Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00319
l DEVELOPMENT SERVICES DATE ISSUED: 6/7/2004
� 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S135AB-01002
SITE ADDRESS: 10220 SW GREENBURG RD 111
SUBDIVISION: THREE LINCOLN -TOWN OF METZGER ZONING: R-12
BLOCK: LOT : 009 JURISDICTION: TIG
Project Description: Job No 4845 Tenant Improvement
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: 2 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:
EQUITYOFFICE WILLAMETTE ELECTRIC INC
10260 SW GREEN BURG RD PO BOX 230547
SUITE 100 TIGARD, OR 97281
PORTLAND, OR 97223
Phone: Phone: 503 - 624 -3631
Reg #: LIC 75059
SUP 1965S
FEES ELE 34 -283C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/7/2004 $60.15
[TAX] 8% State Surcharge 6/7/2004 $4.81 Ceiling Cover
Wall Cover
Total $64.96 Elect'I Service
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: 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: / 9 (,) —S
Call 639 - 4175 by 7:00pm for an inspection the next business day
F l e Pe fi c r�", a 1` !l,. ion FOR OFFICE USE ONLY
w
t�l. 4 ter Received yy� 5� Electrical
4
Date/By: C Wy „� " Permit No.: a o7, _ ao 3 /
•
City of Tigard JUN 7 2004 Planning Approval Sign
Date/By: Permit No.:/
13125 SW Hall Blvd. Plan Review Other 'j
Tigard, Oregon 97223 Date/By: P N o. VD U `�'0V O / l
Phone: 503- 639 -4171 CITY OF TIGA `7
� p� � ,�.
g PfLi [Jt �t . ®N //ymw���l�p�1�ii�� Post - Review Land Use
Date/By: Case No.:
Internet: www.ci.tigard.or.us
Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 `°° g
P q Name/Method: Supplemental Information.
:�.;'r% °` a �'' x� �,,� y , .'� ":��'�".»��'��'��... „�,. } . }. ����• s?�r- "� � ° , ! ` '.�€.ga�.;a;�;r.`�'e: �}.�....�;...,:� ' � " his,
I , : ,C : ., '�W 0 OMINI=.�, z„. DM liti z N TE Ple t he M that ly)
•�ti �, }> � ". ��t,.� "� �.�� ARP k�� �.��
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
- commercial ❑
Addition/alteration/replacement Other: Hazardous
�— 111 ❑ Service over 320 amps - rating of ❑ Building ng o over er 10 10,000 square feet,
6, V .4 ;C T) OORY®.GO,IYS ,"CST ®.., / ',..4t n ''„:A. } 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling &Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Accessory Building ❑ Multi- Family ❑ Building over three stones ID Feeders, 400 amps or more
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
t WS O d `M V - °' O `• x` "' .' Submit sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: /o - 2li w 1a -{ -41.4,- lzc.z . �;. 4 AS
Suite #: // ( Bldg. /Apt. #: '3 ;,--,,,.,,/,,,,-- e Number of inspections per permit allowed
Project Name: 4 ,, H , ..-L. Enhyjp� t= r, D Qty Fee (ea.) Total
Cross street/Directions to job site: (/ New residential- single or multi- family per 1
dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft or portion thereof 33.40 1
Limited energy, residential '75.00 2
Subdivision: Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
k ° ,s pm ® r O °`? ° ` i service and/or feeder 90.90 2
_ Services or feeders - installation,
I f--1/1. ....- I sy nav ems.- -e alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
m „ 'z. "x�a. amps 240.60 2 ;,.�'y 601 amps to 1000 am
" POI' ,l2 � O- �I'� e` � � ��'.... , � ,t�;�,� »' '� �«..,;:,µ � .,w P P
`� Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
City /State /Zip: 200 amps o r less relocation:
00 s o less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
t; .. r v 401 to 600 amps 133.75 2
,. l 1 y. .. , .. a irol. T �G'T PE SON.,�s- � =�
'� ��w� � �•�- w �° �� � 7 Branch circuits -new, alteration, or
Name: extension per panel:
Address: A Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of v
service or feeder fee, first branch circuit / 46.85 / v 2
Phone: Fax: Each additional branch circuit y 6.65 /4 ''' 2
E -mail: Misc.(Service or feeder not included):
.s ; ' .3 a ,yw. ;, dal Each um or irri atir circle 53.40 2
'` ' " `..'':: °.1€ ` ~' ` ' ° "° Each sign or outline lighting 53.40 2
Job No: 'q S y 1'"" Signal circuit(s) or a limited energy panel,
i alteration, or extension Page 2 2
Business Name: 4a), (l 0 ,,,,e l`f e �(erT:4 iC `it. I., Description:
Address: PO 6, aze)s({ —
C1 /State /Zi Q Each additional inspection over the allowable in any of the above:
1 T . /4 it rt ` i ?Z & � Per inspection per hour (min. 1 hour) 62.50
Phone: 4;1 y - ? 6 3 Fax: 64 'L if _ Ze.i. V Investigation fee:
Lic. #: U Other:
CCB Lic. #:
�s 5 ? 7 F ,.. ; Elect a"c',,>timig e�' es ' W ' . :WW1
1
Supervising electrician i r Subtotal $ 6, n , (
signature required: / /ja, 7,-----i Plan Review (25% of Permit Fee) $
Print Name: Of-,v, J ° - ic. #: /9 G c -S State Surcharge (8% of Permit Fee) $ I , Sr i .
�r 9
TOTAL PERMIT FEE $ t ( r 9 4 ,
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set.by Tri- County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
n Audio and Stereo Systems
n Burglar Alarm
Garage Door Opener
n Heating, Ventilation and Air Conditioning System
0 Vacuum Systems
0 Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
HVAC
❑ Instrumentation
El Intercom and Paging Systems
n Landscape Irrigation Control
n Medical
❑ Nurse Calls
Outdoor Landscape Lighting
❑ Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i: \Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BIJILDINC Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 7---/ AM PM BUP
Location I . — :!►i !_ t a . Suite / / / MEC
Contact Person f .c.� -Q co Ph ( / Co 3 ) c �" - � 5 � � PLM
Contractor Ph ( ) 6 D- q--36,3( SWR
BUILDING Tenant/Owner ELC o?Od ti-QD3 / /
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain Slab Inspection Notes?_!c� p SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear � 4 �-+ .
Int Sheath/Shear
Framing
Insulation
Drywall Nailing •
Fi rewal I
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: �+
Final )/ / ! 1 S A , 7 b �f P
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 Alarm
P PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE 0 Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date G Inspector z - — � ^ Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL