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Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00214 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/20/2007 PARCEL: 1 S135AB -01002 SITE ADDRESS: 10220 SW GREENBURG RD 201 ZONING: R -12 SUBDIVISION: LINCOLN CENTER /THREE LINCOLN LOT: 009 JURISDICTION: TIG PROJECT: INFINITY REHAB Project Description: Install voice and data cabling. 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 VERSACOM CORPORATION ONE SW COLUMBIA ST #300 14937 SW TUALATIN - SHERWOOD RD PORTLAND, OR 97258 SUITE 360 SHERWOOD, OR 97140 Phone: Contact #: PM 503 625 - 4484 FAX 503- 625 -1106 FEES Reg #: ELE CLE104 LIC 176140 Description Date Amount SUP 1660LEA [ELPRMT] ELR Permit 6/20/2007 $75.00 [TAX] 8% State Surcha 6/20/2007 $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 B � 1 � � /// Permittee Signature: S&L. p k rarn ern 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. 2007 09:40 5036251106 COMTEL COMMUNICATION PAGE 03 i, mall Permit Appiication RECEIVE FOR OFFICE USE ONLY ipl City of Tigard Re � vw : �OZao S 20 200 uJ _ ��E IMMIN 13125 SW 1 -tall Blvd., Tigard, OR 97223 JUN Plan Review 11' , - ' Phone: 503.639,4171 Fax: 503.598.1960 r)atc/B , T IG R i) Inspection Line: 503.639,4175 CITY OF TI�� t is Ready /ny; Jun r ® Sec Pnge2for Internet; www.tigard- or.gov BUILDII�GDIVISIj m tificd /Melhad: l 6 ' $upplementlIInformatlon TYPE OF WORK. . ' PLAN REVIEW ' • Please cheek All that apply (submit 2 sots of plans w /iict»a checked below); ❑ New construction El Addition /alteration /replacement ❑ Service or feeder 400 amps or more ❑ Building over three atones, ❑ 'Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 1=1 Floating buildings, • less to ground, or exceeds 11,000 ❑ Commercial -use agricultural ❑ 1 - and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other; ['Fire pump. ❑ Installation of75 KVA or JOB , SITE INFORMATION AND LOCATION ❑ Timcrlrency system. larger separately derived system, © Addition of new motor load of ❑ "A" "E" "1-2", "1 -3" y Job no.: E1009 1 Job site address; 10220 SW Greenburg Rd. iOOHP or more. occupancy. ❑ Six or store residential units. ❑ Recreational vehicle parks. City/State/ZIP: Tigard /OR/ ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Il;ia,rdttus locations. fin0 volts nominal. Suits /bldg, /apt:,no.: 201 Project name; Infinity Rehab ❑Service or feeder 600 amps or more. ` FEE SCHEDiULE . Cross street /directions to job site: Lincoln Towers Description Qty, Fen. Total . New residential single- or multi family dwelling unit. includes attached garage. • Subdivision; Lot no.: 1,000 sq, ft, or less 145.5 4 ' la. add') 500 sq. ft. or portion 33,40 1 Tax map/parcel no.: Limited energy, residential 75.00 2 • • DESCRIPTION OF WORK (with above sq. R.) Voice /Data Cable Installation Limited energy, multi - family 75 00 2 residential (with above eq. ft.) S er v ices or feeders installation, alteration, and /or relocation 200 amps or less 80.30 2 0 PROPERTY ,OWNER U TENANT 201 amps to 400 amps 106.85 06.85 _ 2 Name: 401 amps to 600 amps 160,60 2 —^- 601 amps to 1.000 amps 240.60 2 Address: Over 1,000 amps or volts 454,65 2 Ctl.v /Since /7..iP: 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 599 amps 133.75 2 Branch circuits -. new, alteration, or extension, t�panel Owner signature: Date: - A, Fee for branch circuits with • ❑ APPLICANT 1::1 CONTACT PERSON '. . above service or feeder fee, • each branch circuit: 6.65 2 Business name: B, Fee for branch circuits Contact name: without service or feeder fee, 46.85 2 first branch circuit ___ Address; Each add'1 branch circuit 6,65 2 Miscellaneous (service or feeder not included) _ City/State/ZIP: Each manufactured or modular 90.90 2 dwelling, service and /or feeder Phone: ( ) Fax: ; ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53,40 2 CONTRACTOR • Sign or outline lighting 53.40 2 Business name: VcrsaCom Corporation Signal circuit(g) or limited - energy panel, alteration, or Address: 14937 SW Tualatin - Sherwood Rd. Ste. 306 extension. Describe; 1 Page 2 75.00 2 City /State/ZiP: Sherwood /OR/97140 Each additional Ins section over allowable in any of the above Per inspection 62.50 Phone: (503) 625 -4484 Fax; (503) 625 -1106 investigation per hour (1 hr min) 62.50 • CCB Lie.: 176140 5//0/00A Electrical Lie.: CT,F.104 i I l l ' Sup v, Lie,; 1660LF,AIb 14' Industrial plant per hour 73.75 _ - ELE CTRICAL PERMIT:. FEES . • ' Suprv. Electrician signature, required; 7. __ v._- � p Subtotal: 75,00 Print name: 'l'om Richey D etc: 6/i9l2007 Plan review (25 %ofpermit fee): State surcharge (8% of pennit fcc); 6.00 Authorized signature: r 7'-'-? ,t 'TOTAL. PERMIT FEE; 81.00 Print name: Tom Richey // Date: 6/19/2007 This permit npplicufion expires Ira permit is not obtained within lso clays Ater it has been accepted as complete. • " Number of inspections allowed per permit, /ARIA !ding \PermltaUil:C- PermtltAptt.dec, 05723/06 440.4615T(l1 /05 /COM/W811 i r CITY OF TIGARD r BUILDING DIVISION PERMIT #: ELR2007 -00211 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/20/2007 Phone: (503) 639 -4171 ja i Inspection Requests (24 Hrs.): (503) 639 -4175 :_.. INSPECTION WORKSHEET FOR DATE: 6/28/2007 TIME: 7:01AM PAGE: 6 0 SITE ADDRESS: 10220 SW GREENBURG RD 201 CLASS OF WORK: SUBDIVISION: LINCOLN CENTER/THREE LINCOLN LOT #: 009 TYPE OF USE: PROJECT NAME: INFINITY REHAB DESCRIPTION: Install voice and data cabling. OWNER: EOUITY OFFICE PROPERTIES TRUST, PHONE #: CONTRACTOR: VERSACOM CORPORATION PHONE #: 503 - 625 -4484 Inspection Request Scheduled For: Date: 6/28/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 135 Low voltage Co \ (Z- 051096 -01 503. 686 -0042 Y on F-7 Corrections /Comments/ Instructions: it\ PASS ❑ PARTIAL APPROVAL n CANCEL NO ACCESS I l FAIL n CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED 74341 Inspector: Date: �� Phone #: (503) 718 -V A)