Permit CITY OF TIGARD ELECTRICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00106
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/21/2012
Parcel: 1 S135AB01002
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 601
Project: Matrix Absence Management Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Electrical for TI.
Contractor: WILLAMETTE ELECTRIC INC Owner: LINCOLN CENTER LLC
PO BOX 230547 BY SHORENSTEIN PROPERTIES LLC
TIGARD, OR 97281 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 624 -3631 PHONE:
FAX: 503 - 624 -2938
FEES
Quantity Description Date Amount
11 crt Branch Circuits wo /Purchase 02/21/2012 $130.38
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/21/2012 $15.65
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $146.03
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 , • . • • ed by the Oregon Utility Notification Center. Those rules a.(2 set forth in OAR
952 - 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the ules or direc • uestions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: — 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 the next available inspection date.
This pernit 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.
02/20/2012 MON 11:30 FAX 5036242938 Willamette Electric l 002/002
1
Electrical Permit ApplicatioIRECE V . ., :.::::,....„..::. ,.::::,,..: FOR OFFICE USE ONLY
Cis of Ti and wait No.: _ _
IN
'I 13125 SW Hall Blvd., TigaTd,OR 97223 FEB 21 20 12 Dien Review lo
i � Phone: 503.639.4171 Fax: 503.598.1960 DateBv: Other Permit:
ElGAIU) inspection Line: 503.639.4175 CITY OFTIGAFD Date Ready/By: curls H See Page 2for
Internet: www.tigard or.gov VI 1 Notified/Method: ��o Supplemental Information
BuiLDING • 11 d
.. .:.,:..� .,. ... mo
P lease check all that apply (submit 2 sets of plans w /items checked below :
ED New construction �] Addition /alteration/replacement )
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
. ....: a rATECY 11Z;$';Z)t (S�R5JC IY N r
. ...... . ... :....__ -, ... exceeds amps exceeds 1 4 . 0 Floating buildings.
volts
to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 - and 2 family dwelling ® Commercial /industrial 0 Accessory building amps for all other installations, buildings.
y ❑ builder ❑ Other: El Fire pump. 10 Installation of 75 KVA or
B' .......: ..: . .: .:..., ❑Emergency system. larger separately derived system.
Multi Master but
' ; . Sl r; F`O , ON AN1 ; :OCA, hir ,- . :. -:;: ' _':.. motor 1
❑Additioaof ❑ "A ", "E ^,•'1 -2 "," -3 ",
Job no.: Job site address: 100HP or more. occupancy. �! // I �a G` .S Gt .1 i on A(, �- ❑ Six or more residential units. ❑ Recreational vehicle parks.
—___ ❑Healthcare facilities. ❑ Supply voltage for more than
City/State/ZIP: / S (�
/� ez ❑ Hazardous locations. 600 volts nominal.
/Sul Idg. /apt. no.: Pr oject name: r yi et T • x ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: Description I Qtr. f' Fee. 1 Tow 1 •
New residential single- or multi - family dwelling unit.
(i 6 1 pe-r ( , t , / i-/r a (r ft(, Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
. 'DE'SCRIP1 OW OF. WORK above vesq. ft.) 75.00 2
. - Limited energy, multi- family 75.00 • 2
residential (with above sq. ft.)
774'...--. 4.11. 4.11. J .. / ,1, eiP � e....: ,r Services or feeders Installation, alteration, and/or relocation
200 amps or less 100.70 2 • 0 PROPM`RTY Qv NER ` ;01' . : l'ENANt . .. ' amps to amps l33 56 2
201 400
401 amps to 600 amps 200.M 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
mpor services or feeders installation, alteration, and /or
City/State/ZIP: relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 801 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, Qer panel
Owner signature: Date: A. Fee for branch circuits with
• erf e
BFcOI!l4'Att PERSOiV...:... • _ , above scrvlcc or f e
.fIBPL'I . : • -. , - each branch circuit 742 2 • Business name: B. Fee for branch circuits without
service or feeder fee, first / 5618 sl , e . 2
Contact name: branch circuit
. • Each addl branch circuit /p 7.42 7y.4 2
Address: Miscellaneous (service or feeder not induded)
City/State/ZIP: /State/ZIP: Each manufactured or modular 67.84 2
ty dwelling, service and/or feeder
Phone: ( ) I Fax :: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E
Sign or outline lighting
67.84
2
: -• '' • :; ':.. Signal circuit(s) or limited- energy
Business name: Willamette Electric Inc. panel, alteration, or extension. Paget 2
Each additional inspection over allowable in any of the above
Address: P.O. Box 230547 Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Tigard, OR 97281
Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 624 - 3631 I - Fax: (503) 624 Inspections for which no fee is 90.00 / hr
specifically listed ('h hr min)
CCB Lic.: 75059 1 Electrical Lic.: 34 -283C Suprv. Lic.: 4226 -5 ...___,.... I :PERlFlln" ;''
C` Subtotal: / , 'G
Suprv. Electrician signature, required. - Plan review (25% of permit fee):
Print name: David Fife Date: State surcharge (12% of permit fee): / f'"-
TOTAL PERMIT FEE: / y4.. =3
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: Date: _ days after it has been accepted as complete.
Number of inspections allowed per permit.
I:1BuildingWermin\ELC-PennitApp .doe 07/01/10 440.615T(I1 /05/COM/WEB