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Permit CITY OF TIGARD ELECTRICAL PERMIT - RESTRICTED ENERGY icllli DEVELOPMENT SERVICES PERMIT #: ELR2004 -00257 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/12/2004 SITE ADDRESS: 10220 SW GREENBURG RD 201 PARCEL: 1S135AB -01002 SUBDIVISION: THREE LINCOLN -TOWN OF METZGER ZONING: R -12 BLOCK: LOT: 009 JURISDICTION: TIG Project Description: T -stats A. RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPEIIRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: DATA/TELE COMM: NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: : HVAC: X PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: TOTAL # OF SYSTEMS: 1 Owner: Contractor: EQUITY OFFICE PROPERTIES TRUST AMERICAN HEATING ONE W COLUMBIA #300 1339 SW GIDEON ST PORTLAND, OR 97202 PORTLAND, OR 97202 Phone: 503 412 - 4800 Phone: 239 - 4600 Reg #: LIC 33135 ELE 26- 993CRE SUP 2640LEP FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 8/12/2004 $75.00 Elect'I Final [TAX] 8% State Surchart 8/12/2004 $6.00 Total $81.00 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OU at (503) 246 -6699. Issued by Jtj Gf.[�L -tom Permittee Signature U11 , OWNER INSTALLATION ONLY 11111 The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N DATE: LICENSE NO: Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day E'ectrical Permit Application • • , • , FOR OFFICE USE ONLY City of Tigard RDateecei/Bvey: d p f D/ Permit No0/��(J0l`. Q 0,A6 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revi- '1 Phone: 503.639.4171 Fax: 503.598.1960 ti rA' i� B Date : Other Permit: Inspection Line: 503.639.4175 � II! Date Ready/By: j s. v^ El See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: 1 ( Supplemental Information .cvi We' 21,-W: L'T > ,�G^'°s _i -�,' - `- r'Qii$�- €A 3� - - z.»a '�::.. _ ( 44: -;?aj ;- . �v�x�;r9;.��- �.„,� w��..,. " , , , k ,, map ,,,,. :'.- ❑ New construction, ddition/alteration/replacement Please check all that apply: ❑ Demolition ❑ Other: ['Service over 225 amps, comm'l ['Hazardous location ,,. ,, , ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., _ .., C- „ c p er % �STR GCI, p - of 1- and 2- family dwellings 4 or more new residential CI I- and 2- family dwelling commercial /industrial ❑ Accessory building CI System over 600 volts nominal units in one structure ❑ Multi -family ❑Master builder ❑ Other ❑Building over three stories ['Feeders, 400 amps or more �,��. ['Occupant load over 99 persons ❑Manufactured structures or „M ki .1 ti p% ' J B SITE OR]� Ort GAT Ol : ; ,,, ,. ❑E plan RV park Job no.: 5 dy3 Gs I Job site address: wiz() C e.� �_I 11 Health-care facility ['Other: Submit 2 sets of plans with any of the above. City/State /ZIP: ---1 cx_r A, The above are not applicable to temporary construction service. l.ld ./a t ae� Project name: V JJ -_� ,,,J,,. g P . no.: lC I /�17�t.1.)�t�- �1i1L°s�Q)+`3J 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: I Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 I Limited energy, residential 75.00 2 Tax map /parcel no .;r x Limited energy, non - residential 75.00 2 1 . `1 ° &SC. bOS .�. W, �-. .. -rot y . _ Each manufactured or modular ` dwelling, service and /or feeder 90.90 2 4 VAC — ) 1, -rr, s4-o.4' Services or feeders installation, alteration, and/or relocation . 200 amps or less 80.30 2 201 amps to 400 amps 106.85 2 , C) i ` r� 401 amps to 0 amps 160:60 2 Name: � J 0 1 - 4' � 601 amps to 1 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: ( ) Fax: ( ) relocation 200 amps or less 66.85 I 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. - _ ' ' ► ' ' ' - ,_ ”" ' . -., r Fee for branch circuits with -' A service or feeder fee, each Business name: J=}Yne Y`ICQv� i��'a. -�-i e�+Cq `')--,c.,• branch circuit 6.65 2 Contact name: No, er-w e++ B. without o ur service circuits es without service or feeder fee, 46.85 2 S' C ` each branch circuit Address: i 3 3ci C=S1 a�UN �T Each add'I branch circuit 6.65 2 Ci / State/ZIP: M iscellaneous (service or feeder not included t a -" 7 bk2 9 7ZO ( included) Pump or irrigation circle 53.40 2 Phone: (563) 2_39 -e-/ 6 co I Fax: : (5)3) 2 ° L1 Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited- energy panel, alteration, or ��:.. � � am extension. Describe: Page 2 2 Business name: rnU 1 can 4 et . 4 4 Address: Q ` Each additional inspection over allowable in any of the above I 3 _ I . cam Per inspection 62.50 City/State/ZIP: y4 I ce 9 72.0 a. Investigation per hour (1 hr min) 62.50 Phone: ( 3) ..4 6 j I 13 Fax: (503) 7 - 7 "� Industrial plant per hour 73.75 4 Ede- - E Rit_�AI R1VI[�P':ES �n CCB Lic.: - 16 S :M",:.'" E _ t 3 3) 3 S Ele ctrical Lie. �_ 4 S uprv- L Subtotal Suprv. Electrician signature, required: Plan review (25% of permit fee) 76 — Date: State surcharge (8% of permit fee) 1, Print name: s � e / 0 TOTAL PERMIT FEE $`/ i Authorized signature: l /il,. !1< , f - Thi perm application expires if a permit is not obtained within 180 / `[ /� {J�! days after it has been accepted as complete Print name: �,j ., /e , -, , Date: P/ t� * Fee methodology set by Tri- County Building Industry Service Board P/(.1,0 ** Number of inspections per pemut allowed. 1:\ Building \Permits\ELC- PermitApp.doc 12/03 440-4615TO 0/02/C0 M/WEB ■ CITY OF TIGARD 24 -Hour BUILDING Inspection Lirtie:,,(503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST ©© BUP Received Date Requested C ` 3 ( AM PM BUP Location j 0 2- &12_irB uL - Suite 2 - ©l MEC Contact Person Ph ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR 2 4 0 (/- co ZS Crawl Drain Slab Inspection Notes: SIT Post & Beam _ Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing 41 Insulation :■ i �I Drywall Nailing � f I� Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: , l 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 Final PASS PART FAIL ELECTRICAL Service Rough -In UG /Slab Low Voltage larm PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. ❑ Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date 6 ( Inspector PP Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL