Permit " 'CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
IIII DEVELOPMENT SERVICES PERMIT #: ELR2005 -00014
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/18/2005
SITE ADDRESS: 10220 SW GREENBURG RD 125 PARCEL: 1S135AB-01002
SUBDIVISION: THREE LINCOLN -TOWN OF METZGER ZONING: R -12
BLOCK: LOT: 009 JURISDICTION: TIG
Project Description: Voice and Data wiring.
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 GG TELECOMMUNICATION CO
ONE SW COLUMBIA ST #300 121 SW SALMON ST STE P1
PORTLAND, OR 97258 PORTLAND, OR 97204
Phone: Phone: 503 295 - 2922
Reg #: LIC 59692
ELE 34- 248CEA
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 1/18/2005 $75.00 Elect'I Final
[TAX] 8% State Surcharl 1/18/2005 $6.00
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 questi to OUNC at 503) 699.
Issued by ; : 5�A 74�� Permittee 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 7:00 P.M. for an inspection needed the next business day
RECEIVED
Electaieal Permit Application FOR OFFICE l - SF:. ONLY
i J A N 1 Received
City of Tigard 1 2005 Date/By: / - / - 05 a?) Permit No.: NcLQc:6 - G,,C,Cc/
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 5 " ' R ,)ll n Date/By: Other Permit ARE) Inspection Line: 503.639.4175 _ ! _� ^'! Date Ready/By: Juris: ® See Page 2 for
Internet: www.ci.tigard.or_BIJILDING DIVISION Notified/Method: T / C 1 Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply:
❑ Demolition El Other ❑Service over 225 amps, comm'l ❑Hazardous location
❑Service over 320 amps- rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1 - and 2 family dwellings 4 or more new residential
❑ I- and 2- family dwelling ® Commercial /industrial ❑ Accessory building El System over 600 volts nominal units in one structure
['Building over three stories ❑Feeders, 400 amps or more
ID Multi - family ❑Master builder ❑ Other:
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ° - � ❑Egressllighting plan RV park
Job no.: Job site address�Q2�20 S u.) G lkQG gCr7AP ❑Health facility ❑ er � � Submit 2 sets of plans with any of the above.
City/State/ZIP: (/q l GA i) O2 £ 7 22.3 The above are not applicable to temporary construction service.
FEE* SCHEDULE Suit Idgiapt. no.: 1 2,5 Project name: Lt.) • R.N (T"SC 10,4..
Description I Qty. I Fee. I 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 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
) k ( \ dwelling, service and/or feeder 90.90 2
VC, I C? '( ' (. J (1 AG 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
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 10030 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
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
/) service or feeder fee, each 6.65 2
Business n. - �_ // I E- tl u 1 C A- 1D branch circuit
Contact name: t/ I !� without , • A B. Fee o ur ut ser ser circuits
or feeder service fee,
each branch circuit 46.85 2
Address: 12.1 S, Uri • - • LA t ZS - 7 l Each add'l branch circuit 6.65 2
City/State /ZIP: , r D Q R q 7 ;�Q-----_____-. Q / Miscellaneous (service or feeder not included)
Phone:
(50 3 ) 25 5 - 292.2. Fax: ()3) 2A 5 - 08 8 eD Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
i extension. Describe: Page 2 2
Business name: G GG< y e_o f-ti.i u Al / CA-11 0iJ •
Address: J2 I S (, J Sp Ili s t l (•1- T ( Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: VD0 ET J) 0 q 7 2) Lf Investigation per hour (1 hr min) 62.50
Phone: (50 3) _G)5- 22 2 . Fax: (503 2,9 5 • D 6, Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 5 ,, I Z, Electrical Lic.: 3t 2'+8CEA Suprv. Lic.: )21:0 L EA Subtotal 1 L 0
l r ---
Suprv. Electrician signature, required :� 1 i- Gtz- -�"�� Plan review (25 % ofpermit fee)
State surcharge (8% of permit fee) 6 . co
Print name: C P o ff g 4 , 1 Date: c'
TOTAL PERMIT FEE . ) , 00
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: * Fee methodology set by Tri- County Building Industry Service Board
1999
SAVE - HISTORICAL INFORMATION
BUILDINGS) NAME CHANGE
PER KIT CHURCH, ENGINEERING
10220 GREENBURG RD, LINCOLN II NORTH
CHANGED TO 10220 GREENBURG RD, LINCOLN III
10220 GREENBURG RD, LINCOLN II SOUTH
CHANGED TO 10220 GREENBURG RD, LINCOLN II
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (303) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested /,�� AM PM BUP
Location I b - -O Suite 1? S MEC
Contact Person 77-2 Ph ( ) 3.? -6 f?a PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR D00 /
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
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
Fi I
PASS PART FAIL
ICqD
Service
Rough -In
UG /Slab •
Low Voltage
Fire Alarm
1. PART FAIL ❑ 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
ADA \ 0 D ate � ' f Ins ector �`� �Z y �. (? ANN Ext �
Approach /Sidewalk � P � "\ J "�
Other:
Final DO NOT REMOVE this inspection record rom the Job site.
PASS PART FAIL