Permit V i TY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00787
,. DEVELOPMENT r Tigard, SERVICES DATE ( 503) 639 -4171 DATE ISSUED: 12/9/2004
13125 SW Hall PARCEL: 1S135AB-00900
SITE ADDRESS: 10200 SW GREENBURG RD 110
SUBDIVISION: FIVE LINCOLN ZONING: C -P
BLOCK: LOT : JURISDICTION: TIG
Project Description: 11 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: 10 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:
EQUITY OFFICE PROPERTIES TRUST WILLAMETTE ELECTRIC INC
ONE SW COLUMBIA ST #300 PO BOX 230547
PORTLAND, OR 97258 TIGARD, OR 97281
Phone: Phone: 503 - 624 -3631
Reg #: LIC 75059
SUP 1965S
FEES ELE 34 -283C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/9/2004 $113.35
[TAX] 8% State Surcharge 12/9/2004 $9.07 Rough -
Elect'I Final
Total $122.42
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
Issued By: Alt � , � ,4110 � /% Permit Signature: ��c4^�
OWNER INSTALLATION ONLY _
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE: •
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
DEC 09 2:)J4 7:58AM HP LASERJET 3200 p.2
•
/Elect
ermit A ppliC t oi� FOR OFFIiCE ONLY
' 0 11 t O --� 'R= Received /
City of Tigard `J t P ermit No.: T o
13125 SW Hall Blvd., Tigard, OR 97223 ' Date/By: Ott 0_ / , C., ♦ Dy' 0 (/ '1 d
Phone: 503.639.4171 Fax: 503.598.1960 0 9 '" Plan Review ' • DEC lJ � ( il i i,,i It' Other Permit:
2 " `' "'' li � + Date1B
Inspection Line: 503.639.4175 Date Ready/By: IiiM ® See Page 2 far
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
; r , i , ° 3* ,� p}p2p TC .l r It .3, tt i s sR f . at a l e i t. -.: U , t�+ g „
"$ ( ` banI. i a -1!i t i ” " t `t �.4- a�i° 1 '� N'k': F� . � �, i y 9 .�• + ..r -
' ilhil UILIkliad6rd 9Ah.?- ll'ht�; tin :M11 !'IrrYe a�ti�1.littti s . ' qi . f `'" a, . N.I i "'` !' t r 1 110, L110, egt:T i M w-" v 3w '. • . .. . ,
❑ New construction [[rr . .Addition/alterati on/replacement Please check all that apply:
❑ Demolition ❑ Other: ['Service over 225 amps. corn n'I ['Hazardous location
iy " } ` I f Iz 7 ri g ,,. J r 1 �� �T�ta,�� ^ F _ ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
!r 4 0 '' � i r' k x 5 'i t- ' s13' VE. ti ,: of 1- and 2- family dwellings 4 or more new residential
�.�k�,h�,� �t�i�.� � t i , . ��'� �;����C�t�llta�, �... � �x:, It _t�!.� ���.�e l ti. >.�l ..,.bsr.:l.`�.���� 4
❑ 1- and 2- family dwelling ga, Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
ID Multi - family ❑Master builder III Other: ❑Building over three stories ['Feeders, 400 amps or more
/;^ 1qc „ i { rr, a r r r k� + �� t ly i r 3 , � ,, , t ['Occupant load over 99 persons ['Manufactured structures or
- , n i t s an `",a s„Y �r ra 1l rt ,i 1, , i f '4, -. t 1 ' ( t � i ii t L1ti t O - 1 �.1 liL , A ❑Egress lighting plan RV park
Job no.: G 3- Job site address: ( Zeit) stv C-.- (i A ❑Bealth -care facility ❑fie
Submit 2 sets of plans with any of the above.
City/State/ZIP: Ti yin b Ott 97 2 2 3 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: f i 0 1 Project name: cte� t'' rz, >I s d z -: • 1, ', „
f. t ,t � r th'i. ,r121 , 1' ' ...” ' .Qkl�lil �, "-- a ,,Alt"' J t .17 i iT !e,:.-1;-:!..: ..
I t , I_ !� k �,e , TI.( Deteription Qty. Fee. Total
Cross street/directions to job site: 1 New residential single- or multi - family dwelling unit.
q Includes attached garage.
