Permit C ITY O F TIGARD ELECTRICAL PERMIT
i PERMIT #: ELC2005 -00099
� DEVELOPMENT SERVICES , DATE ISSUED: 2/22/2005
I'll 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S135AB-00900
SITE ADDRESS: 10200 SW GREENBURG RD 340
SUBDIVISION: FIVE LINCOLN ZONING. C -
BLOCK: LOT : JURISDICTION: TIG
Project Description: 2 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: 1 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
FEES Reg #: LIC 75059
Description Date Amount SUP 3 4
ELE 34 --2828
3C
[TAX] 8% State Surcharge 2/22/2005 $4.28
[ELPRMT] ELC Permit 2/22/2005 $53.50 REQUIRED ITEMS AND REPORTS
Total $57.78
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- 44.
Issued By: L,c_G��,�! / � Permit 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 639 -4175 by 7:00pm for an inspection the next business day
_FEB 21 2005 4:53PM HP LASERJET 3200 p.
` Electri al liermit Application F OR OFFICE USEONt.l' •
City of Tigard FEB Date/B "��o , Si 9
13125 SW Hail H Alit, lvd., Tigard, OR 97223 P Review
Phone: 503.639.4171 Fax: 503.598.1960 �'t" " ° au{ ti ' �''I' Date/13 Other Permit
Inspection Line: 503.639.4175 CITY OF T '1„.,„,./1 Date Ready/By: JaT H See Page 2 for
Internet: www.citigard.or.us i.tigard.or.us , • '' Notified/Method: 7/6 Supplemental Information
T it� tAx"}t n it 111 ' t i. ' ��i{,��' fir 4 rr �7' - 3 :r9t i i y :'. :.t /Y 7 iK. K.i. ���' N,T .
a � 44 1 1 iin, :, ......:,...at....' �.. b'.ttl�, s!%' I, :low* yi '� , 1! ca:pizc'3 "':% . ,,.„, .j y
4 • z:. � 'e - I ! 1 ,� ;l R+.. '.Cd�uz, } ! 'N i I. t ^• -,t �'a. ` , E7 t " r� `...;� ''- ',hYii<,Y',a p'.. • � : '
❑ New construction] Addition/alteration /replacement Please check all that apply:
❑ Demolition ❑ Other ❑Service'over 225 amps, comm'l ❑Hazardous location
,, El Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
off i gi , t , $11r4ry riiii t3! �� ri jW d? y .�S-+"P�".7 k i t` },l. ;.n i'. ,
�' .t. y , . Jx'41�rl,ALLAI p , „ „n•; !.�i _ r he! . r n e t � a'_°ri •l..l J dQ t : : `= .�• ta� ,.»i] o f 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling .21 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
�, , L 9P r' , t I to nurrltt,t Master i i , rr a w t, >u�t � e : n s� t , „ ['Occupant load over 99 persons ['Manufactured structures or
V ri Sri , t. h. y .� r .P t iN '�a; ,a i '� `u l ss at.�illiJ.• t t f tr t �cE 3 a i±t� yy, al ; 1 ' .. , a
? 1'�t a i 1� . s��1 p. "gy �:, 1 1h! $ ❑Egre s RV. park
t
Job no.: Job site address: ❑ Health -care facility ['Other:
Submit /0 5 ,< -t tut.„,, Submit 2 sets of plans with any of the above.
City / State/ZIP: C 14,,,L 11 a. /� ,'l 3 � 2 Z '? 1 The above a are not applicable to temporary construction service.
' "J r (� 11 's i ' i b� 4N tt�r' --i'" 1i k �C t F n Id l , :.(:;`.;;'•.
Suite/bldg. /apt. no.: 1.. t3 Z.! yt�4T . f1�'lt� 1 Project name:
i f i r E " 2 a . �� ..
_ »,
� S' ,,e, Description Qty. Yee. Total
Cross street/directions to job site: S Lt w cr ` S tii ! New residential single- or multi - family dwelling unit.
Includes attached garage.
