Permit C I ' Y OF T I GA R D ELECTRICAL RESTRICTED ENERGY PERMIT
� DEVELOPMENT SERVICES PERMIT #: ELR2005 - 00102
E 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 5/6/2005
PARCEL: 1 S135AB -01002
SITE ADDRESS: 10220 SW GREENBURG RD 135 ZONING: R -12
SUBDIVISION: THREE LINCOLN -TOWN OF METZGER LOT: 009 JURISDICTION: TIG
Project Description: Voice & Data.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: • HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
EQUITY OFFICE PROPERTIES TRUST PROGRESSIVE TELEPHONE SYSTEMS
ONE SW COLUMBIA ST #300 710 NE CLEVELAND # 120
PORTLAND, OR 97258 GRESHAM, OR 97030
Phone: Phone: 503 665 - 4900
Reg #: ELE 26- 1117CCLE .
LIC 150175
FEES SUP 3290LEA
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 5/6/2005 $75.00
[TAX] 8% State Surcha 5/6/2005 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oft 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 Notification Center. Those rules are set forth in OAR 952 -001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: Permittee Signature:
L
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.
. Electrical Permit Application . C I . ... O I.\
Date received: 15 "9 Permit no.i , L 4c-e6 /
'
.L. City of Tigard I . r oject/appl, no.: Expire date:
of Tigard City o Address: 13125 SW Hall Blvd, T �. , tai 9�� tl �'
Date issued: By: Receipt no.:
Phone: (503) 639 -4171 •
Fax: (503) 598 -1960 MAY 0 6 2005 Case file no.: - Payment type:
Land use approval: ClTV OF Tl3AR®
' Y't' OF Pi {11`IY "I'
❑ I & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
.IOR SITE 1'NFOKM:ATION •
Job address: i 02,20 V C` b eel .- Bldg. no.: Suite no./1 Tax map /tax lot/account no.:
Lot: Block: I Subdivision:
Project name: R,AN9 SrA-15 I Description and location of work on premises: - if51 e via fr,,e, .t- do
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Fee . Max
Description Qty. (ea.) Total no. insp
Business name: Pty cs5t.t te.(.2.Qbwre 50-crow., 4- CC ,
g , . New residential - single or multi - family per
Address: 7(0 ( CA vece,K4 pLve $-t ZO dwellingunit .Includesattachedgarage.
City: 6 rt L, I State:0z_. I ZIP: r'1 7 G 3 a Serviceincluded:
Phone:f'3 e65' 'ER00 I Fax: as 1-(3 I E -mail: 1000 sq. ft. or less 4
CCB no.: 15017.5 lElec. bus. lic. no: Z6 -1117‘16- Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
City /metro lic. no.: '7/3 S , Limited energy, non- residential 2
rj /6 lag
manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): License no: Services or feeders — installation,
alteration or relocation:
PROPERTI' OWNER 200 amps or less 2
Name (print): 20l amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only , l
Owner installation: The installation is being made on property 1 own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
. ... . Owner's signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E -mail:
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) misc. (Service or feeder not included):
0 Service over 225 amps -commercial O Health -care facility Each pump or irrigation circle 2
0 Service over 320 amps- rating of l &2 O Hazardous location Each sign or outline lighting 2
family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel. ('
O System over 600 volts nominal more residential units in one structure alteration. or extension' 1J 2
D Building over three stories ❑ Feeders. 400 amps or more *Description:
0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
0 Egress/lighting plan 0 Other: Per inspection I I I I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all j urisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
� p p jurisdiction Notice: This permit application
0 Visa O MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number, / / within 180 days after it has been State surcharge (8 %) $ 6.06
Expires accepted as complete. TOTAL S 4 r 00
Name of cardholder as shown on credit card
S
Cardholder signature Amount 440 -4615 (6/00 /COM)
•
CITY OF TIGARD ,1
BUILDING DIVISION
Aic PERMIT #: ELR2006-00102
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/80005
Phone: (503) 639-4171 villotill'i'\
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 5/13/2005 TIME: 7:12AM PAGE: 88
SITE ADDRESS: 10220 SW GREENBURG RD 136 CLASS OF WORK:
SUBDIVISION: THREE LINCOLN OF METZGER LOT #: 008 TYPE OF USE:
PROJECT NAME: RANDSTAD
DESCRIPTION: Voice & Data
OWNER: EQUITY OFFICE PROPERTIES TRUST, PHONE #:
CONTRACTOR: PROGRESSIVE TELEPHONE SYSTEMS PHONE #: 503-665-4900
Inspection Request Scheduled For: Date: 5/13/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
136 Low voltage 006798-01 603-665-4900 N
Corrections /Comments/ Instructions:
5:14 El PARTIAL APPROVAL 0 CANCEL El NO ACCESS •
0 FAIL 0 CALL FOR INSPECTION I] ADDITIONAL FEES ASSESSED
Inspector: _ Date:
Inspector: __________ cc /.3 — er Phone #: (503) 718-