.s L, Pv(e.K.v- CU / 1 1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax trap /parcel no
nt�"x nti� �u g te y arn. �i . "u 1.T l, ,t t x r t , e p ,! Limited energy, non- residential 75.00 • 2
lu , ' , 4l€ ii � 'i. it it iitiitlt,s'filaPh:t:!` ':. . w i t ! retai,ka d S , i• - 441'�y '11N s's e. Js a Each manufactured or modular
7
1
-. dwelling, service and /or feeder 90.90 2
1 - . 9 .J ^^ 7 /44 „ /«, f Services or feeders installation, alteration, and/or relocation 200 amps or less . 80.30 2
li `til li r �` ' tk"r r A i
t M .I.P � : ' iir0 ; 6 wLn'fl i i - 6! . dl d1 11 ' '` F ; } -` 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: TO 0 601 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 •
Phone: ( ) I Fax: ( ) relocation
200 amps or less 66.85 1
Owner installation: 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
, 7,P }�^' l , �, if'", r 'rt •'l e' 1. 6"i x•17 i Itl L' U f y , ,af t'i. IN C �i :Vii 1 n. A. Fee for branch circuits with
Ji
6t�tru�S � ��4,i � #atmaal "� 1�, � Y� , 9
' e n ' 1. ,� „. r Ci. ofn0lA11 ,11 4 !J ,v _ .l,i :tr1s .�;i ai
tnt; €71;1:41.0te�i A&'il �' ;
l . .e.
Business name: service h oicuiitt fee, each 6.65 2
B. Fee for branch circuits
Contact name: 1 46.85 l{ i S 2
without service or feeder fee,
each branch circuit
Address: Each add'l branch circuit to 6.65 (, (, ' tO
2
City /State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) I Fax:: ( ) Pump or irrigation circle 53.40 . 2
Sign or outline lighting 53.40 2
E-mail: Signal circuit(s) or limited -
33 �i s„ .! a �bb tai.:,' ro ft,4, g �t�� t. l F ✓ - t ai * `T� +�:z l# a �' 3 1, A `�, 1 ENr., energy panel, alteration, or
E u:a�y]it��x't.. ,,.l k��'.l tt r: a��^ ��l c��_.: d• �, ..^_o�.iA�.���ll�ii.ff?.J,.,,,� 1.,���f�e
extension. Describe: Page 2 2
Business name:
W. Q f ,4- tt..c �� ;xi � 1 ,i..- t.
Address: / d .rd u. Q S Each additional inspection over allowable in any of the above
C Per inspection 62.50
City/State/ZIP: T q a Q ,, ci.;- i ( Investigation per hour (1 hr min) 62.50
Phone: ! Fax Industrial plant per hour 73 75
(32x3 ) - 36 (i ) 6ti( - ,gP.�. ri , e�.,ni. :
'�� ._.i�'�.t���iasmG,,�`- eI�I���;:i ' ?k�'t,���,rs
• CCB Lic.: 3t1S0 5 I Electrical Lie.: 7t.( r C I Suprv. Lie.: 49‘ 5-- r Subtotal / / T 3
Suprv. Electrician signature, required: Plan review (25% of permit fee)
• Print name: n.t Date: 1 ` c- ^c7 State surcharge (8% of permit fee) 9 d
TOTAL PERMIT FEE , 2 2 r 14 Z
Authorized signature/ This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: I Date: • Pee methodology set by Tri- County Building industry Service Board
• • Number of inspections per permit allowed.
is Buitdinglpee nita\ELC- PerroitApp doe 12/02 440-4515T(10/02/coM,weS
CITY OF TIGARD 24 -Hour
BUILDING Inspection Llrie: 1503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date R quested / —°RS AM PM BUP
Location /6 0 O 1 Suite / ( ' MEC
Contact Person "Ph ( ) PLM
Contractor Ph( ) �� �` I� J J SWR
BUILDING Tenant/Owner ELC ` 06 7 R7
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: C
Final
PASS PART FAIL
PLUMBING ; o
Post & Beam I
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
RT FAIL
L
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
j • RT FAIL
El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
Approach/Sidewalk Date ^ - 5 I nspector s t C�J tAi l�' Ext
Other:
Final DO NOT REMOVE this inspection record fro the job site.
PASS PART FAIL