Permit ; a ' 1 CITY OF TI GA D ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00294
, 1 DATE ISSUED: 7/23/2007
TitGRD; 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 135AB -01002
SITE ADDRESS: 10220 SW GREENBURG RD 417 ZONING: R -12
SUBDIVISION: LINCOLN CENTER /THREE LINCOLN LOT: 009 JURISDICTION: TIG
PROJECT: FUJITSU
Project Description: low voltage for HVAC wiring.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
EQUITY OFFICE PROPERTIES TRUST AMERICAN HEATING
ONE SW COLUMBIA ST #300 1339 SW GIDEON ST
PORTLAND, OR 97258 PORTLAND, OR 97202
Phone: Contact #: PRI 503- 239 -4600
FAX 503- 239 -7038
Reg #: ELE 26- 993CRE
FEES LIC 33135
Description Date Amount
[ELPRMT] ELR Permit 7/23/2007 $75.00
[TAX] 8% State Surcha 7/23/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notifi - _ • _ - ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules • iirect questions • • • at 03.246.6699 or 1.800.332.2344.
J /14- ‘eSf
Issu • d By: "//// Permittee Signature:
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'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
` . tw .. F OFFI E I U SE ON t " " . ,,,. `
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Electrical Permit Application {
City of Tigard Da Y 7 a 'e 07 Permit No.: Et 4,9067 -66 A9f/
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 y �'� Ij) i ' Date By: Other Permit:
Inspection Line: 503.639.4175 �a %y;'' �� " Dat ReadyBy: tLL H See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: it Supplemental Information
A�4 . i • rRv s s a a: -t AP ' g .. ..5�• -. - o` tt rg t 4 ,� r - ✓ i
A ,} t , " i i sf.• tl q�,, x a �,r r . e q 4`. , 3 f F 1C Y a Ja S -�E : ;
it, . iy-. ,i R Fr • - si 0 0 a f c`xAry :'� 't -wF � � sla r1,174..erW -. .n. :r + . r
j +���°�- �,�4:� . .i[ —• �fl..47:? iF: Cl � .fP: ' -'�� i� Ir C7 '.f, w K .ti ^ .
❑ New construction N Addition/alteration /replacement Please check all that apply:
['Service over 225 amps, comm'l ❑ Hazardous location
❑ Demolition 0 Other:
• _ ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
'44 f } . , ' ,TE a • : . ` - a T om. `' 0 - - ' - of 1- and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
Building over three stories ['Feeders, 400 amps or more
❑ Multi family ❑ Master builder ❑ Other: ['Occupant load over 99 persons EManufactured structures or
d �.:. t. , - .-rt . .. RV park
"'� g*s ry" F1 o O. I ; •, 2e 4` 0 , �r, 1 ❑E /li ghtingplan p
1 , ' ❑Health -care facility ['Other:
Job no.: I Job t site address: V /^ 2 O SW 6p ' e' SvrS Submit 2 sets of plans with any of the above.
Ci City /State /ZIP: TO G /• O / / 7 2 2 3 J The above are not applicable to temporary construction service
ty/State/ZIP: v 1 �,�., . By . .� t r. w f c: fi a R c. k ^ 4 Y , Y
Suite/bldg./apt. no.: 1 1 —7 () C r l oor, ' -"l t +a, - - — E .� y ., ,- { ,.. -
7 I / I Project name J I I �J server Description Qty. I Fee. Total
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: 1 Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
rte` K )z k'a�v sit '` a - ; ti a ((r @ "d i ' k ' x s I h 4 Wy i t. 7 Each manufactured or modular
/O w vO / / 1j Z f - s 't w (r- l i! dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
, 4TEV ,,, .� ,, r r r 7^ ,� ,, g c` � r : s�,' Wi 201 amps to 400 amps 106.85 2
#r4r�,1°f .r�w.,.�` ;,,, 401 amps to 600 amps 160:60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 i
Owner instal'ation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
4 4 ,, N *r 7 .� v. a , v r :e;' a $" riF A. Fee for - branch circuits wish
n "„! I! r - ' a "^ ' •' = -' service or feeder fee, each
` ' I 6.65 2
Business name: imp ((( f\ i- kec,� to Jo ( ,
branch circuit
1 B. Fee for branch circuits
Contact name: O her f .5 I f Jl without service or feeder fee, 46.85 2
r' w each branch circuit
Address: i33C 5 e {.t (��_tL n s4 • Each add'l branch circuit 6.65 2
City/State/ZIP: .---P0 Y'* 0 4 J t 0 (z vli a 0 - Miscellaneous (service or feeder not included)
A (`� p Pump or irrigation circle 53.40 2
Phone: (�(�) a3 I _ b6 I Fax: )a 1 - ! y 6� 0 Sign or outline lighting 53.40 2
E-mail: Signal circuit(s) or limited-
-." ' F,• .r ��,: y,' , ,, eYom, s, energy panel, alteration, or
3kY�.. -s�a .: f „t�F� nxw' "`Ol RA. T o- K °�.' �' �P�+ic
,, l._! extension. Describe: Page 2 2
Business name: 4-rap xi cr i 7—•�Tl (n L(1 C .
Address: 1 C
` �- ^ l r 5 t a\ , 1 , d� Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: - T o A- t f 0 4 q--) -30 Investigation per hour (1 hr min) 62.50
Phone: ( ) r (� 0 0 I Fax: ( ) cr —,0,33 Industrial plant per hour 73.75
VIM CiaMMT.OWAICIMPROWIENa
CCB Lic.: 33 f a 35 Electrical Lic.: 9 6q3 opt Sup . Lic.: aid-I 0 ri Subtotal
Suprv. Electrician signature, required: . , i / • it ' Plan review (25% of permit fee)
I^
-,
Print name: 5.4e v �� -0 State surcharge (8% of permit fee)
yo 1 1 ` Dat� :
t "l / TOTAL PERMIT FEE
Authorized signature: y 2 This permit application expires if a permit is not obtained within 180
mm . ? I �� days after it has been accepted as complete
Print name: Gi m d Date: 23' O ' Fee methodology set by Tri County Building Industry Service Board
•* Number of inspections per permit allowed.
is\ Building \Pertnits\ELC- PermitApp.doc 12/03 440- 461ST(10 /02/COM/WEB •