'
1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Ea. add'1500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map/parcel no
gwr�t u, i t - -; i # s t +r•vm titer t 1 I r u t ti Each manufactured or modular
, Limited energy, non - residential 75.00 2
i ' £ ttl { " a ' r ? V� to ar „
ts iu ,€r i'!''i� EI .r a li{ i s s�
° fy y" * dwelling, service and/or feeder 90.90 2
P - . 1 i, `� lP✓y iw�¢ - Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
I t 1' , �I /a I i Y' fi° i ^k S rf ,'s! 1I n ia<,ii a � iI r ,' r, - -y'"S` 201 amps to 400 mills 106.85 2
IL i� tit l. A. to iii i 1 Oi �, : .2 ;. 91111: IL �� 1116 h t g t „,,
I, e.� i � ' �r " ,�`r� `� �`t� � '��G.>+�.a�:3.�s. It. .� F ! : i+,�t � • -- 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
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
g ju t a2tl , �Y n� u 'f g l'i o ' ; I t , ° k
I i "'' it l A. Fee for branch circuits with
„
i L ` � $ � �1 (t ' ,,, . I {i d. m6 n.. ;L; >Ltt. ls,,.;.- nits .,_: l it
xs ' 1n' " Lt °lit 1 service or feeder fee, each
Business name: branch circuit 6.65 2
B. Fee for branch circuits
Contact name: • without service or feeder fee, 5
each branch circuit 46.85 � 2
Address:
Each add branch circuit f
6.65 6 -- 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) I Fax :: ( )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
i i,r rsl u-�sel ! iryt E� F" t 4 ' S� U r `f y ' � 1 ��' energy Panel, alteration, or
t '9 !st�l1!ir !I� a� :Pik 3 t t F awn Describe: Page 2 2
Business name: t,. k k 4 , f (, r t a t C i.ti C-- -
(' _ Each additional inspection over allowable in any of the above
Address:
i d ;t.-: 4. Z 3 d y 9- Per inspection 62.50
City /State/ZIP: ..- fl ( 75
Phone: Fax: 0 � el / Z f Investigation
plant gation per hour (1 hr min)
hour 73n) 62.50
Y . p per <' e , A,:
( ) btu -3 �'3 l �ZiS (pZY -�t� { n ff -1( shin t,la1 i l q : .' l ayt : -
ire t5�ra��t e's .,, ,�. . ,� .:u.,wx2,`ui�d.�ae..a�
CCB Lie.: 9 . 5 - 0 Electrical Lie.: ;At(- ? L. Suprv. Lie.: /94 ..S' Subtotal x•-7 5
Suprv. Electrician signature, required: -- - ' Plan review (25% of permit fee)
Print name: r f Date: State surcharge (8% of permit fee) 4 Z
'/� f TOTAL PERMIT FEE i',, 7. -9-1
Authorized signature: This permit application expires If a permit is not obtained within 180
days after It has been accepted as complete
Print name: Date: * Fee methodology set by Tri -County Building Industry Service Board
0 " Number of inspections per permit allowed.
i:l Building lPermin\et-C- PermitApp.doc 12/03 440.46IST(10 /02/COM/WBB
CITY OF TIGARD ,
1 BUILDING DIVISION PERMIT #: ELC2006 -00099
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/22/2005
Phone: (503) 639 -4171 A�a�
Inspection Requests (24 Hrs.): (503) 639 -4175 `__..
INSPECTION WORKSHEET FOR DATE: 3/24/2005 TIME: 7:09AM PAGE: 7
SITE ADDRESS: 10200 SW GREENBURG RD 340 CLASS OF WORK:
SUBDIVISION: FIVE LINCOLN LOT #: TYPE OF USE:
PROJECT NAME: WESTAMERICA MORTGAGE
DESCRIPTION: 2 branch circuits.
OWNER: EQUITY OFFICE PROPERTIES TRUST. PHONE #:
CONTRACTOR: WILLAML.I I E ELECTRIC INC PHONE #: 503-624-3631
Inspection Request Scheduled For: Date: 3/24/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
I./
199 Electrical final 002737 -01 503. 6243631 N
Corrections /Comments /Instructions:
i L - li ,A7/* L— 5 //& iliC, e
(,,-. •
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: i "A�,�i/ , --7 C Date: / // Phone #: (503) 718-
\