Permit - CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00419
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/13/2007
PARCEL: 1 S 135AB -01004
SITE ADDRESS: 10220 SW GREENBURG RD 470 ZONING: C -P
SUBDIVISION: LINCOLN CENTER/TWO LINCOLN LOT: JURISDICTION: TIG
PROJECT: 7- ELEVEN INC
Project Description: Data /telecommunications.
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 TECHNOCOM INC.
ONE SW COLUMBIA #300 7929 SW BURNS WAY # F
PORTLAND, OR 97258 WILSONVILLE, OR 97070
Phone: Contact #: PRI 503- 682 -4195
FAX 503- 682 -2781
FEES Reg #: ELE 34- 269CLE
LIC 73872
Description Date Amount SUP 228ILEA
[ELPRMT] ELR Permit 11/13/2007 $75.00
[TAX] 8% State Surcha 11/13/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
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: r Permittee Signature: (f/j/ /9/ /e,.1 CN
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 Appli ra t ,; I oa OF FICE USE ONLI ° . CEIVE
City of Tigard Received 1/ q / Perm No.: �ti/e �t�JO7 s o0fii if
13125 SW Hall Blvd., Tigard, OR 9 ', 4 0 Q 2007 Plan Review n
Phone: 503.639.4171 Fax: 503.59. .'. `t
Date/B , Other Permit 4,/4g� Q QS�Tr
T.I G A RD Inspection Line: 503.639.4(�}7 ^ v Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gob 1 Y �� 1 � � $ T Notified/Method: Supplemental Information
t��7 11DL DIVISION PLAN' REVIEW -
❑ New construction ® Addition/alteration /replacement Please check all that apply (submit 2 sets of Plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF ;CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
• less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling tg CommerciaUindustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
. ❑ Addition of new motor load of ❑ "A ", "E ", "l - ", "I - ",
� 6,I Job site address:!02 �/ b� I ixor or more. occupancy.
Jobno.:1
fd❑ Six or more residential units. ❑ Recreational vehicle parks.
❑ Health -care facilities. ❑ Supply voltage for more than
City / State/ZIP: , �n ,�j� ' �� g 7� 0 Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 4�� • Project name: 7.--.// 0 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: . • Description 1 Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 14
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK , (with above sq. ft.)
�/ V (I Limited energy, multi - family
V , delta- residential (with above sq. ft.)
75.00 2
��tt..11��°° Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
' ❑ PROPERTY OWNER , I - ❑ TENANT ' 201 amps to 400 amps 106.85 2
Name: L1 000Ir 0 C_EL i t 2 LL,C., erg 401 amps to 600 amps .160.60 2
'56 601 amps to 1,000 amps 240.60 2
Address: ` 1 Over 1,000 amps or volts 454.65 2
City/ State/ZIP: qt �OV Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) I Fax: (C• ) 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 599 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
®, APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
_ each branch circuit .4# Business name: �f) /" Ye, CD rr� �fl c 13. Fee for branch circuits
� t �- d�' without service or feeder fee, 46.85
Contact name: � /�_ � �/ first bran circuit
Address: i/, • Each add'I branch circuit 6.65 2
�� �v' Miscellaneous (service or feeder not included) 2
City / State/Z1P: YV I ► I / V � 7070 Each manufactured or modular 90.90 2
' I dwelling, service and/or feeder
Phone: (5M be 4 Fax:: ( 5!), z,g c ,2_78 C Reconnect only 66.85 2
E -mail: / 0 sand/) er at) gotech n00op i eon-) Pump or irrigation circle 53.40 2
�J CONTRACTOR . Sign or outline lighting 53.40 2
Business name: / `,y�� '—� Signal circuit(s) or limited -
n�l,Vi / 1 L .� l ✓ energy panel, alteration, or
Address: rj g�y SU) ' „, Ol , / f extension. Describe: i Page 2 -75 2
City /State/ZIP: W V / �r ' 0 Each additional inspection over allowable in any of the above
J / Per inspection 62.50
D3
Phone: )( /t75 I Fax: lobo / y ,9/ Investigation per hour (I hr min) 62.50
CCB Lic.: 7:3g1. Electrical Lic .3(/ 2(Cauprv. Lic.: 22/ 1 Industrial plant per hour 73.75
( ' ELECTRICAL PERMIT FEES'
Suprv. Electrician signature, required: =.''____, Subtotal: 75. 00
Print name: cetn�n e4- Date: V 0 g� / 1 Plan review (25% of permit fee):
State surcharge (8% of permit fee): 6, , O Q
Authorized signatu .,-,—_.....--"... TOTAL PERMIT FEE: T
A� nett) e)' D This permit application expires if a permit is not obtained within 180
Print name:
lV / t� t // (/ D g / in days after it has been accepted as complete.
..5-76/ // • Number of inspections allowed per permit.
t: \Building\Permits\ELC -P- ('. pp.doc 05/23/06 440-4615T(I1/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORKK ONLY: " _ ,,,, •
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
p Heating, Ventilation and Air Conditioning System* • ,
❑ Vacuum Systems*
❑ Other.
( COMMERCIAL WORK ONLY:
•
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
p Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling r
KI Other Y o ce- C� �( 064.- C t b k
Total number of commercial systems: I
*No licenses are required. Licenses are required
for all other installations
1:\ Building \Permits\ELC- PermitApp.doc 03/23/06
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BUILDING DIVISION ' PERMIT #: ElR2007-00419
13125 SW Hall Blvd., Tigar . OR 97223 DATE ISSUED: 11/130007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 11.].
INSPECTION WORKSHEET FOR DATE: 2/012000 TIME: 7:00AM PAGE: 36
SITE ADDRESS: 10220 8yYGRBENBURG R[>47O CLASS OF WORK:
SUBDIVISION: LINCOLN CENTER/7WOLINCOLN LOT #: TYPE OF USE:
PROJECT NAME: 7'E\JEVENiNC
DESCRIPTION: Data/telecommunications.
OWNER: EQUITY OFFICE PROPERTIES TRUST, PHONE #:
CONTRACTOR: TECHNDCOW1INC. PHONE #: 5O3
Inspection Request Scheduled For: Date: 2K6/2008 Pour Time:
Code # Inspection Description 8�nfir # Contact Message . -
135 Low voltage 084506-01 503.464'7352 N
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• - • - - ructions:
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PASS E PARTIAL APPROVAL 7 CANCEL NO ACCESS
| I FAIL I CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
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Inspector: �� ^ ^ '^°v�^~/w Date: 1- �� �� \� Phone #: (503) 718-13*