Permit CITY OF TIGARD ELECTRICAL PERMIT
II
12 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00190
T I GA RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/03!2012
Parcel: 1 S 135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 360
Project: DiLorenzo & Company Subdivision: METZGER, TOWN OF Lot: 9
Project Description: (6) branch circuits 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: 503 - 619 -3200
FAX: 503 - 624 -2938
FEES
Quantity Description Date Amount
6 crt Branch Circuits wo /Purchase 04 /03/2012 $93.28
Specifics:, Service or Feeder
1 ea 12% State Surcharge - 04/03/2012 $11.19
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
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Total $104.47
Required Items and Reports (Conditions)
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This p — it is issued su• to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be d e in accordance with = = • roved Mans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
day ATTENTION: Oregon law - qui re s to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR .
95. 001 -0010 thro gh OAR 95 1 1090 • y obtain a copy of the rules or direct questions to OUNC by calling 503. - . • ;7 or 1.800.332.234
Is ued By: - / � j_, � � Perm ittee Signature: ��� / ' ' � �hc _
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:
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CONTRA TOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELE"' = all � �1.
s• .„ .. / 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.
04/02/2012 MON 16:26 FAX 5036242938 Willamette Electric a002/002
Electrical Permit ApplicatioilEC , . , .. ..
E1VED .- ., . FOR OFFICE USE ONLY : J .:: - .-: :- r .• , ,.
Received
Cit of Tigard :
APR 2.°12. ;y9b Datem ' /2._- •;Zq„(/-- -e,
1 , 1 11q " 13125 y SW Hall Blvd., Tigard, OR 97223 PR 3 _ Plan Review
: I • Phone: 503.639.4171 Fax: 503.598,1960 _ a. - -- D te/By: Other Permette
11 CARD 0 2 _ ve
Inspection Line: 503.639A175 CITY OF Tlr,.iAt.Iu Date Ready/By: Jutic .....- , ,- See Page 2 for
rn
Inteet: www.tigard-or.gov BUil ITNG DIViSION Notified/Method: 1 f (1" Supplemental Information
'rypg . .•:...:::::.. , ;:.:'.:::::::::::, ...: : ::": !. , i 0Itt' . -:: s ; ' :: ::::; :.:-.:-:.:; ...-:-'::;;; .- ...:•_-: : 1 .' :,::;:P_LliSiii
0 New construction aAddition/alteration/replacement Please cheek all that apply (submit 2 sets of plans wfitems checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
: :: : ..' : : .,' :::: r ., iy..: exceeds 10,000 amps at 150 volts or 0 Floating buildings.
..: ": . " • ,, : :., • .,,,,..,-.,. -,, .., : , I -. .• • .- •• "'-, " '''' less to ground, or exceeds 14,000 0 Commercial-use agricultural
0 1- and 2-family dwelling A Commercial/industrial 0 Accessory building amps for all other installations. buildings.
D Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
, 0 Emergency system. larger separately derived system.
•! ':: :,,:: . .... :: '' ; .- , :it(31$1 1 **:40#100 1 0 : :::::!, : ; : I 1; '• 0 Addition of new motor load of 0
A 100HP or more. occupancy.
Job no.: ...S
6 7 I Job site address: /0 ? 6 0 i ,.. x , ,,,,,_. ,? 2 , ,.. //.01 7 0 six or more residential units. , - ...f 0 Recreational vehicle parks.
--- , 0 Health-care facilities. 0 Supply voltage for more than
Cit y/State/ZIP: _ / ( j - / o A. 0 Hazardous locations. 600 volts nominal.
O. Id
b .4 0 0 Service or feeder 600 amps or more.
Sun g./apt. no. Project name: j)', 6, . _ -
r r-• ri r-, : _.: . : :, : f
I
:
Cross street/directions to job s , Description l DIP. I Fee. 1 Total •
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168,54 4
Ea. addl 500 sq. ft. or ponion 33.92 i
Tax map/parcel no.: . Limited energy, residential
75.00 2
. ' : • : DESORtPTOPI: ()I? WORK ; " . , : : , ; . :: .... :"::: ..-: (with above stl. ft.)
, .. .
Limited energy, multi-family
...--', A 75.00 • 2
.....-- residential (with above sq. 11.)
/ se",, Z ,.. /..-- - /-1- ‘ 1 PG Lie eioN.. e"..-7 ..2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
Or +.• . • ..• ,
ID PREliti .. :6W0tet. ' : I -.: : 1 :: .1(:) 201 amps to 400 amps 13356 2
• • :. , : :: ,, -.. .. ; .
• , •
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary 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. 401 amps to 599 amps 168.54 2
Branch circuits- new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
.. . . ELAP4ICANT:, ,r1, ; . ,., . T • : ,•:: ):1,:ic...9z.ocr ::: : each branch circuit 742 2
Business name: B. Fee for branch circuits without 78
service or feeder fee, first
/ 56.18 so, --- 2
Contact name: branch circuit
. , Each add'I branch circuit s'"" _ 7.42 1.2 !_f- 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City/State/ZIP: dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: . . . . Sign or outline lighting 67.84 2
.... 1::::'::::' ; ;;;•.:2/:::':''. ( 01.0%.400g7.:::' ....:. ;':':: :,'.. :..-: . ,...L ;:-.::r ..::...---.' :1; Signal circuit(s) or limited-energy
Business name: Willamette Electric Inc. panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: P.O. Box 230547 Additional inspection (1 hr min) 66.25/ hr
Investigation
City/State/ZIP: Tigard, OR 97281 (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
hone: (503) 624 I Fax: (503) CCB Lic.: 75059 /trical Lic 34-283C Supry Lic 4226-S
Electrical . .:
VP , Inspections for which no fee is
' specifically listed ( hr min) 90.00/ hr
_,_________.*._.______.*.__*,,,...__„.,,___,,,_,: :: ,:•::. :::::•.: -. : !EllteTRICAL;:".PERIVIIT=VEEV"
Subtotal: 7 3 24,
Suprv. Electrician signature, requireek •
Plan review (25% of permit fee):
Print name: David Fife Date: State surcharge (1 of permit fee): / / ..x
TOTAL PERMIT FEE: ic.4 Vi,f2-
Authorized signature: This permit application expires if a permit is not obtained within 180 6. ,,„.....-'
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
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IMuildinePenni0NELC-PareitAppdoc 07/01/10 440-4615TO 1/05/COM/WER