Permit CITY OF TIGARD ELECTRICAL PERMIT
Per
COMMUNITY DEVELOPMENT
Permit #: ELC2012 -00394
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/28/2012
Parcel: 1 S 135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 300
Project: Jason & Leiberan Subdivision: METZGER, TOWN OF Lot: 9
Project Description: (4) branch circuits for TI
Contractor: STONER ELECTRIC Owner: LINCOLN CENTER LLC
1904 SE OCHOCO BY SHORENSTEIN PROPERTIES LLC
MILWAUKIE, OR 97222 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 -462 -6500 PHONE:
FAX: 503 - 659 -4968
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 06/28/2012 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/28/2012 $9.41
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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 OA 2 -001- 90. You m �.( 17
ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800..332
Issued By: % J� 1
Permittee Signature: DAS ��4/ 0417 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 503.839.4175 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.
Jun. 28. 2012 9:58AM Stoner Electric Group No. 3208 P. 1
Electrical Permit Application RECEIVE r(l I t OII I ( I I : .S L (1 \ 1.1
.Il \A.1���11 I aaea
City of Tigard oat :: f M® °ami1 gen d. be 310
N ■ • 13125 SW Halt Blvd., Tigard, OR 97223
. Phone: 503.639.4171 Fax: 503.59a -L960 JUN 2 8 2012 Dst we Other PamiIe p c.10/ - aryl Z
i 1 n i t t r Inspection Line: 503.639.4175 Deto Roady/By, IN Sex Page 2 for
Internet: www.tigard.or.gov CITY OF TIG;ARD Noritled/Memod. `a/ Supplementallntormatton
TYPE OF VRIAILDING DIVISION p 1'. W
0 New construction g dditionIaiteretion/replacemcnt t cheek sit drerappy ( submit }sets of plan wawa ebadcea below):
❑ Service or feeder 400 amps or more D Bolling over duce stories.
Cl Demolition ❑ Other: where the available fault current ❑Madrus and boalyards.
• CATEGORY OF CONSTRUCTION • exceoda 10.000 amps m 150 volts or ❑ Plotting buildings
leas to ground, or exceeds 14,000 ❑ Commercial-ate egric liural
❑ 1- and 2-family dwelling KCommerei &Uindustrial ❑ Accessory building , for !Rosier installanms buildings.
❑Multiamily 0 Master builder ❑Other: CI Fue faXtup. IIinaauaamot73KVA
- • JOB. INFORMATION AND LOCATION • 0 Fmerimof new motor "A",'8."1 -2". derived 3". rem
.
• • ' ❑ AddiGonofneswmotorlopdof ❑ "A ", °8 ", "1- 2 ". "(J ".
Job no.: 6 93g to, I lb site address; levet, St►J l l @e1/t CUAli F(., or more rosidantwunits. [] Reanaticmal vehicle parts.
Cily/Slate/i IP. 1 �C>•I
��� ( ❑Health ous localioos. Seines.
O Haxardus ❑ Supply voltage far more than
'off- 600 volts criminal. Suite/bldg./apt.no.: (" ) 1 Project name: 2.3 s ' (tee I e,eg.411 ❑Swat orReda600snips
FEE SCHEDULE
Cross stroet/dhcctions to job Site: Derutpdoe j:937,_1 i rte. I rota I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: 1 Lot no,: 1,000 sq. fl. orleaa 168.54 4
Ea. add'1500 sq. D. or portion 33.92 1
Tax map/parcel no.: Limited energy. residential -
• with above sq. R) 75.00 2
DESCRIPTION OF WORK Limited energy, multi-family
`./( ' v f
e ov- ■tgN l v) rk4VC e t reeldentialpith above sq. ft.) 75.00 _ 2
kY�S
Services or feeders Installation, alteration, and/or relo cation
200 amps or less 100.70 2
• . . ❑ PROPERTY OWNER 1. ❑ TENANT . 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps ro 1.000 amps 301-04 2
Address: Over 1,000 amps or voles 552.26 2
City /State/ZIP: ret at services or feeders Inatauad a
on, altersllon, nd/or
-
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. Pee for branch circuits wish
❑ APPLItA rr ( ❑ CONrACt . PERSON . above service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits willow
.. service or Roder foe, filet I 56.18 561 15 [/ 2
Contact name: branch circuit
' Each add'] branch circuit 3 7.42 2Za ti, 2
Address: Miscellaneous (service or f eeder not Included
Each City /State/ZIP: a dwelling, service and/or Rater r 67.54 2
Phone: ( ) y I Fax; : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 61.84 2
Sign or outline lighting 67,84 2
•
CONTRACTOR Signal circuit(s) or limited - Coagy
• Business STONER ELECTRIC, INC. panel, alteration, orextension. Page2 2
Each additional Inspection over allowable in any of the above
Address: 1904 SE OCHOCO Additional inspection (I hr min) 66.25/ hr
Investigation (1 hr min) 6625/1w
City / StateZIP: MILWAUKIE, OR 97222 Industrial plant (1 hr min) 78.18/hr -
Phone: ( 503) I Fax: ( 503) 659 -4968 Inspections for which no too is 90.00/ hr
l / specifically listed (r16 hr min)
Lie.; 44823 ,6 trial Lie-: 26 -122C J rv. Lie.: 3496S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: - Subtotal: 1 t I
Plan review (25% of permil fee): 41
Print name: MICH EL FALCONER [ Date: State surcharge (12% of permit fee): 12.
TOTAL PERMIT FEE: 91 0 4 g . 5'
Authorized signatu D 6 ��� - thus permitaplication apermitisnotobtainedvathIn180
1
Print name: I Date; �� days after It bee been accepted as complete.
� - • Number ofinspeodons allowed paper®i.
-
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