Permit CITY OF TIGARD ELECTRICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00272
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/10/2012
Parcel: 1 S135AB01006
Jurisdiction: Tigard
Site address: 10500 SW GREENBURG RD 200
Project: Mutual Fund Subdivision: ASHBROOK FARM Lot: 6
Project Description: Install five (5)dedicated circuits, safe off existing circuits & install rcpts.
Contractor: FIVE STAR ELECTRIC, INC. Owner: LINCOLN CENTER LLC
PO BOX 555 BY SHORENSTEIN PROPERTIES LLC
BANKS, OR 97106 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 324 -0948 PHONE:
FAX: 503 - 324 -0973
FEES
Quantity Description Date Amount
8 crt Branch Circuits wo /Purchase 05/10/2012 $108.12
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/10/2012 $12.97
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $121.09
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 0 52- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
bidP Issued By: Permittee Signature: �PPLI 14T1ok
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
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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 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.
Fax: Ma 9 2012 09:08am P002 003
,r,tectricat rermit Ai
.
City of Tigard La Vi 1,,,, 0 1 :F I. Li Received •
Dair-A3 . 5/ff ,i— • .pcmhil...:— ...._,,, — .00,..7-
13125 SW Hall Blvd., Tigard, OR 97223 -
?bps: 503 tt .6394171 Fax: so3.598.1960 MAY 9 2012 ZW1111111.11111111111 , Otba Permit
bISpettio Lim: 503.6394175 D ate R . ..i , 1 . ';.. ' • , k , I El See Patti 2 Atitt i
Intemet www.tigard CITY OF TIGARD Nctiggedftdethcd: /111[11 Supple:mutat We/nudes
7 ---- - - i , - • -- .7„ - 77T .. .: 7 ' -.7 -,.•..'-- ..'-` 7,, . 7 ''':'• 1 :; '' '... : ' , = ''''': ', ,.' .,. , : , ,':' • ...: ,'-:,''' • %; --; r
- - --= . ' - .- — ''' • ' - --'-'" -.-L--% ew n u -....:-.. -;-- ".'.7',".7 .. Zii,; witheti .!. etr plena verteatteehedafilbelet50: '
0 N costa Tzt Addition/alteration/replacement 13 &ivies crikester 400 =Ps es tel:eis riiikelabta evetilatim 4ostit.
0 Demolition 0 Other where the avieluble faith etureet DM ausiboutyards.
l ' . -' -1: .: ''' tr " '''. r. ' ':. ' - ''' . ' '■ ---` :- -'' ‘''. I: - '7' as:weds 10.000 scups lit isi miner' alieatieg Enthilegs..1 .. %
0 1 - and 2-family dwelling ptcorronerendfmdustrial li Accessory building amps fbr et! etbur.tueleDetions. beildmita . :
0 Multi 0 Master builder 0 Other: Dr testy. 1=1 Testaustion oi75 EWA or
le,sger seremtslY derived system
lob io.: E52! 100HP or mote. occupancy.
Job site adthess4 . • • - - f r A ill 0‘ i - - • - gRerozaliosal veit.itilamb.
) ._ ___.,„ .. _, ID sec cr awe raidcutal mos,
, .
City/State/ZIP: ---- # & ") gi • 0 Health-care faellitios, ' Sepply wittese for Mete than
_ .-..,...- ---, Elliszardpas location& 600 volts acmittal. ,
SuiteibldgJapt. no 'if Project Ilainc: 11 " g ' 1
a .
parvii car 53edat 66 , - oxietse. I
' • - -
_ •. - ____ ___.,- ,.., • . , . . ... _ _
, A., -- - ,•-•,.,•, ,• ... - . _ . _„ , _ , ._
Cross street/directions to job site: „9 O - aNZ. s - ,- -` 7-- - -- iii■EN - almaie_.'illliningEli.ifli
New residential single- or multi-famdy dweltiog unit.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
T mapipatre1 110.: Ea. add 500 sq. ft or parties 33.92 1
ax ,
Limited energy,
• .,., . , _ • , i . — - - _ =age. multi•familY : ; • III 75.00 ' ' 4 r . ' 13
Y1 'it:__. a! 9. _ -e0k - f - , , ft
i
. residanig v.ith above • .
