Permit 4'__7- CITY OF TIGARD ELECTRICAL PERMIT
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Permit ELC2011 -00308
;-:__ COMMUNITY DEVELOPMENT Date Issued: 06/08/2011
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439
?IGARt3 Parcel: 1 S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 220
Project: Lecroy Subdivision: METZGER, TOWN OF Lot:
Project Description: (6) branch circuits for dedicated outlets.
Contractor: CAPITOL ELECTRIC CO INC Owner: LINCOLN CENTER LLC
11401 NE MARX STREET BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97220 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE:
PHONE: 503 - 255 -9488
FAX: 503 - 257 -7121
FEES
Quantity Description Date Amount
6 crt Branch Circuits wo /Purchase 06/08/2011 $93.28
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/08/2011 $11.19
Type of Use: COM Electrical
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 w ill 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 OA 52- -0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /
Issued By: Permittee Signature: d� , / " ,,L/6 � r70 '"
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 the next available inspection date.
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.
06/07/2011 09:54 5032577121 CAPITOL ELECTRIC PAGE 02/02
li;lectrical Permit A . 1•catiol p B� vol Rete;
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R E r D D atc /By: w/d I� / Pormit no..GC� // oc ,, 0 f� -
City of Tigard o
, 13125 SW Hail 1.31vd„ Tigard, Ott 97223 1 ► s Plan Review Other Permit
e.. Phone: 503.630.4171 Fax: 503.598,396n N e 2011 DatcfBy:
p Date Ready /By: funs 1 Srag
TIGARD inspection Line: 503.639,4175 LI ec 2Ibr
Internet: wwW.tigarrl•Of.gov CITY OF TIGA, D Notified /Method: `� sephlemcntel Infm
81111 �i' 'G C ,,,:..:a...
1 TYPE OF WORK - .•`" IoI�Jf(J!4 PLAN REVinw
Li New construction I:'-1 Addition /alteration /replacement Please chock all that apply (oubmlt 2 sets of plans w /Items checked hrilow):
❑ f)cntol ❑ Other; 7 Service or feeder 400 amps or more lJ Building over three stories
CATEGORY OF CONSTRUCTION where the available fault current ❑ Marinas and boatyard
L. I I- and 2- family dwelling H C'ntmncroial /industrial Li Accessory building exceeds 10,000 amps ai 150 volts or ❑ Floating buildings
❑ Multi - family — NA Masler Builder I.3 Other _ less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
JOB SITE INFORMATION AND LOCATION amps for all Other Installations. _ I Installation of 75 KVA or
buildings
i
❑ Flre Pump
Job no.: 110649 Job site address: 10220 SW Graenburg Rd
❑ Emer System larger soparalely derived s
❑ Addition of now motor load of ❑ "A ", "E ", "1.2", "1 -3 ",
City/State/ZIP; Tigard Oregon 100HP or mare. r.] occupancy
41./ ./Suite /bldg. /api. no,; 220 Projce1, n:une: Lecroy I1 Six or more residential units ❑ ReCroalional vehicle parks,
❑ I lca1t11 -care facilities ❑ Supply voltage Ihr more than
Gros: Si veer/Directions tech llite: ❑ Hazardous locations 600 volts nominal,
_ ❑ Service or fcc s or der 600 nm more
FEE SCFTEDULE
Subdivision: 1 Lot no,; neccrlpll5n _I Oty, I Fee, tnl "
Tax map /parcel nO.; New residential - single or multi - family dwelling unit.
DESC.RIPT)ON OF WORK Includes attached garage-
Acid dedicated outlets 1000 sq. ft or less $ 168.54 4
Eu. A(ld'l 500 sq. ft or portion _ S 23.92 I
— 7 OWNER T I - • Li TSNANT Limited energy residential
(with above s.. ft. $ 75.00 2
Name; l.imilcd energy, mulli.family
—" residential with abevt sq- (t.) r Si 75 ,0n 2
Add Service or fceder,s installation, alteration, and /or relocation —
200 amps or loss $ 100,70 2
City /Start /7.f P: 201 amps to 400 amps $ 133.56 2
401 amps to 600 amps • 5 200.34 2
Phone; Fax; 601 amps to 1000 aMps S 301,04
Owner installation: This installation is being made on property that I own which is not Over 1000 am •s Or volts 5 552,26 2
intended for sale, lease, rent or exchange, according to ORS 447, 449, 670, and 701 Temporary services or feeders Instnllntion, alteration, and /or
owner signature: Date: relocation
200 amps or less R 39,36 I
• APPLICANT CONTACT PERSON 201 31n sp to 400 amps _ 1 125,08 2
401 anus to 599 am•s 5 168.54 2
Business Name:
Brands circuits - new, ali'erntinn, or extension, per panel
A, Fee for branch circuits with
Contact name: service or feeder roc, sash
branch circuit 5 7.42 2
Address: - -
_ B. Fee for branch circuits
without. service or feeder fee.
City /State /ZIP: first branch circuit 1 $ 56.19 56.18 2
bash additional branch circuit: 5 $ 7.42 37.10 2
Phone: Fux; '
Miscellaneous (service or feeder not Included
E-mail: Each manufactured Or modular
CONTRACTOR dwelling, service and Or feeder s 67.84 2
Business Nome; CAPITOL ELECTRIC CO., INC. Reconnect only 1 67,84 2
Pum or irri *alien circle $ 67,84 2
Si n or $ 67,84 2
Contact name; "^
Signal circuit(s) or limited -
Add ass; 11401 NE MARX ST. energy panel, alterations, Or
extension. Describe: 5 75.00 2
City /State /ZIP: PORTLAND, OR 97220 -1041 Page 2
Each additional Inspection over allowable In any of the above
Phone: 503 -255 -9488 Pax: 503.257 -7121 Per inspection $ 66.25
Investigation per hour (I hr min) 5 66.25 —
CCB Lie.: 48748; Eleciricnl Lis,;.- 26.4960 Suprv. Lie,; 3132 -5 Industrial plant per hour - $ 76.18
Supty- Electrician signaion;, required. 1,1� / A�/2 J�� ELECTRICAL PERMIT FEES'
4. fr °/ SublOtal $ 93.28
Print Name: DARRELL MCNEEL Date: 06/0711 1 _
State surcharge ( 12% of permit fc� 5 11,19
Authorized signature:
/lam /' TOTAL PERMIT FETE $ 104.47
Prin(. Name: DARRELL M EL Tills permit oppticntlen expire.; ire permit n not ohinlued within tan
torn upper It too been Accepted ns cemplcee-
• Number of inspections per permit altowCd.
[Ann iill im e .rermh.,Mtl- C:- P 10)1/09 480.4015T( IIm9f170rvuwala