct questions to OUNC by callin • . , 6.6699 or 1.800.332.2344.
Issued : y: \ \\ ! G �L f Permittee Sign • .' i>� �(L/
OWNER INSTALLATION ONLY U
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.
Electrical Permit Application eJ /`v1 • FOR OFFICE USE ONLY
City g of Tigard • Received permit No.: Ex. 0 20/0- CO 5a.7
111111 Date /By: , 0 ,/,'" /O
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
G • Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit:
Inspection Line: 503.639.4175 Date Ready /By: orris: el See Page 2 for
T I G A Ii D N otified/Method: Su
Internet: www.tigard or.gov Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction xi Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more N. Building over three stories.
❑ Demolition ❑ Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I - ", "1 - ",
100HP or more. occupancy.
Job no.: 320 3y Job site address: 3333 �(� fo P (cfaa� ❑ Six or more residential units. p
qr 0 vehicle parks.
City /State /ZIP: -�— a �� 9� �� 0 locations. ❑Health-care facilities. ❑Supply voltage for more than
� 600 volts nominal.
`
Suite /bldg. /apt. no.: Project name: 7'rht ilq 1?. I i)li µiL , k( T .1. ❑ Service or feeder 600 amps or more.
J FEE SCHEDULE
Cross street/directions to job site: s ,. 5 - C ,: (� <r tb Description I Qtr. I Fee. 1 Total I *
" New residential single- or multi - family dwelling unit.
''. b)44 £4 ldo_ it t Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft or less 168.54 4
Ea. add'I 500 sq. 11. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
AA ,,,, !( [ ( 1 I Limited energy, multi - family 75.00 2
1 1�1 D F DI S 1 f I )k IOtt J si. DN l (GON _ IiAu S) residential (with above sq. ft.)
#.0 (' 1 t - J ( Services or feeders installation, alteration, and/or relocati��
N 41 A) S Power Says +lnn 200 amps or less 10 0.70 ([9�/ 9 2
VI PROPERTY OW ER I ❑ TENANT 201 amps to 400 amps 133.56 __ II 2
j� / 401 amps to 600 amps r 200.34 .4(+ % 3y 2
Name:
D e a.com 'U �'q MC.� G-000p 601 amps to 1,000 amps 301.04 2
Address: 103 r G1 /s` s} s� 'a Over 1,000 amps or volts 552.26 2
I Temporary services or feeders installation, alteration, and /or
City/State /ZIP: f�Ot I a ho0 4) 232 relocation
( 3) 2 7 7 - c o 1 / 2 / I- 4 M
Phone: Vt/ Fax: (��) J '7 200 amps or less 59.36 1 17
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
A APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, q O 7.42 � !�f9. 2
each branch circuit !�
Business name: D 4 C �� I N ��� G B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: ''••
U� f i s%d� St i AI& branch circuit
'tt � !� 1 }.� Each add'I branch circuit 7.42 2
Address: 212 1�4�� Dr. su /CG 1 /0 Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: ty (j, (15 to {./ 0 C O/ 21 dwelling, service and/or feeder
67.84 2
� Reconnect only 67.84 2
Phone: (.53 ) 6 /�. 8 1 e 9 Fax: (Su )g) s. o� $� Pump or irrigation circle 67.84 2
E - mail: Pat / se@ iibSe(Jdif ifoM Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy QV
Business name: R42s t a 81 � AL, panel, alteration, l ins extension. c Page n 75 2
Each additional inspection over allowable owable in any of the above
Address: 2 92s A W Arlo cje , Zr 4' /761 Additional inspection (1 hr min) 66.25/ hr
A �J, � (� ei'WV Investigation (1 hr min) 66.25/ hr
City /State /ZIP:
�t+ "'�� Industrial plant (1 hr min) 78.18/ hr
Phone: (5n ) CIS-- 0 I S( ! Fax: ( ) 41r-ex I / Inspections for which no fee is 90.00/ hr
�+' V specifically listed (% hr min)
CCB Lic.: /03931 Electrical Lic.: • - 92 Suprv. Lic.: S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: L o Subtotal: 10,27,E
• _ Plan review (25% of permit fee):
Print name: S-/ `N Jam 1 104 A , Date: r jo ,0 State surcharge (12% of permit fee): / 23.1r l TOTAL PERMIT FEE: „ f'�i
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. / /5/, a9
\
1:\Building\PermitsELC- PermitApp.doc 07/01/10 440 -4615T(l 1 /05 /COM /WEB ! f " //�
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: i
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PermitApp.doc 07/01/10
CITY OF TIGARD ELECTRICAL PERMIT
0 COMMUNITY DEVELOPMENT Permit #: ELC2010 -00527
T I G A g.0 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/30/2010
Parcel: 2S101 DA00104
Jurisdiction: Tigard
Site address: 13333 SW 68TH PKWY
Subdivision: FARMERS INSURANCE Lot: 0
Project: ACS
Project Description: Work is for TI on first floor, 1/3 of second floor and 2nd floor lobby. Low voltage is for fire alarm.
