Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00173
TIGARD 13125 - SW Hall. Blvd., Tigard OR- 97223 - 503.718:2439 Date Issued: 03/27/2012
Parcel: 1 S 135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 285
Project: Crump Insurance Subdivision: METZGER, TOWN OF Lot: 9
Project Description: (6) branch circuits
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
6 crt Branch Circuits wo /Purchase 03/27/2012 $93.28
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/27/2012 $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 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 • :2 -00 : • ' Y• may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 987 or 1.800.332.2344.
Issued By: L�#� % /Ij. - - Permittee Signature: c1// '/ 1 770 ,, v /
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 603.639.4175 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.
03/27/2012 09:59 5032577121 CAPITOL ELECTRIC PAGE 02/02
1- CIPPICI. II l•.O'I,\'
Electrical Permit A► pplication . it no.: EGCl,2o /2 -40L 7 .3
City of Tigard 1� Flan Review Other Pclmit:
• 131.25 SW Hall 1311/t1„ Tigard, oa ` CO ti� Haters
Phone: 503.639.41171 Fax 5 t t f _N • , '')O Dat R I_ sco re for
'- Inspection Lire: 503.639.4115 �At\� �;. q„•aem.nmttnaxn
Tic_, :� tt i; Internet: www- tigard'a•g10 \ \\ O C ' \ ` 1 : 4v' - Notified /Method:
j o vLA REVIEW
TYPE OF WORK _` crx-• - t lltems checked below):
Addition /altorationrcPlaec Bunten three ed be rtes
e
Ncw cnnetruction 1.J Please check all that apply (Submit seta of plans w❑ Senate or feeder 400 amps or more ❑ B over
❑ Demolition 0 Other: where the available fault currant 0 Menge and boatyards
CATEGORY OF CONSTRUCTION -
Li 1- and 2- Family dwelling EI ColnmetcialRnduatrial • Accessory building exceeds 10.000 amps at 150 volts or ❑ Floating buildings
❑ Master Builder [] Multi -fh +nib
- Other loss to ground, or exceeds 14,000 ❑ Cemmerelal -use agricultural
_ . tions• buildings
_
JOB SITE INFORMATION AND LOCATION - amps for all other Installations.
(] Fire Pump ri Installation of 75 INA Or
Job no.: 120507 l Joh site address; - 10300 SW Greenbur9 Rd [] Eme,90ncy system larger Separately derived system,
❑ Addition of now motor load of n A. "E•. 9-2 ", •1.3 "'
City/State/2.1P: Tigard Oregon - _ 100HP or more. 0 occupancy
❑ Slx or more residential units ❑ Recreational vehicle parks.
Suite/bldg./apt. no.: 285 Project name: Crump Insuraene ❑ Health-care facilities ❑ Supply voltage fbr more than
e / ��I J� H>?ardous locations 600 volts nominal.
Cross street/Directions to 'oh site: • ' L �:7i -m∎ !`
" .] service M feeder 600 antes or more ---
FEE SCHEDULE -
Lot no,: Description Qty, (1 Pm e Total J "•
Subdivision:
D New residential - single or multifamily dwelling trait.
Tax mOp�treel no.: _� Includes attached garage. 1A9 54 4
ESCRIPTION OF WORK
Tenant improvement of suite 283, add OP outlets and relocate li thtin 1000: • . attached
or leas Ea. Add'l 500 SCR or portion S 33.91 , 1
A GUSCU. - Art - i Ai Su = / G Limited energy residential
1_,) PROPERTY OWNER TENANT _ 5 75.00 2
(with above sq, EU
Name; Limited energy, multifamily Z
residential (with above 59. EL) , S 75.00
Addrms: Service or feeders installation, alteratton, and /or relocation
200 amps or llen r S 100.70 2
City/SG7tcIZIP: _ 201 a to 400 am s S 133,56 2
401 amps to 600 amps S 200.34 2
Phone:
FAX: 601 ate to 1000 amps 5 301.04 2
Owner Installation: This installation is bcing made on properly that I own which is not Over a services volts S 551.26 = f�ders Installation, alteration, and/or for sale. lease, rent or exchange, according to ORS 447, 449. 670, and 701 rOtttcatlon
Ovate,' signature: Date; 200 201 am �a r Or less S 59.36 I
5 l0 400 a S 125.08 2
APPLICANT CONTACT PERSON S 12 2
401 amps to 599 amps
Business Name: J r nch circuits • new, alteration, or extension, pC pancl
- - A. Fcc for branch circuits with
Contact name: _ service or feeder fee. each 2
branch circuit - S 741
Address: B. Fee for branch circuits
without service or feeder fcc,
City/State/ZIP: - _
Each additional branch circuit: first branch Circuit 1 S 56.15 58A8 2 ,
�- _ _ 5 S 7.42 37.10 2
Phone: Fax: Mlscellaeeous16ervlcc or feeder not Included) .
Each manufactured or modular S 67,8a 2
L•mail: dwcllia5, service and or Ibcdcr
CONTRACTOR _ - Reeenneet only _ S 67.84 2 _
S 67, 2
Business Na: CAPITOL ELECTRIC CO., INC. Pura ne itri •ion circle 5 2
Sign or outline Ihting
S 67.54
Contact Hume: Gary Stelort Signal circuit(s) or limited -
energy panel, alterations, or
Address: 11401 NE MARX ST• s 75.00 2
extension. Describe: _
_
City/Stat .1 Page 2
PORTLAND, OR 97220.1041 _ >Each additional inspection over allowable In any of the above
Per inspection r i 66.23
P. • no: 503455'9488 Pax: , 3.2574121 / Invertign p er hour ( 1 hr min S 66.25
✓ Industrial plant per hour S 75.18
O � CCO Lie.: 48748 Icctrieal I ic.: 26. 3u•rv. Li�: �3f/ 1325 ELECTRICAL PERMIT FEES*
di1. ,� y " 4 '4 ' Subtotal ` 29
Suprv. Electrician signature, requi - • ,
tc: 03127/12 Plan review (25 of permit fcc
I $ 93
Print Name: Darrell Ma : / Stale surcharge ( 12% or permit fee) S 11,19
Authorized signature: //� TOTAL PERMR FEE $ 104,47 i �
J j ./.... C "'�
Print Name: Darrell - C I Tht. permit ap neoaoo .alma if a permit 1i oat ohtalaed wilMn 1 ao
der otter tt boo bled aeceplod as campl4mr
• Number of ineicctlona par permit allowed.
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