Permit q CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2013 -00017
Date Issued: 01/10/2013
TIGARD" 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 parcel: 1 S135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 500
Project: Bridgewell Subdivision: METZGER, TOWN OF Lot: 9
Project Description: (2) branch circuits for TI
Contractor: WILLAMETTE ELECTRIC INC Owner: LINCOLN CENTER LLC
PO BOX 230547 BY SHORENSTEIN PROPERTIES LLC
TIGARD, OR 97281 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE 503- 624 -3631 PHONE
FAX: 503 - 624 -2938
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 01/10/2013 $63 60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/10/2013 $7 63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71 23
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 9 - 0 -00 You ma obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1 88000 332 2344
Issued By: Cr �� Vet .l a.t Permittee Signature: (I/i( 4 P l C�4l /ot _/
OWNER INSTALLATION ONLY
The installations 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.
01/09/2013 WED 14:41 FAX 5036242938 Willamette Electric 81002 /002
Electrical Permit Application ��� l " FOR orrlcE Use ONLY: .- -• l• .;:;:, ;•':.:;
City of Tigard 1 i R.. V E R eceives
Date gy: 1/ it)/ 1 3 • Permit No.: E(� aU /3. 4,201
w 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review r
i a Phone: 503.639.4171 Fax: 503.598.1960 JAN 0 9 2013 Date/By: Other Permit: &ApA) 1 a _ ) r O
TI GARD Inspection Line: 503.639.4175 Date Ready/By: r VI /
See page 2 for
Internet: www.tigard or.gov Cr r I OF TIGARD Notified/Method: t' Supplemental information
,.• ' „ . rfa •ol W I DIVISION .. ; ' 1G - Ai:ii l✓w , ,:.- _ ._
P lease check all that apply (submit 3 sets of • below): e.,
❑ New construction � Addition /alteration /replacement plans w /items checked
❑ Service or feeder 400 amps or more 0 Building over three stories.
El Demolition ❑ Other: where the available fault current 0 Marinas and boatyards.
baildingsings.
„04,1 t.olt'� CO
060 S'i�: titre q exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
. _ ;,;. ,,:, N .:' . less to ground, or exceeds 14,000 gs.
❑ 1 - and 2- family dwelling [ l Commercial /industrial ❑ Accessory building amps for all other installations. tb al -use ag
❑Multi- family 0 Master builder 0 Other: 0 Fire pump. 0 of 75 KVA or
YI L ❑ Emergency system. larger separately
1 _ . `D T 4 ❑ Addition load derived system.
lioo 0fnewmotOr dof A „ E,.�.t_2,..,i_3. I
Sc,, 0013P or more. occupancy, 1
Job no.: •7 .7 I , Job site address: /6,2 U S L T t; �9., R g . kit/ ❑ Six or more residential units ❑ Recreational vehicle parks.
City/State/ZIP: °� 6.... /} 1. ❑ Health-care facilities. ❑ Supply voltage for more than i
tY j it l e + / 7 ,A� ❑ Hazardous locations. 600 volts nominal. i
(6uif_Obldg. /apt. no.: •• Project name: /3r , • ,, / ❑ Service or feeder 600 amps or more.
a 1
Cross strect/directions to job site: Description Qty. Fee. Tote •
New residential single- or multi- family dwelling unit.
Includes attached garage.
•
Subdivision: ( Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map/parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 1
Limited energy, residential 7500 2
DESCRIPTION oy 'WOItK (with above sq. ft.)
' Limited energy, multi - family 75.00 2
c',./—/-,,c residential (with above sq. ft)
4/, 4/, Y Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ YROpE1tTY :QWNIER , D ,l'ENAN '. 201 amps to 400 amps 133.56 2 i
Name: 401 amps to 600 amps 200.34 2 .
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State/ZIP: relocation
Phone: ( ) l Fax: ( ) 200 amps or less 59.36 ' 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee fbr branch circuits with
S APPLICAIV'r. , .J • COAT'►cr ItSi 1V.. above service or feeder fee, 7,42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first / 56.18 5� / ¢ 2
Contact name: branch circuit ,
- . Each add'l branch circuit / 7.42 7 `/ 2
Address: Miscellaneous (service or feeder not included)
City/ State/ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder `
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 _ 2
Sign or outline lighting 67.84 2
•-,:.•-:-'-', .: V g' - t' - ' - Signal circuit(s) or limited-energy
Business name: Willamette Electric Inc. panel, alteration, or extension. Page 2 _ 2
Each additional inspection over allowable in any of the above
Address: P.O. Box 230547 Additional inspection (I hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City /State/ZIP: Tigard, OR 97281 Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 624 -3631 ' Fax: (503) 624 -2938 Inspections for which no fee is 90.00 / hr
specifically listed ('h hr min)
CCB Lic.: 75059 Electrical Lic.: 34 -283C Suprv. Lic.: 42265 ; ' • 7' 1 ,tt; i a, .1. ° ' .. T - . . 2 1 ;•
cs� "--- Subtotal: Ill
Suprv. Electrician signature, requ '
Plan review (25% of permit fee):
Print name: David Fife Date: (// �J' ` - State surcharge (12%ofpermit fee): 1 1- 3
Authorized signature: r ( TOTAL PERMIT FEE: 7 /
This permit application expires if a permit is not obtained within 180
Print name: Date: • days after it has been accepted as complete.
Number of inspections allowed per permit.
1 .Iauildtng\Permiu'ELOPermitApp .doe 07/01/10 4404615T(t1/05/CAM/WEB