Permit •
CITY OF TIGARD ELECTRICAL PERMIT
t ,.' . c i • COMMUNITY DEVELOPMENT Permit #: ELC2012 00660
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/20/2012
I1GAFlD Parcel: 1 S135AB00900 •
Jurisdiction: Tigard
• Site address: 10200 SW GREENBURG RD 110
Project: Fidelity National Title Subdivision: METZGER, TOWN OF Lot: 9
Project Description: (5) branch circuits for TI
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
5 crt Branch Circuits wo /Purchase 11%20/2012 $85.86
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/20/2012 $10.30
Type of Use: COM - Electrical
Class of Work: ALT -
Type of Const:
Occupancy Grp:
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Total $96.16
Required Items and Reports (Conditions)
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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 9 2 - 001. Y -u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
ti OA/ 19 ° PL.
Issued By: Permittee Signature:
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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.
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11/16/2012 09:55 5032577121 /� CAPITOL ELECTRIC PAGE 02/02
Electrical Permit �lppllcAtJO>� EI ' 4.I�E r( l li 1)11 11 1: (s f: ()Nil
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City of Tigard Date/By 1/ Zo /Z ,4 no g - /- 420 A -0. - , •
13125 SW Hall Blvd., Tigard, OR 97223 Plan Rcvic
-�I 1 1 other Permit: 503.639A171 Fa= 503.598.1.,,.. .. ZO Date/By;
T I c:: ,. R r , lmpeetion Lino: 543.639.4175 Date Ready/By: J uris; ��� El See Nan 1 nx
Internet: www.tigard-or.gov CITY OF TIGARD Notifed/Method; / 17 supplemental taro ann
Yi• : :- 1 - X41 �] 9 F - V 3.,':�rl '•A.L� -. -... _. b..� � .�� � W ._
., �..._� c. ��F,,,. �2r7�� >••Fr lrl- -..� .. .. _ _ r+ „ c _ �. .�.v7.�. TS: ti�� -^.. r:� .._._ aryl'' -.v. .�� :+�>._ .,, :'. �•- -- ,
O New construction 0 Addition/alteration /replacement Please check ell that apply (submit 2 sate of plans wlitems c below):
❑ Demolition ❑ Other. ❑ Service or feeder 400 amps or more ❑ Building over three stories
', r _ r _ L 3 , - , , sire I - T.:1! where the available faun current ❑ Marines and boatyards
O 1 -and 2- family dwelling ❑' Commercial /industrial ❑ Accessory building exceeds 10,000 amps at 150 volts or ❑ Floating buildings
❑ Multi -tam i ❑ Master Builder 0 Other less to ground, or exceeds 14,000 ❑ Commercial-use agricultural
r. r ..¢. -n ` , ,c l -xla. 20 2,.r �,' ;:.!_t� : ;t5...;.?, r'r ” ;1; amps for all other Installations. buildings
❑ Fire Pump ❑ Installation of 75 KVA or
Job no.; 130031 Job site address; 10200 SW Greenberg Rd 0 Emergency system larger separately derived system.
❑ Addition or new motor toed of ❑ 'A" "E" "1 -2". '1-3",
City/State/Z1P: Tigard OR
100Hp or more. ❑ occupancy
"1
0 Six or more residential units ❑ Recreetlonel vehicle ponce. s.
Sttite/bldg. /apt no.: 110 /IPrOject name: Fidelity Title 0 Health-care facilities ❑ Supply voltage for mom than
Cross Street/Directions 30 site: ❑ Hazardous locations 600 volts nominal.
❑ Service or feeder 600 am' S Or mote _
I .. . -
�.. s ...__,. _ , : „ _ ...._
-_ � Wi
Lot no,: z.
Subdivision: Description Qty. Pea Toud "
Tax ma • creel nn.: New residential - single or multi- family dwelling unit.
_ . !.:R F`s�S A 1 i .:f t.rl / !_ J r r .i i . �::4 = Includes attached gunge-
Tenant Imporvement 1000 sq. n. or less $ 168.54 4
Ea. Adds 500 sq. ft or portion 5 33.92 I
Limited energy residential
(with above sq. R) $ 75.00 2
Nome: _ Limited energy, multi- family
residential (with above sq, R.) $ 75.00 2
Address: Service or feeders Installation, alteration, and/or relocation
200 amps or less 5 100.70 2
City /Smtc/1.IP: 201 amps to 400 amps S 13336 2
Phone: Fax 401 amps to 600 amps 3 200.34 2
601 amps to 1000 amps S 301.04 2
Owner installntinn: This installation being made on property that I own which is not Over 1000 amps or volts S 552.26 2
intended for sale. lease, rent nr exchange. according to ORS 447, 449, 670, and 701 Temporary services or feeders Installation, alteration, and /or
Owner signature: Date: relocation I 40 11 amps to 599 maps S 168.54 1 2
Business Namc. Branch cireeits • new, alteration, or extension, per panel
A. Fee for brunch circuits with
Contact name: service or feeder fee, each
branch circuit S 7.42 2
Address: _ B. Fee tar branch circuits
without service or feeder fcc,
Ciry /State/7,,TP: first branch circuit 1 5 56.18 56.18 2
Each additional branch circuit: 4 5 7.42 29 -88 2
Phone: Fax: Miscellaneous (service or feeder not Included)
E -mail: Each manufactured or modular
dwelling, service and or feeder S 67.84 2
Reconnect only S 67.84 2
Business Name: CAPITOL ELECTRIC CO.. INC.
Pump or irrigation circle S 67.84 2
Contact name: Danny Gibbs Sign or outline lighting 5 67.84 2
Signal circuits) or limited-
Address; 11401 NE MARX ST. energy panel, alterations. or
extension. Describe: 5 75,00 2
City/State/ZIP; P ORTLAND, OR 97220.1041 Page 2
Each additional inspection over allowable In any of the above
h one: 6 03.265 -9488 Fax: 503 Per inspection $ 66.25
Investigation per hour (1 hr min) $ 66.25
CCB Lic.: 48748 4 ' Electrical Lie.: 26 -4960 I Supry ' .: 3132 -S Industrial 'lam -bout 3 78.(8
Surrv. i leetrlcian signature required: /
Subteen $ 85.8 t: - ,__.a' rs c , �
Print Name; Darrell om
Me Date: Plan review (25% of permit fcc)
: 1 11611
Authorized signature; / 'J � � Smte surcharge ( 12% omit lee) $ 10.30
1 TOTAL PERMIT FEE $ 98.16 ✓
Print Name; Darrell I This mink nppilenllon expires it a peril* is 001 4btnl0*4 511510 too
dorr 1111.1-14 h.. b..n nee.pnrt or corop4l..
• Number of inspections per permit allowed,
I.1111uildina5Potinit,\LLC- Pen.ni App•Ine iorovau 440-06 157(1 I FOS/CONN/EH