Permit CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2012 -00255
T I GA R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/02/2012
Parcel: 1 S135AB04500
Jurisdiction: Tigard
Site address: 10250 SW GREENBURG RD 214
Project: Gerald Miller Subdivision: 1991 -055 PARTITION PLAT Lot: 1
Project Description: (2) branch circuits
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
2 crt Branch Circuits wo/Purchase 05/02/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/02/2012 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 a - • -nce • 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. A ' NTION: Oregon I- : • es you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 - 110 thro gh OAR 952 1 009# •u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.33 44.
Issue. By:
I PermitteeSignature: it
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' op g y I / •% j � ( 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.
Electrical Permit Applicatioi 1 (' 'il/ FOR OFFICE USE ONLY
City of Tigard Da / 2 - k , Permit No.: c Ss
I C • 13125 SW Hall Blvd., Tigard, OR 97223 ^RAY — 2 20 12 Plan Review Other Permit: P�j�a 7g
Phone: 503.639.4171 Fax: 503.598.19 Date/By:
T 1 G n It D Inspection Line: 503.639.4175 Date Ready/By: )uric: ® See Page 2 for
Internet: www.tigard or.gov CITY OF TIGA D Notified/Method: Supplemental Information
., '1'I�PE�QF . � > �A N YIE --
❑ New construction J Add Please check all that apply (submit 2 sets of plans w/items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
o , exceeds 10 am at 150 volts o r Floating buildings.
. _,.. -- less to ground, or exceeds 14,000 ❑ Commtncial -use agricultural • ❑ 1 - and 2- family dwelling 0 Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: 0 Fire pump. Installation of 75 KVA or
: : :- ,..._ ::. .,- ; _ - - Emergency system. larger separately derived system.
`4'fi SIT 1 FO1C21 iAt1ON 'Ati. Y O i ' ❑
.. ..� li on of new motor load of "A ", "E °, '
Job no.: D Sd Six or or more. occupancy.
4, I Job site address: A .S /n� l^P. �/1 (�/� 4... ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/ State/ZIP: J / 13 Health-care facilities. CI Supply voltage for more than
El Hazardous locations. / J �► � . - p 600 volts nominal.
v
(i ldg. /apt. no.: _// I Project na me: fr. l /t'y� ❑ Service or . feeder 600 amps or more
•
G
1rE
Cross street/directions to job site: D escri p tio n I
Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
. Includes attached garage.
Subdivision: I 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
.,. . . . .. ... ... : . _ - 75.00 2
:
D S. ., ,T1;ON. OF..WOR . (with ve sq. ft)
_
Limited energy, mufti- family 75.00 • 2
�i1 G - / .. - . 0 C� /1.1 tort residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
. -:
_ :. �_ :.: . ..... ;. ; .
❑ PROPERTY: QWNER :
_ 201 amps to 400 amps 133.56 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
- 201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ : _ A P PL ICA N 1'.r : :,' 4 ; CoN1`ACT; PERSON_` .
above service or ceder fee, 7 42 2
.., r- eac branch c
Business name: B. Fee for branch circuits without
service or feeder fee, first / 56.18 cid, .i 2
Contact name: branch circuit ,
Each add'I branch circuit /' 7.42 7 , 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City/State/ZIP: dwelling, service and/or feeder
Phone: ( ) I Fa : : ( ) Reconnect only 67.84 2
E - mail: Pump or irrigation circle 67.84 2
. ;,. :.__ . :,' � -. , �.:;1_., ,.:_--:,.,.- -- _ 67.84 2
• Sign outline lighting
..: .‘ _., C,Q N,, 1V ; ;r. . . ; `j' ; - , - :. ; sr, • ; ,- . S c ircu i t(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 (1 hr min) 66.25/ hr
City/ State/ZIP: Tigard, OR 97281 Industrial plant (1 hr min) 78.18/ hr
-
Phone: (503) 624 -3631 I Fax: (503) 624 -2938 Inspections for which no fee is 90.00/ hr
specifically listed ( hr min) -
CCB Lic.: 75059 Electrical Lic.: 34 - 283C I Suprv. Lic.: 4226 -S '' ELECTRICAL ',PERMITiOFS '', ir .;__L : Z "
Subtotal: , 3 r
Suprv. Electrician signature, requi - Plan review (25% of permit fee):
Print name: David Fife Date: State surcharge (12 %ofpermit fee): 7 /O2
TOTAL PERMIT FEE: 7/ A3
Authorized signature: This permit application expires Ira permit is not obtained within 180
Print name: I Date: days after it has been accepted as complete.
N umber of inspections allowed per permit.
I :\Building\PermiulELGPermitApp .doe 07/01/10 440- 4615T(11/05 /COM/WEa