Permit CITY OF TIGARD ELECTRICAL PERMIT
r1111
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00330
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/31/2012
Parcel: 2S113AB00600
Jurisdiction: Tigard
Site address: 16125 SW 72ND AVE
Project: St. Jude Medical Center Subdivision: COUNCIL VIEW ACRES (LOTS 21-44) Lot: 30
Project Description: (16) branch circuits for TI
Contractor: CHRISTENSON ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES LP
111 SW COLUMBIA ST, STE 480 ATTN: N PIVEN
PORTLAND, OR 97201 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 -419 -3300 PHONE:
FAX: 503 -419 -3695
FEES
Quantity Description Date Amount
16 crt Branch Circuits wo /Purchase 05/31/2012 $167.48
Specifics:, Service or Feeder
1 ea 12% State Surcharge - 05/31/2012 $20.10
Type of Use: COM Electrical
•
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $187.58
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 9 - 0 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /
Issued By: Permittee Signature:
Q j 0G /G� 70Al
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 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.
MAY -29 -2012 TUE 03:02 PM CHRISTENSON ELECTRIC, INC_ FAX NO. 95034193695 P, 01/02 ��
. - - - - - - - - .._ _ - -' '- - �� �� • ' FOR Of Fla: use o�LV ,� ��J1'�
lectrical .Permit pi licatiolnRE.i,,t ._ EE -- rennil /�'� t�� ' 9 202 ��3° I.), MAY 2 ew Other Penh: f �. V p
y 13125 SW Hal{ . Tigard, OR 97 _3 C1atclBv: — HI Sec Page z for / L.1t�'
Phone: 5 24
Line: 50 9 Fax: �03.598.19G0 1 I . p : pate Ready /lip HI See age information �// 7
•.lr -f.
fIGARD
Inspection rne www.ligard u Line: 503.639.417 — 4i Notified/Method; r
Internet: r.guv It Pi "'` ': ,`I [ fin
. •. y .PE• OF. !OR[C Pl en:� c chick all that ap (submit 2 sea of plans wlitenrs checked het owy
0 New construction dition /alterationlreplaccment
0 Service or feeder 400 amps er more Q Building over three stories.
where thc available Fault current ❑Marinas and boatyards. •
❑ Demolition Other: or Commercial -use I, u rut •
- ., •GATECURI!:OF ' : CON ST'Iti1GTI0 II lions.
_ exceeds available b l e at I volts Marinas
buildings.
N�'� ", . : �.' : � ' : ' • less 10 Bround. or rxeeeds 14 00(1 �
t_o,n„ tCrcia - a Brie Ito
buildings.
�� Accessor building imps for all nthcrinsta a • installation of 75 KVA or
❑ I and 2-family dwelling ► . ommercial /induslria ❑ y 11 Fire pump• larger separately derived system.
❑ Master builder El Other: El
E mergency system.
❑ Multi -family "A", , "E".•:1 ^ ,... I -3"
I;O C,ATION Q Additio of row motor load of CI occupancy. Sl`I'F. ;Alyi) .. .. ' Ar,, 1 001IP or more,
�QH:.. in � j Recreational vehicle parts.
all 4 I Job site address: I l s ❑ Six or more residential units. 0 Supply voltage for e p r s.
Jobno,: __ r 0 Health- caro facilities.
600 volts nominal.
��r� `t • � ❑liaznrdouslocations. ,,.'
�i s% p ❑ Servirvice a feeder 600 amps or more,
— ..'. '
Suite/bldg./apt. no.: P roject name X 1`S " •:.' ; ,.... ... •F,IL.C.:tiC1�FDUi;E.'' .. 'deter MI street/directions to job sitc t — New residential single - or mold - family dwelling unit.
• Sip . n ����
I• V i.. InCludeS Attached garage.
1 sq. il, or less
Lot no.: 4. or portion MOM
Subdivision: Ea. add'I Soo sq.
Limited energy, residential 1111 75.00
Tax Inaplparcel no.: (with above s • . ft
',_) E5C ;RIP.T'ION' °!Ok.�;WO� ��:; "., - • • Limited energy, multi•familY
75.00 III
r esidential (with above • ft l
It. 1 -I' I ° :•: ,1 I . 0 1 _ J P IL �ft, Services or feeders installation, al on100. par relocation
r ( ,
ZOO amps Of tees ����
pROPERTY; It: :,.. ; ' .:.. ' : , •' amps m 200 34 al
,� v'fE "�`•'• : ;...: 600 amps
a
401
❑ - 3 •
Over 1,000 amps or volts ��
Name: 601 amps to 1.000 amps
Address: Temporary services ur feeders installation. alteration, and /ur
relocation 11111111111151 11
P h on State/Zl P. 200 amps or less . . .
Fax: ( ) 201 amps to 400 amps 125.06 MINH
Phone: ( ) 165.54 r
Owner installation[ This installation is being made on property that I own which is not pranelt circuits— new, alteration or extension, . or edict
intended for salt:, lease, rent, or exchange, according to ORS 447, 449, 670. and 701 • A Fee for branch circuits new, w(rh
Date: above branch or feeder fie, 7.42
Owner signature: PERSON';, ... above service a or feeder
"[j'iGA ' hard 5(0 `�
':.: A Pi: TCAI! tT'` i ':;:i ":•r.'`:�4`��'�:::,���: • ' 13. Fee for branch circuitsx�(t l
service or fender fee. first 56.16
Business name: brooch circuit -mayB
Contact name:
Mlacellaneou service ur (co der not Included
Each munufectured or modular MIMI 2
dweltin', service and/or feeder �� 2
CitylStatc/7.IP: Reconnect: only ��
Fax: ( ) Pump or irrigation circle �� � E1 IIIIM
Phone: ( )
. Sign or E -mail: Signal c rc limited -cne IN
.
. . , . . '•.;: ' . ' ' • • tcrution,orcxlension � t h e
," �� "aC'OPlfr'1tA�T.01t "•' • � �
• Itcl, attention, .�. Each additional ins action over allowable In an of
*� r " Of. (' / Additional inspection (I hr min) ��
_ � •
Address: �� � � '
n l ,� v
�� �: Ji �� `,' ` — ♦ Inspections for which no tee i9 9U,(10/ hr
Jill/ � _ L�y �, lc. &all listed PA hr min
Phone: Iw ti . .. , itti '1 �:, ELten t 4Z' Ai °'.T'ER1Yl 1C•':REIES.`:..:... •: —4111111.11111.1111 111121.11.11.10 : 11011U kt
Suprv. Elcetri signature, required: 1.7T
( PO;
f - -= ..1.•__'
State surcharge (l294) of peril*
fee): �� ���
�� � — 1r
1 .� pale: TOTAL PERMIT FEE: i�
This permit application euptrm If a permit is put obtained within IRO
Authorized signature: days after It has been accepted as c nmptcte.
Date, • Number or inspections allowed per permit. (,(
Print name: T iZ ' s
a49.4d I Si(l I er-----
1: 1aulldingrPr J+rriitt�r�'�•t'�^INPP'� mpl llo �� I 'I _
/q—c
R 02A2
AUTOMATIC COVER SHEET
DATE: MAY -29 -2012 TUE 03:02 PM
T0.
FAX d: 95035981960
FROM: CHRISTENSON ELECTRIC,INC
FAX #: 95034193695
02 PAGES WERE SENT
(INCLUDING THIS COVER PAGE)