Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00613
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/02/2010
Parcel: 1 S135AB01002
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 601
Subdivision: LINCOLN THREE Lot: 0
Project: Matrix Absence Management
Project Description: TI
Owner: FEES
LINCOLN CENTER LLC Quantity Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555
CALIFORNIA ST 49TH FL 14 crt Branch Circuits 11/02/2010 $152.64
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 11/02/2010 $18.32
Electrical
Contractor:
CAPITOL ELECTRIC CO INC
11401 NE MARX STREET
PORTLAND, OR 97220
PHONE: 503 - 255 -9488
FAX: 503 - 257 -7121
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $170.96
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: � Permittee Signature: z_4!.
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.
11/01/2010 10:15 5032577121 CAPITOL ELECTRIC PAGE 02/02
Electrical Fermat Apnli catioR
m oth? (1Fhlc 1. I;S1: ONLY
City of Tigard Datc /By: f I //L . Da a
• 13125 SW Hall blvd,. Tigard, OR 97223NO V 1 2010 Plan Review /
Phone: 503,639. Fax 503.598.19 Date/By: / ‘—
T I •_i CAF, f.T inspect nn Line,: 503, 3Q Date Ready /By; L.. sro INK z Mr
Internet: www,tigard- or,gov CITY OF TIGARD Notified/Method: ■• . Swplcmmml rnrormntinn
BUILDING DIVISION
TYPE OF WORK .. PLAN REVIEW
❑ New construction 1-!.I Addition/alteration /replacement Pleats chit& all that apply (submit 2 seta of plans Wiens checked below);
❑ Demolition Li Otter. n Service or feeder 400 amps or moro ❑ Building over tnree stories
CATEGORY OF CONSTRUCTION where the available fault current ❑ Marinas and boatyards
0 1- and 2- family dwelling i J1 Commercial /industrial ❑ Accessory building exceeds 10,000 amps at 150 volts or Floating bultdingt
❑ Multi-family ❑ Master Builder LJ Other less to ground, or exceeds 14,000 Commercial -use agricultural
JOB 5175 LNEORMATION AND LOCATION amps for all other Installations. ❑ buildings
Job no.: 101285 I ,lob site address; 10220 SW Greenberg Rd �� Fire Pump ❑Installation of 75 KVA or
E Emergency Syslcm larger aeparetely derived system.
(Icy/State/ZIP: Tigard Oregon ❑ Addition of new motor toad of ❑ "A ", "E', "1 -2", "1 -3 ",
100HPormote. LJ occupancy
Suitc/hldgJapt no.: 601 !Project name: Matrix Management U Slx or more realdenUal units n ROGreatlenal vehicle pants.
_ ❑ Hcalth -carc facilities ❑ Supply voltage for more than
Cross Street/Directions to job Site: n Hazardous locations ❑ 600 volts nominal,
❑ Service or feeder 600 amps or more
PEE SCHEDULE
Subdivision; j I Lot no.; Dimerlptlen L Qty. I Pee. 1 Tatnl I
Tax map /parcel no.: New residential - single or mold- family dwelling unit,
DESCRIPTION OF WORK includes attached garage.
Tenant improvement add lights/outlets 1000 sq. 11 or leas S 168.54 4
Ea. Add1 500 sq. ft or portion S 33.92 1
0 PROPERTY OWNER 1 LJ TENANT Limited energy residential
(with above sq. ill_ 8 75.00 2
Name; .
Limited energy. multi- family
Address: residential (with above sq. ft.) S 75.00 _ 2
Service or feeders Instalinden, alteration, and /or relocation
200 amps or [Eta S I0D.70 2
City /Siax1ZIP: 201 amps to 400 amps 8 133.56 2
Phone: Pax: 401 amps to 600 amps 8 20D.34 2
601 amps to 1000 amps S 301.01 2
Owner Installation: This installation is being made on property that! own which ix nor Over 1000 amps or volts _ S 552.20 2
intended for sale, lase, rcnt or exchange, according to ORS 447, 449. 670. end 701 Temporary services or feeders Installation, alteration, and /or
Owner signature: Date: relocation _
200 amps or less x 59.36 1
L ,I APPLICANT 1 LJ CONTACT PERSON 20t amps to 400 amps 8 1 25.09 2
Business Namc: 40l amps to 599 amps 8 169,54 2
Branch circuits- new, alteration. or extension. per pa net
Contact name: A. Fcc for branch circuits with
service or feeder fac, cacti
Address:
branch circuit $ 7, 2
(9. Fee for branch circuits
without service or feeder fcc.
City/State/ZIP: first branch circuit 1 S 56.15 58.18 2
Phone: Fax: Each additional branch circuit: 13 _ $ 7.42 _ 96.46 2
Miscellaneous (scrviee or feeder not included)
E -mail: Each manufactured or modular
CONTRACTOR dwelling, service and or feeder S 67.R4 2
Business Namc: CAPITOL ELECTRIC CO., INC. Reconnect only S 67,84 2
Pump or irrigation circle 8 67,84 2
Contact name; John McNeal Sign or outline lighting 8 67,94 2
Signal Circuit(g) or limited -
Address: 11401 NE MARX ST. energy panel, alterations, or
extension. Describe: Fire Alarm S 75.00 2
City/Statc/ZIP: PORTLAND, OR 97220-1041 Page 2
Each additional Inspection over allowable In any of the above
Phone: 503- 255 -9488 Fax: 503.257 -7121 Pcr inspection S 66.25
Investigation per hour l hr min) S 66.25
CCB Lic.: 48748 (Electrical Lic.: 26 -496C ISuprv. Lic.: 3132 -S Industrial plant per hour 5 78,18
Suprv. Electrician sign it ".: Afrt , AI ,ELECTRICAL. PERMIT FES"
r /1i...4 Subtotal S 152.64
Print Name: EtilkR C EEL Date: 111 :1 /1 Phan review (25%of permit fen)
Authorized signature; State surcharge ( 12% of permit fcc) $ 18.32
.�/� TOTAL PERMIT FEE $ 170.96
Print Namc: DARRELL (A L Tarn permit appnatlon mprron It a pe•Mll In not ahtaln,d wtthle ran
• days after It bas been accepted al templet,
• Number of inspections per permit allowed.
TO ?- 0 WeAl