10/19/10, adding (6) 200 am or less svc/fdr, (1) 401 -600 amp svc/fdr, (20) branch circuits & (1)
low voltage for HVAC 11/5/10, adding (1) 601 -1000 amp svc /fdr.�
Owner: FEES
TRIANGLE POINTE LLC Quantity Description Date Amount
901 NE GLISAN ST #100
PORTLAND, OR 97232 205 crt Branch Circuits 09/30/2010 $1,569.86
wo /Purchase Service or
PHONE: Feeder
1 ea Signal circuit or Limited 09/30/2010 $75.00
Energy Panel
Contractor: 1 ea 12% State Surcharge - 09/30/2010 $197.38
ROSENDIN ELECTRIC INC Electrical
2925 NW ALOCLEK DR #170 1 ea Plan Review Electricial 09/30/2010 $411.22
HILLSBORO, OR 97124 6 ea Services or Feeders - 200 10/19/2010 $604.20
PHONE: 503 - 615 -8189 amps or less
FAX 503-615-0689 1 ea Services or Feeders - 401 to 10/19/2010 $200.34
600 amps
20 crt Branch Circuits w /Purchase 10/19/2010 $148.40
Service or Feeder
Type of Use: COM 1 ea Signal circuit or Limited 10/19/2010 $75.00
Energy Panel
Class of Work: ALT Type of Const: 123 da 12% State Surcharge - 10/19/2010 $123.35
Occupancy Grp: Electrical (manual)
0 ea 12% State Surcharge - 11/05/2010 $138.16
Electrical
0 ea Plan Review Electricial 11/05/2010 $256.98
1 ea Services or Feeders - 601 to 11/05/2010 $301.04
1000 amps
Total $4,137.05
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. AN work will
be done i ccordance • 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. ENTION: Oregon t.. :•uir- you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -0 -0010 through OAR • • • • • 01. You may obtain a copy of the rules or direct questions to OUNC by cal I.•_ -: , 46.6699 or 1.800.33 .2344.
Iss d By: • Permittee - i• nature: 110 � ' it
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
r-
SIGNATURE OF SUPR. ELEC' ( I —` _ �` . ` 1I' 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.
CITY OF TIGARD ELECTRICAL PERMIT
1 0 COMMUNITY DEVELOPMENT Permit #: ELC2010 -00527
T 1 GAR. D ' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/30/2010
Parcel: 2S101 DA00104
Jurisdiction: Tigard
Site address: 13333 SW 68TH PKWY
Subdivision: FARMERS INSURANCE Lot: 0
Project: ACS
Project Description: Work is for TI on first floor, 1/3 of second floor and 2nd floor lobby.
Owner: FEES
TRIANGLE POINTE LLC Quantity Description Date Amount
901 NE GLISAN ST #100
PORTLAND, OR 97232 205 crt Branch Circuits 09/30/2010 $1,569.86
wo /Purchase Service or
PHONE: Feeder
1 ea Signal circuit or Limited 09/30/2010 $75.00
Energy Panel
Contractor: 1 ea 12% State Surcharge - 09/30/2010 $197.38
ROSENDIN ELECTRIC INC Electrical
2925 NW ALOCLEK DR #170 1 ea Plan Review Electricial 09/30/2010 $411.22
HILLSBORO, OR 97124
PHONE: 503 - 615 -8189
FAX: 503 - 615 -0689
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $2,253.46
Required Items and Reports (Conditions)
This permit ssued subject • . - regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don 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 requ ._ •u to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 101 -0010 thro gh OAR 952 -001 -• 00. o . ay obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.; 00.3 .2344.
