Permit 11 11111 CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMEN Permit #: ELC2012 -00433
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/23/2012
Parcel: 1 S 135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 420
Project: Spec Space Subdivision: METZGER, TOWN OF Lot: 9
Project Description: (1) branch circuit
Contractor: CAPITOL ELECTRIC CO INC Owner: LINCOLN CENTER LLC
11401 NE MARX STREET BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97220 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 255 -9488 PHONE:
FAX: 503 - 257 -7121
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 07/23/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/23/2012 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 OAR 952 -001- 90. Yo 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: O� �/0/- .8 Z./ e4-77o' ^ 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 503.639.4176 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.
07/19/2012 13:43 5032577121 CAPITOL ELECTRIC PAGE 02/02
Electrical Permit Application s atilt 01.1 - I U '►; Ii, (Y\1.1
Received
City of Tigard Datc/By: 7 a3 /,Z .; , ; •. rmitno.: '7.GroZO /o? —Do 933
• 13125 SW Nail Blvd., Tigard, OR 97223 iIi' Plan Review Other Permit:
I . Phone: 503.639.4171 Pax: S03.59g, i9t)W L
1-1,.,7,\ n , r r inspection Lime: 503.639.4115 19 2012 Da Re
EIRININEENIM
internee wnYW_tigAfd•t)t.gpv Date Ready/13y;
13 IS 1 tYOFTIGARD Notified/Method
i , _:.:., s 4 { T' .: i X 4. _" i , .J •27-:•: rep a; ant `` a ' �.. . ,. r? _..w t . 7 _ �_ 's :ni
: : . — �q; ' 2_ {J.
- - - 'c - - . :
■ New construction _ • Addrhon/altcratt Please 010ek ell that apply (submit g sets of plans wittonts checked below):
❑ Demolition ❑ Other: ❑ Service or feeder 400 amps or more ❑ Wilding over three stories
s . �• :" 73.° _. _ f - :.1._• 77: - [ ,. :3 ti:'.', y ` where the evadable fault currant ❑ Marinas and boatyards
• I. and 2-family dwelling El Commercial /industrial • Accessory building exceeds 10,000 amps at 150 volts or ❑ Floating busainga
❑ Multi -famil ❑ Master Builder ❑ Other less to ground. or exceeds 14,000 ❑ Commerclal.use agricultural
"«f 1' _∎.mod: :,,". - :. ;!Zifi: r, 1 _ 12.. 1�,.�t.N : i t ..
� •- __. _... � � q.., :g ,,�,__ ;, amps for all olheNllstallallona. bmldlraga
Job no.: . 120891 Job site address; 10300 SW Groenburg Rd ❑are Pump ❑ Installation 0175 KVA or
�. ❑ Emergency system larger separately derived system.
City/State/ZIP: Tigard OR ❑ Addition of new motor load at ❑ "A ", "E , ry -2- '1 3 ",
100HP or more. ❑ occupancy
Suite/bldg. /opt. no.: 420 rojcct name: Nice Dame ❑ Six or more raeldemial undo ❑Recreational vehicle parka.
❑ 1 facilities ❑ Supply voltage for more than
Cross Stltct/Directions oJob site: ❑ Hazardous locations 600 volts nominal,
❑ Service or feeder 600 am or more
Subdivision: .1 Y !r { .: •r�7� ` e �. : i . i1. �, .fi '? -
I Lot no.: :. .�,_ _ �... •e .._> . ...... N_--
w _ a
Deicriphoe Qtr Fee. Total
Tax me / areal he.; New residential, single or molt) -ftimt dwelling t
S • lY B unit
y, fit, ry ,, { M �4 ?. `�__ sn;.? '. (,Aj ):'r!•!:J.i:___ •', ,!: - '� . ., +'• YrJ '' feehldee gnashed garage. Add (I) OP Outlet 11X10 sq. ft nr less S 168.54 — q
Ea. Add1 S00 sq, R or portion S 33,92 1
. •.-- , ---.r. _ _ . ._!_, _.+ _ 7... , Limited energy residential
Name: ,(with above sq. ft.) S 75.00 2
Limited energy. mulli•fmmily
Address: residential (with above sq. R, S 75.0a 2
Service or feeders Installation, alteration, and /or relocation
City/State/ZIP: 200 amps or less S 100,70 2
201 amps to 400 amps S 133,56 2
Phone; Fox: 401 amps to 600 amps S 200.34 2
601 amps to 1000 amps S 301.04 2
Owner inatallation: This installation is being made on property that T own which is not Over 1000 amps or volts 8 552.26 2
intended for sale, lease, rent or exchange, according 10 ORS 447, 449, 670, and 701 Temporary scr•vkat or feeders Installation, alteration, and/or
Owner signature: Date: relocation
200 amps or less - S 59.76 I
• • i i + ,' . ° ir a;,4 !• i_ .. t : 7; ',. ul i . _ L __75 .1 + 201 amps to 400 amps s 125.08 2
Business Name: 402 amps M 599 amps S 160.54 2
Branch circuits - new, alteration, or extension, per panel
Contact name; A. Fcc for branch circuits with
service or feeder fee, each
Address: branch circuit S 7.42 2
B. Fcc for branch circuits
City/State/ZIP: without service or feeder fee.
'first blanch circuit 1 S 56.18 56.18 2
Phone: Pax: Each additional branch circuit: S 7.42 2
Miscellaneous (service or feeder not included)
—
E-mail:
±-.: �� feeder
Each ma_ service manufactured or modular
. � ._,_ ,_ _•_,_.- ... __ - .,, � :_;..v dwelling, and or • S 67,84 2
Business Name: CAPITOL ELECTRIC CO., INC. Reconnect only 5 67,04 2
Pump or irrigation circle S 67.84 2
Contact name: Gary Staler) Sign oroutline lighting 5 47.84 _ 2
Signal circuit(s) or limited.
—
Address: 11401 NE MARX ST. energy panel, alterations, or
extension, Describe: $ 75.00 2
City/Slate/ZIP: PORTLAND, OR 97220 -1041 _ , Page 2
• Each additional Inspection over allowable in any of the above
hone: 803- 265.9488 F Per inspection
Fax: 3 -267 -7121 / S 66,25
investigation per hour (1 k min) S 66.25
CCB Lic,: 48748 Electrical Li • •496C Su rv, Lie.: 3132 -S e� Industrial •loot . hour
St rv. Electrician signature. _ 5 is t8
tP required: ! btot '? ". J,f'•. til':5 t`• a, .�� '�$ .58.18
��� Subtotal S 56,18
Print Na me; Dar rell McNeal �� Date: 0711911 Plan review (25% of permit fee)
Authorized signature: '' _ J State surcharge ( 12% of permit fee) S 6,74
�(J�- TOTAL PERMIT PEE $ 62,92 ✓
Print Name: Darrell Mc eel
Thin pesmIt opl'dtmduo expire it a permit h ne obtained within 180
days Niter It bra been aenpted as eomplele.
• Number of inspections per permit allowed.
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