Permit CITY O F TIGARD
ELECTRICAL PERMIT
PERMIT #: ELC2004 -00822
4. . I re DEVELOPMENT SERVICES DATE ISSUED: 12/29/2004
I
"�' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S135AB-01002
SITE ADDRESS: 10220 SW GREENBURG RD 125
SUBDIVISION: THREE LINCOLN -TOWN OF METZGER ZONING: R-12
BLOCK: LOT : 009 JURISDICTION: TIG
Project Description: (5) 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: 4 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 12/29/200 $73.45
[TAX] 8% State Surcharge 12/29/200' $5.88 Rough -in,
Elect'I Final
Total $79.33
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: 4. 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:
1 CONTRACT! R I . •TALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: / __./ DATE:
(7 Z 9 -
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
•
Electrical Permit Application - - -.- - _--- .- .F OFFICE- USE.ONLY t.� -: , r :_
f�
City of Tigard ECIL ���� Date/By: q'Q% J� PetmitNo A �'_A
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone. 503. 639.4171 Fax: 503.598.196 (� aQ ' + n 2 q 200k L f u "� �I DateB : Other Permit:
Inspection Line: 503.639.4175 0 his !_�,�. o'! Date Ready/By: 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
=.,�4r. '�sN:.� ;�.,> ._.aft. ^j.:.g..ir.,�, .. ...... ., � ;e; � o.� , � ` m ° :a.� „ : ; <c c�-, ai�
2a any - «',a ,,, ..5 +. •C v - > s. ; :. ':o'. , ;,,� , • _ ;<. x
.� >. -� ;. ���'H�K .TPE,..` .�• �. '','1:''':)!-.:' • _ ��� �ww � .- ;:mss. � <_. - ��i�s'� ��=� ?s,`�. �w.� ,. a }rte.- �� +., '���_�tr= �- ,�_ ..
❑ New construction m',A al Please check all that apply:
111 Demolition ❑ Other: EService over 225 amps, comm'l ❑ Hazardous location
,, -4 , _ , - , : _ „ „ EService over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
tiles „”' , , CAT ' ,r '* , . , : * of 1- and 2-family dwellings 4 or more new residential
- • t .q= - ,,. .,..� xi._ •,a ,R . __.., . t, sib x R�
❑ I- and 2- family dwelling ; [ CommerciaUindustrial ❑ Accessory building ESystem over 600 volts nominal units in one structure
❑ Multi family ❑ Master builder ❑ Other: ❑Building over three stories ['Feeders, 400 amps or more
. 3u ^ , R „ rya .,,, ,, ,,,, ;, ,, , -, „ -_; . ,,,, ,, a, _ ❑Occupant load over 99 persons EManufactured structures or
a` - , , : l #, JOB' SUTE T]VEO TION D OCAT�IO :? . w l i' a,. ,' ❑Egress /lighting plan RV park
Job no.: e:AJ ❑Health -care facility
['Other:
`� Job site address: i (9 Z 2 U S ( :; +- U Submit 2 sets of plans with any of the above.
City /State /ZIP: The above are not applicable to temporary construction service.
;:, £ - - r.'� r1Vrif E*:S;C_ ` 'r ;' ... ' ....
Suite/bldg. /apt. no.: 12, 5 Project name: j n - - - It p.l,�l A s.lo -- r k 4 L WI ,0NA Descriptio Qty. Fee. Total
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential 75.00 2
�� _� _ Limited energy, non - residential 75.00 2
i( x ; , �r , DES RIRTION (QF ; W ORKr$ x ! -, s i Each manufactured or modular
/ � S erv ic es service rs installation, feeder 90.90 2
r ( '” Services or feeders installation, alteration, and/or relocation.
200 amps or less 80.30 2
,5' RROPERTT' 'O ffe C' =' j4 _ TE1 VT ,. s: . » 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: PO, 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 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
*: '”` 5 ' «.),.. : :. ',.s s,� . 4 ; c; l'= 'p a a«, •:. ; F a =u ; .. , _
1' , `APLI C`A1VT wv 4 ,O , i x ;,t A ,, e, C ONTAG , T; PERS® - A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, C�/
each branch circuit ( 46.85 (Y -) 2
Address: ( Cc:- Each add'1 branch circuit t 2 ( 6.65 .4 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
- 'A,w rrr�r i:�n` ;ati,' p- as.«.. t „... . €€a ,� , - x� ,- " ; :�X°^:,� =y'S`ry^: ;=x,-as:c I alteration, . x = <, :`.. i... ... k:.rn.x :.. Ot RAC:tiw A ratr a irega energy panel, a ton, or
� T extension. Describe: Page 2 2
Business name: j1/ , t j C �(2 t c
Address: p G ,a„ , G 3 a �(-(' Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: 1-14, !f!" 4 Investigation per hour (1 hr nun) 62.50
) Industrial plant per hour 73.75
Phone: , 5 ( Fax: 5 k( 3 e
" ' 07,0;fgajeff tE_RM-TT FEES *) F „l` ° '„_ .` :i>i - -
CCB Lic.: 9-5-6 Electrical Lic.: `3 , I - i Z Suprv. Lic.: CMG j-5 Subtotal 7 3 q 5
.`�/
Suprv. Electrician signature, required: f 42 Plan review (25% of permit fee) i
i L - Z�� State surcharge (8% of permit fee) c
Print name: ,) �� k �c Date: (
TOTAL PERMIT FEE 7 9 3 3
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
** Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PermitApp.doc 12/03 440- 4615T(10/02/COM /WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
_ ¥� �.° �;'„;,� y .;r = r,;�.a� „,, :,;xf. � t�y"rvy ._:'',."'tr:: „ ^�, �.; - :'�a�
RE SIll.KI WORK QNL gull= , , i _ , , �:,
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
0.107.47.0 WOI? . =n T
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved: •
❑ Audio and Stereo Systems
• ❑ Boiler Controls
•
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
iABwldingPermits \ELC- PennitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspectia iL3: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: " (503) 639 -4171
BUP
Received Date Req ested 1 — �� AM PM BUP
Location f d� 4 2.„,..' 'Ai ...��1. Suite /, ±7 MEC
Contact Person Ph ) PLM
Contractor Ph ( ) �2 L F34 3/ SWR
BUILDING Tenant/Owner ELC 616 )C -
Footing ELC
Foundation Access:
Ftg Drain 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:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab •
Rough -In
C
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
�1`" %�� ❑ Reinspection fee of $ required before next inspection. Pay - ,'ty Hall, 13125 SW Hall Blvd.
PART y ;
ti l
SITE • ❑ Please call for reinspection RE: `O, Una∎le to inspect — no access
Fire Supply Line
ADA I ' ��J �� ,
Approach/Sidewalk Date Inspector 1 Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
•