Is ed By: ) . 1--- �� » 4 L. f Perm Signature: 0 � . _
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.
Electrical Permit Application ` rt l li c) l l l c: l : I : l: 0\1.\
Cl of Tigard - Received G Permit No.: LC x j(v - (, J 7
•
City g v, D ate/Bv: }t t 1 U
• 13125 SW Hall Blvd., Tigard, OR 97223 q �. Plan Review G
C Phone: 503.639.4171 Fax: 503.598.1960 c W _ y: teB : O Other Permit:
Inspection Line:
Ins 503.63 S`e ' '_ • ReadyReady/By: 7 � f
y: /1 O�a( ruris: See Page 2 for
T I i A R I)
Internet: www.tigard Q G � �C tl V J ® Supplemental Information IL �l• _,�
• • .ail - �i
TYPE OF WORK °''' � ` .,, - � .- PLAN REVIEW
Plea
❑ New construction ® Addition/alteration/repl ment se check : • that apply (submit a sets 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.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire PumP. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of
Job no.: pending I J site address: 13333 SW 68 Parkway boor or more. Recreational g ❑ Six or more residential units. ❑ Recreationn
al vehicle parks.
City/State/ZIP: Ti rd OR 97223 ❑ Health-care facilities. ❑ Supply voltage for more than
ty ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 10 o 1 Project name: Triangle Pointe PH2 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Corner of 1 -5 and Hwy 217 - NW corner Description I Qtr. 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 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family
Tennant remodel of l floor and 1/3 of 2 floor. 2 floor Lobby also residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
® PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps ..-4 106.85 . 2
Name: Deacon Development Group 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 901 NE Glisan Street Suite 100 Over 1,000 amps or volts 454.65 2
City/State/ZIP: Portland OR 97232 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (503)297 -8791 I Fax: (503)297 -8997 200 amps or less I 66.85 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 - 2
Owner si ature: Date: Branch circuits — new, alteration, or extemsi , r panel
A. Fee for branch circuits with go S
®APJKAA111T 1 ® CONTACT PERSON above service or feeder fee, , l 1%972 2
each branch circuit
Busine : e: Rosendin Electric, Inc. B. Fee for branch circuits
ntact name: Steve Hogberg without service or feeder fee, 46.85 2
• og first branch circuit
•
Address: 2925 NW Aloclek Dr #170 Each add'1 branch circuit 6.65 2
Miscellaneous (service or feeder not included) -
City/State/ZIP: Hillsboro, Or 97124 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (503) 615 8189 Fax:: (503) 61 0689 Reconnect only 66.85 2
-mail: shogberg @rosendin.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: on Signal p a nel t(s) or limited -
energy panel, alteration, or
Address: extension. Describe: 1 Page 2 75.00 2
City/ State/ZIP: Each additional inspection over allowable in an of the above
Per inspection 62.50
Phone: (503)297- -8491-- I Fax: (503) 297 -8997 Investigation per hour (1 hr min) 62.50
Q CCB Lic.: 103939 Electrical Lic.: 37 - 692C Suprv. Lic.: 3991S Industrial plant per hour 73.75 -
( ELECTRICAL PERMIT FEES g y
\t) Suprv. Electrician signature, required: Subtotal: 1535:50 1, (f��
MN Print name: Stephen Lawhead pgt • 2� ( Plan review (25% of permit fee): 38+62 b g
t� State surcharge (12% of permit fee): ' °-J 4
C Authorized signature: l 1 L . TOTAL PERMIT FEE: �„S •
Print name: Date:
I
This permit application expires if a permit is not obtained within 180
0 days after it has been accepted as complete.
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E1e trical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other.
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
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