Permit • CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00428
4p DEVELOPMENT SERVICES DATE ISSUED: 7/15/2004
II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171
PARCEL: 2S101 DA -00102
SITE ADDRESS: 13221 SW 68TH PKWY 120
SUBDIVISION: TRIANGLE CORPORATE PARK ZONING. MUE
BLOCK: LOT : 002 JURISDICTION: TIG
Project Description: 10 branch circuits.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 9 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
TIGARD TRIANGLE I LLC GREENWAY ELECTRIC COMPANY
4650 SW MACADAM AVE STE 220 9460 SW TIGARD STE. 104
PORTLAND, OR 97201 TIGARD, OR 97223
Phone: Phone: 503 - 620 - 6020
Reg #: LIC 153421
ELE 34 -617C
FEES SUP 5025S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 7/15/2004 $106.70
[TAX] 8% State Surcharge 7/15/2004 $8.54 Rough -
Elect'I Final
Total $115.24
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 issuan .-, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oreg. n Utili N - ific• Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these r -s o, •irect ions o OUNC at 5
246 -0699 or 1 -000-3 -2344. _ �j
Issued By: �■ _ - - /�� Permit Signature: _ /
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lea • - or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:OOpm for an inspection the next business day
Electrical Permit Application FoR ()Fria: usE: ONIN
City of Tigard Received Permit No.:
Date/B : /y � �� '09 (ill a
13125 SW Hall Blvd., Tigard, OR 97223 �n Plan Revie
Phone: 503.639.4171 Fax: 503.598.1960 ,, Date/B Other Permit:
Inspection Linc: 503.639.4175 : -_ski c'I .! n Date Ready /By: tuns: Et See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ['Service over 225 amps, comm'l ❑Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION 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
❑ Multi- family ❑Master builder ❑Other: ❑Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: 1032 -21 Job site address: 13221 SW 68th Parkway ❑Health -care facility ❑Other: Submit 2 sets of plans with any of the above.
City/State /ZIP: Tigard, OR 97223 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: Ethics Point TI FEE* SCHEDULE
Description I Qty. I Fee. I Total I ••
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 0.00 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 0.00 1
Tax map /parcel no.: Limited cncrgy, residential 75.00 0.00 2
Limited cncrgy, non - residential 75.00 0.00 2
DESCRIPTION OF WORK Each manufactured or modular
Installation of lighting and miscellaneous circuits dwelling, service and/or feeder 90.90 0.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 0.00 2
❑ PROPERTY OWNER 1 ❑ TENANT 201 amps to 400 amps 106.85 0.00 2
401 amps to 600 amps 160.60 0.00 2
Name: 601 amps to 1,000 amps 240.60 0.00 2
Address: Over 1,000 amps or volts 454.65 0.00 2
Reconnect only 66.85 0.00 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 0.00 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 0.00 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 0.00 2
Owner signature: t -, Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT 1 ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each
Business name: branch circuit 6.65 0.00 2
B. Fee for branch circuits
Contact name: without service or feeder fcc,
Address: each branch circuit 1 46.85 46.85 2
Each add'l branch circuit 9 6.65 59.85 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 0.00 - 2
Sign or outline lighting 53.40 0.00 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: Greenway Electric Company 0.00
Address: 9460 SW Tigard St., Ste. 104 Each additional inspection over allowable in any of the above
Per inspection 62.50 0.00
City/State /ZIP: Tigard, Oregon 97223 Investigation per hour (1 hr min) 62.50 0.00
Phone: (503) 620 -6020 I Fax: (503) 620 -6124 Industrial plant per hour 73.75 0.00
ELECTRICAL PERMIT FEES*
CCB Lic.: 153421 Electrical Lic.: 34 -617C Suprv. Lic.: 5025S Subtotal $106.70
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) $8.54
Print name: James V. Rooney Date: 07/15/2004 TOTAL PERMIT FEE $115.24
Authorized signature: a ✓ 14 4k3-05 Thls permit application expires if a permit is not obtained within 180
days after it bas been accepted as complete
Print name: Mark Sh." Date: 07/15/2004 • Fee methodology set by Tri-County Building Industry Service Board
•• Number of inspections per permit allowed.
is\ Building \Pennits\ELC- PcrmitApp.doc 12/03 4404615T(10/02/COM/WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: .(503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
7 BUP
Received 7 40 Date Requested � AM PM BUP
Location / 323 5& �fL! /ebAr 1 Suite l MEC
Contact Person 6!/ rC Ph ( ) WO --6O c 0 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC CI
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation p F641., Ftivol
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS. PART FAIL
PLUMBING
Post &Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
-
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
IC
e e
Rough -In
UG/Slab
Low Voltage
Fire Alarm
gap PART FAIL El fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Please call for reinspection RE: El Unable to inspect - no access
Fire Supply Line K
ADA Approach/Sidewalk Date 7- 2r oy Ins pe c tor / j . - im y Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL