Permit CITY OF TIGARD ELECTRICAL PERMIT
- COMMUNITY DEVELOPMENT
PERMIT ISSUED ELC2007-00421
DATE ISSUED: 6/20/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 135AB -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: (4) branch circuits for receptacles.
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: 3 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 R C COSTELLO ELECTRICAL CONTRACTING
ONE SW COLUMBIA ST #300 PO BOX 336
PORTLAND, OR 97258 AURORA, OR 97202
Phone: Contact #: PRI 503 - 982 -7400
FAX 503 - 982 -7401
FEES
Description Date Amount Reg #: ELE 3 -344C
[ELPRMT] ELC Permit 6/20/2007 $66.80 LIC 87402
[TAX] 8% State Surcharge 6/20/2007 $5.34 SUP 3934S
Total $72.14 REQUIRED ITEMS AND REPORTS
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 . TTENTION •regon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 9 - 001 -0010 through 0 ' 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issue B j / 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 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.
Electri l. P,pr1211t Application FOR OFFICE USE ONLY
Received
Date/By: // 0 D Mil Permit No.: Ea.. , . - ' MIll
City of Tigard Date/By:
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 Uw4 a ,Ki �"BP I 14\
Date/B :
Inspection Line: 503.639.4175 I Date Ready/By: H See Page 2 for
Internet: www.ci.tigard.or.us
Notified/Method: Supplemental Information
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❑ New construction El Please check all that apply:
Addition/alteration/replacement
El Service over 225 amps, comm'l Hazardous location
❑ Demolition ❑ Other: ❑ Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
° 5 ° "'� a ' 4 or more new residential
_�_ ' • �'�•�" " ;�: .,�N � - ,.f1;° of I -and 2- family dwellings
tw „ y , G. ", OlLY; 4 . C, S= a; ' fie . r, g
���z�:t�,: �t..9,:;du!�?e� � <;•;�'' %zb +." . -*,�_; ��t_� ` ��nD, �N�'-;",.' S;', ":'.si'M -u ,a �.iic;- �w,.- �::'r- units in one structure
,,,� �- ti. r.° '�� • � ��� -' � � uni
❑ 1- and 2 family dwelling El Commercial /industrial El Accessory building ❑ System over 600 volts nominal
Building over three stories ['Feeders, 400 amps or more
M aster builder ❑ Other: ❑Manufactured structures or
❑ Multi family ❑ ID load over 99 persons
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1 OBE TI? O. 7TiI03 `Dkv r1`F1 o ❑Egress /lighting plan
RV park
t{,'- 3k�fi'a_ %:3..� ^.'. uy� a:'. r5s•" s? P+_ s. ,G• .} r;. +'k. ^rt'•x- •3??`Ri J."+n�`ur.,J. - ni_'
t ❑Health -care facility ❑Other:
Job no.: Job site address: /0 22 0 P�MO�, Submit 2 sets of plans with any of the above.
City /State /ZIP: 7 'art,' D R The above are not applicable to temporary construction service.
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Slut 1 . /apt. no.: Project nam i ^� +� ( en : Description 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'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
.� :�. s rs Nv �. �. �r..v. :i ..w :;t�;S.L,�iP.'�S,,I 4Y' �^�fv= �!1.:.
T =' ".t --i 4' "lime ig44;;1 liti ; F , ' r :" `= Ylt r`'+, =• modular
a �s �;� ry €r, ±, 'S,C `� I OF , i„ _" 5, 4: t 0 '� Each manufactured or
.fah -''S't £� . c a trwu�,er�.zf. %.t,'i:.rn kII ,R::. fie. €�::at�
LL /^ _ dwelling, service and /or feeder 90.90 2
L7Cant. r h (Arco 1 i 5 ' , r f Q 1tl i cr TM i 1.x Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
r ,vr >�-V ;, ; w-=.., . ,> .>;tI :� w : n' 201 amps to 400 amps 106.85 2
°" ,`�` •44 ... - 41!t >; s t ;..' Y,,: TEN Tl'. ,, 2
E. ��la" ��. �war �::,, x�- r��- ..`; t.�.w � �;"_-" 3.' te.,:1k:�:.,xr sr..�:..:.r�a > r : :..`��. 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
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
a . ° x` t € ° "-`zf "' : _. •, "', t . : ',` ; . "'.- riic° ; A. Fee for branch circuits with
��+ a����a��� °�;��� �( ;a� �. u �':� � `s'`r SFI`IIl X.s�� ^yn r�E�+` +�.f ^.:�•pkYkAt.Js 'Si4`r1 v"»t!i5:xl�..
