Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00403
111 DEVELOPMENT SERVICES DATE ISSUED: 7/6/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S135AB - 01002
SITE ADDRESS: 10220 SW GREENBURG RD 350
SUBDIVISION: THREE LINCOLN -TOWN OF METZGER ZONING: R-12
BLOCK: LOT : 009 JURISDICTION: TIG
Project Description: Tenant Improvement
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: 7 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 WILLAMETTE ELECTRIC INC
10260 SW GREEN BURG RD #100 PO BOX 230547
TIGARD, OR 97223 TIGARD, OR 97281
Phone: Phone: 503 - 624 - 3631
Reg #: LIC 75059
SUP 1965S
FEES ELE 34 -283C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 7/6/2004 $93.40
[TAX] 8% State Surcharge 7/6/2004 $7,47 Ceiling Cover
Wall Cover
Total $100.87 Elect'I Final
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 a re 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 By: I Permit Signature: ,fij)'7 �/
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 639 -4175 by 7:00pm for an inspection the next business day
Elec Ap ! _,s4" • !. VV E.® FOR OFFICE USE ONLY ' 77- City of Tigard Received Permit No.: (a0V " bD o
13125 SW Hall Blvd., Tigard, OR 97223 , 1 1 Da By:
g 200 �„�`'� Plan Date Review ry
Phone: 503.639.4171 Fax: 503.598.1960,V L y� tdhlit � 1 ' � Date/B Other Permit ` ,, „ „ 0 ASV
Inspection Line: 503.639.4175 al I' Date Ready/By: Juris: Ei ee Page 2 for
Internet: www.ci.tigard.or.us /� T�/ G -r IGAR ' Notified/Method: Supplemental Information
a sl 1 1 () Ir11QN
--' a' . `rn's s'" f ` -' ',,:': ` a '< :i b;. r "' -n �? "a" +=i A- .. s ir ..rl0F.--c::x .,s ri: €su:C_s.r ,,,e ' -'.." -
`e . t i i ' ; e r , #,,,,, ° d �r” xi ;;a P L A N tE.vi�Ew.v., :,.6,.-:
.. .exio . .z4. . : 1: , , .. 4,,Ik^ va . 'h u,. ax ; ,,,, v�'�.';.;tr %`,.s.;i.Ag "}c. ...F' ,, ..
❑ New construction 14 Addition/alteration /replacement Please check all that apply:
❑ Demolition ❑Other: EService over 225 amps, comm'l EHazardous location
r:. r .,.; i .,, ;,::- ;,, „tea a .: a FMf w ; °; b ` � - ,,, ^, „, ,„ ❑ Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
r ., .; , - ZCA 41 5. OF COI S= 2U T k tr . of 1 -and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling J Commercial/industrial ❑ Accessory building ESystem over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑ Other: ❑Building over three stories [Weeders, 400 amps or more
t s ,.4,,„ , . <, N ` : ,: p. „,, u - ['Occupant load over 99 persons Manufactured structures or
I d . _ JOB ITE g,RIIZA'I'�TON= , ' = A� ab, 2, 7:11 ❑E /li plan RV park
Job no.: fo �+ N -y site a Job sitddress: fi VI ❑Health -care facility ['Other:
0 Z2.0 4. t w /' � J Submit 2 sets of plans with any of the above.
City /State /ZIP: rl m Z 0 O 9 Z - 3 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: S Project name: � 'r Sd es i n i ' ;m '; ,FEE*':' §GHQ :.;' s.`. **
ee �� Description Qty. Fee. Total
Cross street/directions to job site: Z— G ■ N r ,,J_ S u , 5`U 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'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.:
arrr-xs,;�l,. _ - �,,,, _ „ {_ SIMIAN Limited energy, non - residential 75.00 2
. ` . ,,, ' 'AESCRI{?P :t: OF A z�
�, � .�,�_ n �.� ,�,.,..,,,.,:. , „�,,, ,�� ,���, , � ; Each manufactured or modular
dwelling, service and /or feeder 90.90 2
I , - 1 2.1"\ot� -L ( / e eta Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
ttaf '.rsn N iii is 9; i ii -W .. , - . �... r � 201 amps to 400 amps 106.85 2
1” ,;;.: PRbI'E OWI�IE w °. - s ®TENANT . 0 . �
.(. s"* - �,K �, ate 401 amps to 600 amps 160.60 2
Name: £ 0 ` L t r.. � 601 amps to 1,000 amps 240.60 2
Address: a ,41, W Ca Iv ,,,, L r c .V ?(J 6 Over 1,000 amps or volts 454.65 2
Reconnect only . 66.85 2
City /State /ZIP: 0 s L , � Q om „ t,7Z Z Sd' Temporary services or feeders installation, alteration, and /or
relocation
Phone: (56? ) g O Fax: ( )
�� g 1 � 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
4 : .m si —te: � 1 : 44s „ — - :rt':' 'R;;?''R °�` + :�.,;: .€ _ .,,P - . eI ";. =r ., , ..m. -;, .s:.� }y ...:.:, Aa a
gv APP ,IC T;, x , "r° , CONIAGT.1PEiRSON A. Fee for branch circuits with
service or feeder fee, 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 y` &� 2
Address:
Each add'1 branch circuit 17- 6.65 i G 5� 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 -
"" r �' ' panel, alteration, or
�� '��� . � �; � �`.. � . .,�����ON�RAG�OR,,��rr�.�`��>, ,;,�. �.t .... t t, 1� r�.» ���� energy on Describe: 2 2
” ' exte escri e: Page
Business name: (� I I ,e..._ ge ( T i 1,—
Address P � �il 2-36 5-4 Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: .1't i„i-n_ct, O ....._ 9- Z& / Investigation per hour (t hr min) 62.50
S . Industrial plant per hour 73.75
Phone: (3 ! zy - S b3 / Fax: () (,- 4s - Z MEWS ;EI ECTRiIC ='PERM TRIFEES *`vim `` 1 '' :" 1
CCB Lic.: I y e i Electrical Lie.: 3y _ Z& 7 c_.- Suprv. Lie.: /9‘ S — Subtotal 9 3 , � q 0
Suprv. Electrician signature, required: Plan r eview (25% of permit fee)
e:4.--... Ft 47
� State surcharge (8% of permit fee)
Print name J l C''( o i R Date: I, -Zy _U Y TOTAL PERMIT FEE �-
lOUo s
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.
i:\ Building \Pemuts\ELC- PermitApp.doc 12/03 440- 4615T(I0 /02 /COM/WEB
c ;
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
R` §Wk W, a =O 'Y.. . 1. .. h.
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
w O T 7AL 'o.7Wi : NIL ; <
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
•
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: •
*No licenses are required. Licenses are required
for all other installations
i:\ Building\Permits\ELC- PeimitApp. doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line:, (503) 639 -4175
INSPECTION DIVISION Business Uric' (503) 639 -4171 MST
BUP
Received Date Requested AM PM BUP
Location • _ __I _ 1 / uite MEC
Contact Person Ph ( ■ PLM
Contractor Ph ( ) 6 ? q 3c ?)/ SWR
BUILDING Tenant/Owner ELC aid 4 f — 6)
Footing
Foundation ELC
Access:
Ftg Drain
ELR
Crawl Drain
Slab Inspection Notes: SIT
(4
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing -_ ASV
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
Fire Alarm
PART FAIL 111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
grAeLialP SITE Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA -cr-
(/ gnu
Approach /Sidewalk Date 7 Inspector " / 41L 4L& Q -! Ext
Other:
Final - DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL