Permit _ I CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2013 -00079
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/30/2013
Parcel: 1 S 135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 110
Project: Fidelity National Title Subdivision: METZGER, TOWN OF Lot: 9
Project Description: (1) branch circuit for GP outlet
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 al Branch Circuits wo /Purchase 01/30/2013 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/30/2013 $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 I 9 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 11.800.332.2344..
Issued By: ' 0 Permittee Signature: AU 4 1 1. PLf e i4- T 1O
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.
01/30/2013 10:52 5032577121 CAPITOL ELECTRIC PAGE 02/02
« I. 1�I. l li u: I ti t)�i:
F. "v
Electrical Permit Application -1..d11 �Y J.E� r ccc:v .
City of Tigard Date/By: / /30 /3 .permit ne6a LDl 3 0 0 07 7
13125 SW Ilalvd., Tigard, OR 97223 JAN 3 0 2013 P an Kevicw Other Permit:
■ n B
' , Phone; 503.639.4171 Fax 503.598.1960 Dale /By:
-E-1,-.; -, t: t • Inspection Line: 503.639.4175 cIr OF lc/GARD Date Ready/By; Jurjso ❑ `moo rase 2 for
Internet: www,tigard -Qr.glov Notified/Method; I ( sll :pi Inrarmmioa
BUILDING DIVISION •
H "`.:'F ., :r..zc•M';,..a ;y= 1�,r: _.= ,. :u.�n��:w man '�t{ri�..ir�aC'i"r:`,':.,.,.: =
❑ New construction E 4 Addition/alteration/replacement Praise check all that apply (submit g sets of plane wAtems Checked below):
❑ Demolition 0 Other, ❑ Service or feeder 400 amps or mom ❑ Building over three stories
., . S ,L "4 , .,=, ;. ?:E ^'''. {_;? ;.".7: i.�; %.:J y427j '4u t F
: E!. F'.:: _�" �s ur : >..1 Marinas and boatyards
:fir• =1=? W, �� -- _ ';f�. yr: _ :-M`.: L ,.._... ....- . a:..., -- �' 3�.� • ...: -., where available fault kurisnt
❑ I- and 2•fhmlly dwelling 0 Commercial /indusfnl ❑ Acemsory building exceeds 10,000 amps at 150 volts or ❑ Floating buildings
❑ Multi-fermi ❑ Muter Builder ❑ Other less to ground, or exceeds 14,000 ❑ Commerelal -use agricultural
E>_ - �;:;5 ^ �1 ."ri -' y i. :JE;..1 :_+,: :; n.!IlVa: 1LP6`::: .7.!'_ -'� . ;;,w. ,z- w 1 amps for all other Installations. buildings
Job no.: 130433 Job site address; 10200 SW Greenburg Rd ❑ Fire Pump ❑ Installation of 75 KVA or
❑ Emergency system larger separately derived aystom,
Ctly /$tate/7.1P: Tigard OR ❑ Addition of new motor load of ❑ "A "E ", - 1.2°, "1-3 ",
100HP or more. ❑ occupancy
Suite/bldg./apt. ldg. /apt. no.: 110 Project name: Fidelity Add GP Outlet ❑ Slx or mom residential units ❑ Recreational vehicle perks.
❑ Health -care fbcitities ❑ Supply voltage for more than
Cross Strcet/Directions to 'ob site; ❑ Haaudous locations 600 volts nominal,
❑ Service or fbedcr 600 am . or more
- :• 5. r.- :V_,: &,c ,= „:,.,,- -
Subdivision: .�•M . _.1� ,�.... K .,. __�- .-
,':•.
ivisi n: Lolno.: ... =: =:.� t.:.. r ..'
new.; Qtr. Foe. Tail
Task ma / erect no.: New residential • single or multifamily dwelling unit.
. HZ -• P s 1 ;rq o Mire , , .7 Y _• , ' Includes attached garr%e.
Install GP outlet 1 000 sq. R. or less $ 159,54 4
Ea. Add'l 500 sq, ft or portion 5 33.92 1
i t a a. jT , 7'i,, .l Mt7 Y! ,..i'�” G ;!i !„ -; ,' "; -,T } i a Limited energy residential
Name; (with above sq. It) S 75,00 2
Limited energy, multi - family
residential (with above sq. ft.) S 75.00 2
Address: Service or feeders installation, alteration, and /or relocation
City/State/ZIP; /5tater7lP; 200 amps or Iaav S 100.70 2
ty 201 amps to 400 amps $ 133.56 2
Phone: fox: 401 amps to 600 amps $ 200,54 2
601 amps to 1000 amps S 30L04 2
Owner Installation: This installation is being made on property that I own which is not Over 1000 amps or volts S 552.26 - 2
intended for sale, lease, rent or exchange, according to ORS 447, 449, 670, and 701 Temporary services or feeders installation, alteration, and /or
Owner signature: Date: - relocation
200 amps or less S 59,56 1
vumFDtt +c *ok1i5 = nx ,zg:S.4.� •; ' `.'-'1:„i:J`:;Kc3s�7':lia-':;, 201 amps to400amps S 125.08 2
Business Name; 401 amps to 599 amps S 168.54 2
Branch circuits , new, alteration, or extension, per pane/
A, Fcc for branch circuits With
Contact name: service or feeder fbe, each
branch circuit $ 7.42 2
Address; B, Fcc for branch circuits
City/State/ZIP; without service or feeder fcc,
first branch circuit 1 S 56.18 56.16 2
Phone; pax: Each additional branch c i r c u i t : - -._ S 7.42 2
Miscellaneous (service or feeder not included)
E -mail: Each manufactured or modular
a , r , �"s r -- ;r1c - . ; i'cirA , •2i •7:« .. L;a • 'ti•n: .. 7 , dwelling, an or feeder S 67.84 2
5r af='. lei+ ni� i..- Sk':.,.:�_:.:y;.._�. = .: " . [
. U!�i °,�(�, i�;�x.SN+: . -_ .,q,; ;
,,r._. .. i d f
,
Business Name: CAPITOL ELECTRIC CO., INC. Reconnect only S 67.84 2
P or irrigation circle - s 67.84 2
Contact name: Gary Stelert Sign or outline lighting S 67,84 2
Signal circuit(s) or limited -
Address: 11401 NE MARX ST. energy panel, alterations, or
extension. Describe: $ 75.00 2
City /State/7.IP; PORTLAND, OR 97220.1041 Page 2
Each additional Inspection over allowable in any of the above
Phone: 503- 254 -9498 Fax: 503- 257.7121 Per inspection 8 66.25
Investigation per hour hr min) $ 66.25
CCl3 Lic.: 46748 Electrical Lie.: 26 - 496C EMEME9111 Industrial slant r hour 5 78.18
�% / �� I? 1'L; ±,- 1 �:'..: _NC...i? �:.;:.wr' 1 ".Z." * . r.�....: ; =7 ,.ry n':a:'5
., / ' Subtotal S 66.18
�.r� r a! w : Plan review (25% of Ecmtit fee)
/ /��IIZ11 State surchar5e { 12% ofpermit the) 't 6.74
TOTAL e IT PEE $ 62.92
Print Name: Darrell McNeal - Thb vannlr app6cnuon expire* an permit I. not abtnlned within 1,80
Onyx otter it ban been accepted nt complete.
• Number of inspections per perm allowed.
I: muiminp \roriniumt.C- Pcm 10/01/OP 110- 1615Tt11m:/COnvwe6