Permit CITY OF T I GA R D ELECTRICAL PERMIT
PERMIT #: ELC2004 -00487
,ov��� DEVELOPMENT I E SERVICES
(503) 639 -4171 DATE ISSUED: 8/5/2004
A:14 PARCEL: 1S126DC-03300
SITE ADDRESS: 09900 SW GREENBURG RD 220
SUBDIVISION: LEHMANN ACRE TRACT ZONING: C P
BLOCK: LOT : 005 JURISDICTION: TIG
Project Description: TI - branch circuits (7).
Job #3010.
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: 6 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:
ATHERTON REALTY PARTNERSHIP HILLSBORO ELECTRIC
MARTHA ATHERTON 21185 NW EVERGREEN PARKWAY
2100 S WOLF HILLSBORO, OR 97124
DES PLAINES, IL 60018
Phone: 847- 298 -8600 Phone: 503 - 439 -9666
Reg #: ELE 34 -4399C
LIC 134481
FEES SUP 4941S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/5/2004 $86.75
[TAX] 8% State Surcharge 8/5/2004 $6.94 Rough -in
Elect'l Final
Total $93.69
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 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 or 1 -800- 332 -2344.
Issued By: % - ., A4 . Permit Signature: .S.! ,,.t \c\c
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 639 -4175 by 7:00pm for an inspection the next business day
Frpm :HILLSBORO ELECTRIC LLC. 5036013680 08/04/2004 10:45 #611 P.002
Electrical Permit On G FoR ovticE iisE,oNIv
City of Tigard AUG 0 4 20O4. Daf /13y: -D c/ CAM Perm ,l /y C: 4/ :'
13125 SW Hall Blvd., Tigard, OR 97__ Plan Review .
Phone: 503.639.4171 Fax: 503.598,1960 - Iripr�i `l+ Date/13 : Other Permit. . •
inspection Line: 503.639.4175 CITY OF TIGARD A , ; I,L: h4 1 Date Ready /By: ® See Page 2 for
• Internet: www.ci.tigard.or.us BUILDING DIVISION Notified/Method: Supplemental information
❑ New construction ,Addition/alteration / replacement Please check all that apply:
• ❑ Demolition ❑Other; — 05ervice over 225 amps, carnm'I ❑Hazardous location •
['Service over 320 amps . rating ❑ Buildng over 10,000 sq. ft.,
' .. CATEGORY, OR: CONSTRLICTION ,' -;.;' !•" i:' ,' .': ; : ' `� "' ; ':.,;. , of 1• and 2 family dwellings 4 or more new residential
❑ I - find 2-family dwelling I Commercial /industrial ❑ Accessory building System over 600 volts nominal units in one structure
❑Building over three stories EFeeders, 400 amps or more
0 Multi-family ❑Master builder ❑ Other: ❑OCCUpant load over 99 persons ❑Manufactured structures or
.. JO SITE INFOJEtMATION'.AND LOCATION ❑Egress/Iighting plan RV park
w . DI-care facility ❑Other:
Job no.: Job site address: 9' � ��,� /� Submit 2 sets of plans with any of the above.
City /State /ZiP: Ailkyjel, Qie • 9' 43 The above are not applicable to temporary construction service. .
ED
Suite/bldg. /apt. no.: 4 1,4 . Project name: akin 6/4 //1e51 / • ... FEE w S CL-1
, �: -. '''.....••••:: ;.
Nampdee IJLL. � Qty. � Ft 1 Totai
Cross strect/direetions to - job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
. 1,000 sq, ft. or less 145.15 4
Subdivision: I Lot no.: Es. add'1 500 sq. ft. or portion 33,40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited •:']•!: . .. ..
energy, 2
..:.... 75.00
' . ,,.,.::, DESCRIPTION OF W ORK'.... n r modular
:;:.. ., . ...:... : -' ! '� � Each manufactured o
.1..- dwelling, service and/or feeder 90.90 _ 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
• ..: ❑ PROPERTY' OWNER • ..;., "' ` ;..; .I � :i.TENAN T.:::.:: •s° .; ,;' •..
amps t
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 1
Owner installations: This installation is being made on property that I own which is not ' 20i 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
Iv ;,;_,I :, D': P
APLICANT-,.=:: r.: :,:.'::'i:. :.::: 'i. ,":: :0 CONTACT PESONt :• :• : ,
• , ,, : .;;,; R , , A Fee for branch circuits n)//h •
' service or feeder fee, each
6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
46.85 '761' ?
each branch circuit
Address:
E ach add'1 branch circuit (p 6.65 35, 90 2
City /State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) ( ) Pum or irrigation circle 53,40 _ 2
Fax::
• Sign or outline lighting 53,40 2
E -mail: Signal circuit(s) or limited-
,r
''' "'' C NT alteration, o
...:....:...:'.•
,: • ... • _•,:,.......:. ; ...... ::..: .. .:.:. O xACTOR s , >.;:::: ":: ';�: • ;; ;; •:.::': �� :; '.. 'f:... ti : .: :e � energy pan 8
en e,ate
extension. Describe: Page 2 2
Businessnarne:Hillsboro Electric L.L.C. -
Address: 21185 NW Evergreen PKWY e #110 Each additional Inspection over allowable In any of the above
Per inspection 62.50
City/ State/ZIP: Hi 11sboro, OR. 97124 Investigation per hour(1hrmin) 62.50
Phone: (5 0 3) 439-9666 Fax: (5 0 3)601-3680 Industrial plant per hour 73.75_
i' ELECTRICAL :PERMIT FE : • : "•. •
CCB Lic - :l 3 4 4 81 Electrical Lic:3 4 9 9 C Suprv. Lic,: 494"g Subtotal 26.7s—
Suprv. Electrician signature; required: J� Plan review (25% of permit fee) -----
Print name: Joey Vitacco Date: eV,i6 State surcharge (8% of permit fee) L
• TOTAL PERMIT FEE y -� Co?
Authorized signature: This permit application expires if u permit is not obtained within 180 ,
days after it No been accepted as complete
Print name: . Date: " Foe methodology set by Tri- County Building Industry Service I3oard
-- - Ct Number of per permit allowed.
■s \amllding \Pen ➢its \Et-C•PermltApp.doc 12 /t13 440-4 IYr(lo/a2/COM/WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection :, (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested q 7D AM PM BUP
Location ! g r Suite ZZd MEC
Contact Person -P. Ph ) 3 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC Q06 7 " /87
Footing
Foundation ELC
Access: H A ELR ��1
Ftg Drain 2 �l V
Crawl Drain c JIJ l �
Slab Inspection Notes: SIT INV41.
Post & Beam
WNW
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall P560 F�
Fire Sprinkler �/ re
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
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire larm
" Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
E 0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
-(0 � A
Approach /Sidewalk Dat l o Inspector" Est
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL