Permit �� CITY OF TIGA ELECTRICAL PERMIT
` COMMUNITY DEVELOPMENT Permit #: ELC2011 -00529
Date Issued: 09/27/2011
T I GARD 13125 SW Hall Blvd , Tigard OR 97223 503.718 2439
Parcel: 1S135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 1180
Project: NSKB, LLC Subdivision: METZGER, TOWN OF Lot: 9
Project Description: (5) branch circuits and low voltage for fire alarm.
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 503 - 255 -9488 PHONE'
FAX: 503 - 257 -7121
FEES
Quantity Description Date Amount
5 crt Branch Circuits wo /Purchase 09/27/2011 $85.86
Specifics: Service or Feeder
1 ea Signal circuit or Limited 09/27/2011 $75.00
Type of Use: COM Energy Panel
Class of Work: ALT 1 ea 12% State Surcharge - 09/27/2011 $19.30
Electrical
Type of Const:
Occupancy Grp:
Total $180 16
Required Items and Reports (Conditions)
This permit is issue 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 a rdance wi h 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 ATT TION Oregon 'law requi -s you to follow e ules adopted by the Oregon Utility Notific• •n Center Those riles are set forth in OAR
952 - 001 -00 0 through OAR 952 -101 -0090 ou -, • • • n = cop 4 the rules or direct questions to OUNC by calla•.• • 32 1987 or 1 800 33 2344 •
Issued B • %'O \ ' _, / �. L 1 4 r ' Permittee Signatur t 5 t� _
OWNER INSTALLATION ONLY
The installation is being made on property I own which is no intended for sale, lease or rent
OWNER'S SIGNATURE Date:
CONTRACTOR INSTILLATION ONLY
SIGNATURE OF SUPR. ELEC' t!�' «�i . Date: j/2174
LICENSE NO. "
g/ 3 R5
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.
Electrical Permit Application Received - FOR OFFICEUSE ONLY , '
City of Tigard s Date /By: % Permit no E /1 _'��, 52 e 13125 SW }-tall Blvd., Tigard, OR 97223 ' `t'S Plan Review /(C1!
1 14
C Phone: 503.639.4171 Fax: 503.598:1950' \\ Date /By: Other Permit
TIC;ARD Inspection Line: 503.639.4175 X 40 �.� Date Ready /By Jufis g
`, See Pa e 2 for
Internet: www.tigard- or.gov
S ', � Notifie /Method Supplemental Information
TYPE OF WORK 4"+4'.;a',. l''V6` PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement..)' , {W.s . �J Please check all that apply (submit 2 sets of plans w /items checked below)
❑ Demolition ❑ Other . 11N., .\ ❑ Service or feeder 400 amps or more ❑ Building over three stories
_ CATEGORY OF CONSTRUCTION 'I' where the available fault current ❑ Marinas and boatyards
❑ I - and 2 -family dwelling U Commercial /industrial ❑ Accessory building exceeds 10,000 amps at 150 volts or ❑ Floating buildings
❑ Multi - family ❑ Master Builder ❑ Other less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
JOB SITE INFORMATION AND LOCATION amps for all other installations buildings
Job no 111267 Job site address 10260 SW Greenburg Rd. ❑ Fire Pump El Installation of 75 KVA or
❑ Emergency system larger separately derived system
City /State /ZIP: Tigard, OR 97224 ❑ Addition of new motor load of ❑ 'A", "E ", "1 - ", "1 - ",
100HP or more ❑ occupancy
Suite/bldg /apt no . 1175 Project name. NSKB ❑ Six or more residential units ❑ Recreational vehicle parks.
❑ Health -care facilities ❑ Supply voltage for more than
Cross Street/Directions to job site. ❑ Hazardous locations 600 volts nominal
❑ Service or feeder 600 amps or more
Subdivision Lot no FEE SCHEDULE
Description I Qty. I Fee. I Total
Tax map /parcel no New residential - single or multi - family dwelling unit.
DESCRIPTION OF WORK Includes attached garage.
Tennant Improvement 1000 sq. ft or less $ 168 54 4
Ea Add'I 500 sq ft or portion $ 33 92 1
Li PROPERTY OWNER I ❑ TENANT Limited energy residential
Name (with above sq. ft.) $ 75 00 2
Limited energy, multi - family
Address. residential (with above sq. ft) $ 75 00 2
Service or feeders installation, alteration, and /or relocation
City/State/ZIP: 200 amps or less 8 100 70 2
201 amps to 400 amps $ 133 56 2
Phone Fax 401 amps to 600 amps $ 200 34 2
601 amps to 1000 amps 5 301 04 2
Owner installation: This installation is being made on property that I own which is not Over 1000 amps 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 installation, alteration, and /or
Owner signature Date relocation
200 amps or less 5 59 36 1
❑ APPLICANT I Li CONTACT PERSON 201 amps to 400 amps $ 125 08 2
401 amps to 599 amps $ 168 54 2
Business Name: -
Branch circuits - new, alteration, or extension, per panel
Contact name: A. Fee for branch circuits with
service or feeder fee, each
Address branch circuit $ 7.42 2
B. Fee for branch circuits
without service or feeder fee,
City/State/ZIP
first branch circuit 1 $ 56.18 56.18 2
Phone: Fax. Each additional branch circuit. 4 5 7.42 29.68 2
Miscellaneous (service or feeder not included)
E -mail Each manufactured or modular
CONTRACTOR dwelling, service and or feeder 5 67 84 2
Business Name CAPITOL ELECTRIC CO., INC. Reconnect only 5 67 84 2
Pump or irrigation circle $ 67 84 2
Contact name John McNeel Sign or outline lighting 5 67 84 2
Signal circuit(s) or limited -
Address 11401 NE MARX ST. energy panel, alterations, or
extension Describe: ft(Q, F+kOrefl 1 $ 7500 7500 2
City /State /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 Per inspection 5 66 25
Investigation per hour (1 hr min) $ 66 25
CCB Lic : 48748 IElectrrcal Lic • 26 - 496C ISupry Lic 3132 - S Industrial plant per hour $ 78 18
Supry Electrician signature, required q ��jj ELECTRICAL PERMIT FEES*
1l' D /�� Subtotal $ 160.86
Print Name DARRELL,JICNEEL' ate 09/26/11 Plan review (25% of permit fee)
Authorized signature State surcharge ( 12% of permit fee) $ 19.30
L TOTAL PERMIT FEE $ 180.16
Print Name: DARRELL MCNEEL This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
* Number of inspections per permit allowed
I \Budding \ Permits \ELC- PcrmitApp doe 10/01/09 440.4615T( I l /05 /COM /WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RE 1DENTIAL,WORKONLY ;;rF, -',.
Fee for all residential systesm 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:
C00i MERCIA06 "- .`,., ,,,: „<:__.1 a;: .., " -'<. --
Fee for each commercial sytem $ 75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication installation
0 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