Permit CITY T I G R D ELECTRICAL RESTRICTED ENERGY PERMIT
, DEVELOPMENT SERVICES PERMIT #: ELR2005 -00252
d.>!II DATE ISSUED: 8/25/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S135AB-01004
SITE ADDRESS: 10220 SW GREENBURG RD 120 ZONING: C -P
SUBDIVISION: LINCOLN CENTER /TWO LINCOLN LOT: JURISDICTION: TIG
Project Description: Data /voice
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 SUPERIOR TEL
ONE SW COLUMBIA #300 PO BOX 69599
PORTLAND, OR 97258 PORTLAND, OR 97239
Phone: 503- 639 -8865 Phone: 503 -242 -1109
Reg #: ELE 26- 712CLE
LIC 78741
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 8/25/2005 $75.00
[TAX] 8% State Surchar€ 8/25/2005 $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 95 001- 00. You may obtain copies of these rules or di�rec au: lions to O NC .t 503- 6- 699.
Issued By: t.e A) Permittee Signa -w�, � ,L
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.
El Permit ApplicaWnC -- -. . FOR-OFFIGE-USE-ONLY , � � • - -
r Received
City of Tigard Date /B : 1,�� / ���� Permit No.'s ,— r���,,,,0`� F
U
13125 SW Hall Blvd., Tigard, OR 97223 20 Plan Revie
Phone: 503.639.4171 Fax: 503.598.1960 DateB Other Permit
CITY OFTiG`
Inspection Line: 503.639.4175 u ,� ' -1 I' Date Ready /By. Juris. ® See Page 2 for
.,
Internet: www.ci.[igard.or.us Notified /Method: Supplemental Information
BUILDING-; FMnclnM
»TYPES % :QR WQR-;< L
.: >azi.
..�_...�,,, gin,:.:._.. »..
❑ New construction ® Addition /alteration/replacement Please check all that apply:
❑ Demolition ❑ Other: over 225 ['Hazardous Service o r 225 amps comet azar location
Service over 320 amps rating Buildng over 10,000 sq. ft.,
_ GATEGQRY ;O F'' GONSTRi)GTIQN , ; :: : �,:k,—E& - w � �` ; 7,- a, < x _ o 1- and 2 - farm dwellin s 4 or more new residential
❑ 1- and 2- family dwelling ® 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 inure
. .lt - f ;- ;. ..,:,;. �� persons structures or
❑Occupant load over 99 e Manufactu ted structures
. - n JOB» SITE::,INFORMATION :`ANA. LQCATION.:; ;;,:,. ,> >,.:.: ,,K,,
e' _' _ �- � ° � , .. - .: E g ress /li p RV park
`'tT r;,: �' �R. y^ v . , ." �. 1: �=. �i� a-...: �: �t�"= �°`.,..: ,......� =R.,._- .- ,.,...�:, /', .x.�r ^,_,'.. �.�.� "'�.., ..r.......:'��,���,;'-
❑Health - care facility ['Other: Job no.: Job site address: 10220 SW Greenburg Road #120
Submit 2 sets of plans with any of the above.
City /State /ZIP: 97223 The above are not applicable to temporary construction service.
Suite /bldg./apt. no.: 120 Project name: Northwest Mortgage ``'''' -'` " ' � ` SCI EA "` "`;' ;'';`'
Description Qty. Fee. Total I **
Cross street /directions to job site: In Lincoln Tower #2 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'/ 500 sq. ft. or portion 33.40 I
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non - residential 75.00 2
;;.;: `r:..,.<..r;,;,.,. .,n,:_., ESCRLPTION` OF<., WORK,F.,• » , ;: :, ; ..,. < Each manufactured or modular
Limited Energy data cabling to patch panel dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
�. 5
,zs
N
,: PROPE ,- ' <;, " -, '
:
>•.,:'`'`�`�:�:.; °' "., ❑ .. , , . . " : ,: ' �:• ':: ?❑ �; ` - ° - ° ",, <_'; =;- < °,':_; ;`, - .. -
' " ° "" ' � �� � " � . : ,-:,.":,:',,',,,"%- � 401 amps to 600 amps 160.60 ')
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
//� a p$' Fax: relocation
Phone: ( )
Ca vJ / D 4,5 ( ) 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
`APPIIC`A'NT ;�� �`s =_ � ®i =CO�NTAC'F:�;PE�RSON= _;����� � A Fee for branch circuits with
service or feeder ee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address:
Each add'I branch circuit 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
..,,: CONTRACTOR=,== :'. ; ,:�,.9. ":.. : , . ,,; - ,; " ;,,',;:�_'> energy panel, alteration, o
extension. Describe: Page 2 2
Business name: Superior Tel
Address: PO Box 69599 Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: Portland OR 97239 Investigation per hour (I hr mine 62.50
Phone: (971) 409.3017 mobile; 503.242.1109 Fax: (503) 241 - 3704 Industrial plant per hour 73.75
-7- , 7 ,,,_:. ,:;-. --...- .;>`.::.,ELECTBICAL ''PER1S40 FEES 4 �: '' ':
CCB Lie.: 78741 Electrical Lic.: 26- 712CLE Suprv. Lic.: 1664LEB Subtotal ��
Suprv. Electrician signature, required: ��� Plan review (25% of permit fee)
Print name: v C, , �+ ' Q r ......
Date: 8 - 25 - 05 State surcharge (8% of permit fee)
1` TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete
Print name: Date: * Fee methodology set by Tn- County Building Industry Service Board
** Number of inspections per permit allowed.
r \Building \ Permits \ELC- Permit App.doc 12/03 440- 4615T(10 /02 /COM/WEB
WY OF TIGARD
BUILDING DIVISION . ' PERMIT #: ELR2005 00252
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/2512005
Phone: (503) 639 -4171 &Nithilllt
Inspection Requests (24,Hrs.): (503) 639 -4175
INSPECTION WORKSHEE F DATE: 9/7/2005 TIME: 7 :08AM PAGE: 33
SITE ADDRESS: 10220 SW OR : BURG RD 120 CLASS OF WORK:
SUBDIVISION: LINCOLN CENT ` :` O LINCOLN LOT #: TYPE OF USE:
PROJECT NAME: NORTHWEST MOR _ AGE
DESCRIPTION: Data/voice
OWNER: EQUITY OFFICE PROPE' TIES TRUST, PHONE #: 503 -639 -8865
CONTRACTOR: SUPERIOR TEL PHONE #: 503.242 -1109
Inspection Request Scheduled For: Date: 9/712005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 LOW voltage 015 ∎ 74 -01 971 - 409 -3017 N
15 fj-y NI 4 %L.— a�.
Corrections/Comments/Instructions:
i r ASS I 1 PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: k2'' (Q) L� Date: 9( i 06 Phone #: (503) 718-
.