Permit C ITY OF TIGARD ELECTRICAL PERMIT
, PERMIT #: ELC2003 -00490
� l DE VELOPMENT SERVICES DA ISSUED: 8/7/03
41, ti 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1 S135AB 01002
SITE ADDRESS: 10220 SW GREENBURG RD 350
SUBDIVISION: THREE LINCOLN -TOWN OF METZGER ZONING: R-12
BLOCK: LOT : 009 JURISDICTION: TIG
Project Description: Install (7) branch circuits.
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: 6 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:
SPIEKER PROPERTIES L.P. WILLAMETTE ELECTRIC INC
10260 SW GREENBURG RD PO BOX 230547
SUITE 100 TIGARD, OR 97281
PORTLAND, OR 97223
Phone: Phone: 503 - 624 - 3631
Reg #: LIC 75059
SUP 1965S
FEES ELE 34 -283C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/7/03 $86.75
[TAX] 8% State Tax 8/7/03 $6.94 Rough -in
Elect' Final
Total $93.69
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 quest ns to OUNC a43) , 6 -6699 or
1- 800 - 332 -2344. /
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Issued By: Permit Signature: -V Ale .
P
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:
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Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Applicati FOR OFHYC1.; USE? ONLY .
Received p t� Electrical
Z8
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. Date/By: 0 -7.03 PermitNq cc003 - 00 `' 4
Cii of T'I and Planning Approval Sign
y g Date/By: Permit No.:
13125 SW Hall Blvd. R/ CEe I F Plan Review Other
Tigard, Oregon 97223 U Its Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -59I8_-1960 Post- Review Land Use
Internet: www.ci.tigard.or.us U
A U ��"*> r',M I V Contac t Case No.:
2' Fsl J Contac Jugs ® See Page 2 for
. 24 -hour Inspection Request: 503,639-41-75. Name/Method: / / j _ Supplemental Information.
BUILDING DIVISION
.r :. �? 't.; •f: . u;v ,' s , ; t u, ;'a�' PleasC. I'. . - • El p: ro TYPE WORK;; §�'• _ �':�'.� <: Y.;,�i. , �� +�.: =;, ;� : ?�'� " +- :: PL'AN REVIEW. check'all that's l ,
New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Ilazardous location
B. Addition/alteration /replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
;?;i';_` -`'` i;: ',•. " OF;
C ATEGORY,CONS,TR T10N .`.i,'li ; 'i r: I & 2 family dwellings four or more residential units in
❑ I & 2- Family dwelling Q Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
[] Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
..;'.'!?',I;:,...!,2(;, t - t :p.: ; yya .ri /
JOB SITE INFORMATION;antiOGAfiION:r� :.,. • Submit sets of plans with any of the above. , .,, ,
The above are not applicable to temporary construction service.
Job site address: ozzo SI,/ C-.L5.._J1..< 5 S 3 - .,, r .. ,..:.: ,;, ,. L
1 v f0 4c:G,''e =trite &��:,. :`; ','�C�' ;FEE"! SCI IEllUliFJx7; ��' + , ��.<•, :�rl�a'�i'':'}� ;t.:; °.,.
Suite #: 7 U � Bldg. /Apt. #: Number of inspections per permit allowed '
Project Name: S r 2ce Description . Qty Fee (ea.) Total I
Cross street/Directions to job site: New residential - single or multi- family per
dwelling unit. Includes attached garage.
Z (,, w n Cv 3 j U Service Included:
1000 sq. It. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40
Subdivision: Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
WP ti ":`?.k i' , itj'; D N; ESCRIPTIO OF ?WO ' a f i/t:,c`itI i "�" " t ^ a<i0 service and/or feeder 90.90 2
Services or feeders - Installation,
...,.....+...... I rh, „ rn a _ alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
;y l saa Y'•' �r ' t ... ±
r �l � '.�' , = ",QW1VC� R`_K;, �`':''.��a �� ' ' ��rll ^ �'ti�'�'.L � 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation: •
City /State /Zip: 200 amps or less 66.85 I
Phone: I Fax: 201 amps to 400 amps 100.30 2
p , f. $t �,p;° 401 to 600 amps 133.75 2
®fA JPIa`I(f,4�NT =;• . ,; ; + ; ..'`'�1'' ;e:°_ - ®'CONTA 1p'EIi,SOI� zfk •�sr;s•f1'. Branch circuits - new, alteration, or
Name: extension per panel:
Address: A Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 6.65 2
City /State /Zip: • B Fee for branch circuits without purchase of
service or feeder fee, first branch circuit ( 46.85 &- 2
Phone: I Fax: Each additional branch circuit G 6.65 q ✓-' 2
E- mail Misc.(Service or feeder not included):
-.°' .t t • C <'• . v f it , a '• .a t+} , ;; Each pump or irrigation circle 53.40 2 •
� . ' . < CO TRA.q o , R � �w S3 s -- — ,, Each sign or outline lighting 53.40 2
Job No: ' 4• - Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name: W , ii et M i fi e ale , 7 c c / a Description:
Address: Po e z 30 s-'- ?-
p Each additional inspection over the allowable in any of the above:
City /State /Zip:. - 1-, 5 a n n 'OA / 7- ? H Per inspection per hour (min. 1 hour) 62.50
Phone: 6 z.4 - 3 6 3 / • Fax: 4'2.4 - - 2 9 K is' Investigation fee:
CCB Lie. #: :� c Lic. #: 3c - Z L Other:
y i & 3 ,IR•t s3` ,. lt, tEN - Oikal 'vitnaCt F'e' r:s raa, `
Supervising electrician Subtotal $ g6
signature required: Plan Review (25% of Permit Fee) $
Print 0A- .Y 1= , { lc. #: /1 b S' S State Surcharge (8% of Permit Fee) S ( r 'y 4 1
TOTAL PERMIT FEE $ q' r 6 q
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Authorized Notice: This permit application expires if a permit Is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
°Fee methodology set by Trl- County Building Industry Service Board.
' (Please print name)
i:\Dsts\Permit Forms\ElcPermitApp.doc 01/03 •
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
Audio and Stereo Systems
Burglar Alarm
0 Garage Door Opener
0 Heating, Ventilation and Air Conditioning System
0 Vacuum Systems
Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 -260 -260)
Check Type of Work Involved:
Audio and Stereo Systems
Boiler Controls
• Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
HVAC
El Instrumentation
0 Intercom and Paging Systems
0 Landscape Irrigation Control
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❑ Medical
E l Nurse Calls
El Outdoor Landscape Lighting
❑ Protective Signaling
• Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms\ElcPermitAppPg2.doc i,;103
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Request d 7---2 AM PM BUP
Location ID ?-3-6 Suite 3 56 MEC
Contact Person Ph ( ) PLM
Contractor - E/ c,' * Ph ( ) —3 3/ SWR
BUILDING Tenant/Owner ELC 3 — off) 4 [. q
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
- Slab Inspection Notes: / SIT
Post & Beam c ) Y��
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
Final
PASS PART FAIL
ELECTRICAL
Service •
Rough -In
UG /Slab
Low Voltage /1A 7
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SI El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Date ✓ A Or v C Inspector ' Ext
Approach /Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
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