Senates or feeders instaRa • ■ , , • , - , , 1 ' • and/or rebate* '
•,... . . ,,, . .
' I Mt %1 w S‘ '
4 A A , . . a 200 amps or km ME 100.70 in
13 ___ . _• • _ , , •
Name! -___ •_. •• _ _ . , _•• .. .,.,_
+Di amps to 600 amp - IMO 20034 IIIIIME1
sot aDvs to 1,000 amps 301.04 2
. .
Address: Over 1,000 amps or volts ' 55226 • 2
Temporary services or feeders installation, alteraties
City/State/ZIP:
relocation
Plume:( ) Fax: ( ) 200 araps or las 5936 El
201 ' 2
Owner installation: This installation is being made on property that I own which is not amps to 400 amps , 125.08 401 to 599
168. 54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Braaeh.cirenits -new, altersaloaeor eeteurinu, • - wind
Owner signature: Date: _ A. Fee for branch circuits with
'.',, -," * - ` , ', - 7 , r: - - - , ' -.';', . ' ::":' '.‘,., ` ' 2 4., -',., , :' ' ,-,,, 7 -•- ,: ,:f.',;: abcve s 'ice ' fecax fr 7.42 2
Business name: B. Fee for branch ctrarits wirier's/I
service or *oder Fee, fun i 56.18 Sig. 1 g 2
branch circuit
Contact name:
Each add'I branch circuit liril .1112:311PREZia El
Address: - 1, .,..1, .. , service or ..• net
- • .
Each mesufscousd or modular 67.84
City/State/ZIP: dwelling. service and/or feeder ,
Phone: ( ) Fax: : ( ) Reconnect only 67.84
Pimp or irrignicerchcle ' 67,Rai
E
_ , Sign et outtine lighting 11.11 67.84
,,, ' . -, , ''.'..: - -.::,;:-.-Z._ , ;:.:-:A-' , ..,,.:72:-:.,.,-,.,',..v.....:i . ,: , si circon(s)
orb
Business name: Five si- ek. c , Ipic . Each additional, inspestien over allow** in ilaYalhe shave
Address: Po --li s 5,..... Additional inspeclion (I lit min) 6625/hr
bavessgation (1 lit win) . 6625,/ hr I
City/State/ZIP: •T‘Do ....,, i Mi.. 'Ti I C) tp Indusnisl plant (1 ht rain) 78.18/hr
;*. • ., • : ( - *k i p 6 - p ' • I Fax: (50- • i - • A' - - - - :orts Sarvilaicli so fee is , 90130/ bt
" ..,' listed hrmin IN
Electrical lAc .
_,.
subtotal: • 02,11% ta.
. - / - ,
Suprv. Electrician signature, required. : AIP"' 2—'w-g.YA IMPE:11'
../7............ f .„..o .0 _ _ _ Flea review (25% of peanit fee>:
hint name: - i .,. • it , , a Date: ' /MI
k..../ Stiac =charge ( of penult 11 =0: Miki
TarAL Fwar FE .r.1.9-1• 06 )
Authorized sigoany*:
- IlthiPermil aPPliagekta suttipplif .4teuraft is sot earsinedmisbia 180
Print .
rint name: I Date: days OW it bus Er;in accepted is colopiese. - d i/
• Number of inspections allowed per wank
L‘suilcriugenottelELC-Perzoiptapstee ammo 440-461570 itostrowim3B .
Fax: May 9 2012 09:O8am P001/003
FACSIMILE TRANSMITTAL SHEET
TO: FROM:
Building Permits Becca Sinner
COMPANY: DATE:
City of Tigard 5/8/12
FAX NUMBER TOTAL NO. OF PAGES INCLUDING COVER:
503- 598 -1960 3
PHONE NUMBER SENDER'S REFERENCE NUMBER:
RE: YOUR REFERENCE NUMBER:
Electzical Permit
Thanks,
3 /Li • 4/17V,L) ' s t`-. \
Becca Sinner ■
Administrative Assistant
Five Star Electric, Inc.
Phone: 503- 324 -0948
Fax_ 503-324-0973
bsinner@fiivestarelectnc.org
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P.O. Box 555, Banks, OR 97106 * Phone: (503) 324 -0948, Fax (503) 324 -0973 * CCB# 158231
LICENSED • BONDED • INSURED •
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