- - service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, ' 46.85 76 J 2
each branch circuit
Address: Each addi branch circuit 3 6.65 , 14 .4 S 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 -
t;r.x•_,: >` : r -, , ; .-� Mrr . ';F'fi,: -i ~rat. �.;t°`.•.�, ,.,
,, k energy panel alteration:
js � r. ` .i ,t. .'4i " i� ce/�` , M'..RA r® 'hr.;7 n i ; xr. .s, - - ,,+� r 4 ,.. - 4 gY P or
3�- �a�,;r � -r. �.1'.''.� -�:,. �.s...��.. s,s;;su'��"� "�; , ,�z��.� // :3 �� • , `a a,c..k - k °.,.3 extension. Describe: Page 2 2
Business name: p C C. Co sit.1IQ El ar71 1 Go I aA -i/'aG hf
`_ Each additional inspection over allowable in any of the above
Address:- (�, 750 '' 3 3 W Per inspection 62.50
City /State /ZIP: A o 7 q ri Qi) Z Investigation per hour (t hr nn) 62.50
pay Industrial plant per hour 73.75
Phone: 1) 9 �' ! �t)U Fa x: (SDS) q g2 L/0 a � ENTE ET ROMI'C i IT' "Errs * <r `: : : :, :. ''''
CCB Lic.: sri L! 2 Electrical Lic.: Z .11-1/1 ( Suprv. Lic.: 3a( s s Subtotal 6(. gd
Suprv. Electrician signature, required: ���� -- Plan review (25% of permit fee)
State surcharge (8% of permit fee) S • 3 6 1
Print name: /I //
F 4„... '� • cos �Lu Date: 20 ' / a TOTAL PERMIT FEE n a . 1 Li
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.
is\ Building \Permits\ELC- PermitApp.doc 12/03 440- 4615T(I0 /02 /COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007 -00421
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6120/2007
Phone: (503) 639 -4171 u��i l � l r�
Inspection Requests (24 Hrs.): (503) 639 -4175 �' __�
INSPECTION WORKSHEET FOR DATE: 6/29/2007 TIME: 7:00AM PAGE: 13
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: (4) branch circuits for receptacles.
OWNER: EQUITY OFFICE PROPERTIES TRUST, PHONE #:
CONTRACTOR: R C COSTELLO ELECTRICAL CONTRACTING PHONE #: 503 - 982.7400
Inspection Request Scheduled For: Date: 6/29/2007 Pour Time:
Code # Inspection Description ( ,-Confirm -# Contact # Message
199 . Electrical final 051207 -01 503 - 504 -6758 N
3
Corrections /Comments / Instructions:
PA M PARTIAL APPROVAL ❑CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: • N U:)l Date: 6 0 ! Phone #: (503) 718- 244k
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007-00421
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/20/2007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 6/21/2007 TIME: 7:03AM PAGE: 98
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: (4) branch circuits for receptacles.
OWNER: EQUITY OFFICE PROPERTIES TRUST, PHONE #:
CONTRACTOR: R C COSTELLO ELECTRICAL CONTRACTING PHONE #: 503-982-7400
Inspection Request Scheduled For: Date: 6/21/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
125 Wall cover 050605-01 503-504-6758 N •
Corrections/Comments/Instructions:
•
•
l■ PASS I I PARTIAL APPROVAL CANCEL I I NO ACCESS
I I FAIL CALL FOR INSPECTION ri ADDITIONAL FEES ASSESSED
Inspector: G si?) Date: 4. Phone #: (503) 718-