Permit CITY TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00679
A DEVELOPMENT SERVICES DATE ISSUED: 10/26/2004
13125 SW Hall Blvd.. Ticiard. OR 97223 (503) 639 -4171 PARCEL: 1S135AB - 01004
SITE ADDRESS: 10220 SW GREENBURG RD 410
SUBDIVISION: TWO LINCOLN - TOWN OF METZGER ZONING. C -P
BLOCK: LOT : JURISDICTION: TIG
Project Description: JOB NO. 740 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: 9 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
ONE SW COLUMBIA #300 PO BOX 230547
PORTLAND, OR 97258 TIGARD, OR 97281
Phone: 503 -4152 -4800 Phone: 503 - 624 -3631
Reg #: L1C 75059
SUP 1965S
FEES ELE 34 -283C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 10/26/200 $106.70
[TAX] 8% State Surcharge 10/26/200 $8.54 Ceiling Cover
Wall Cover
Total $115.24 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 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 By: I LP/M. Permit 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 639 -4175 by 7:00pm for an inspection the next business day
CT 22 2004 2:03PM HP LASERJET 3200 p - 2
• FOR OFFICE USE ONLY
Electrical Permit A /
, s } i( �, I� (t n� Received Permit bra. ,ZDO -o0 f07
City of Tigard '° E IL�� 11�f// Rec eiv ,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other Yermit:6 far) l dOSr�
�' �T "`ih DateB
Phone: 503.639.4171 Fax: 503.598.1960. ' � . l I Date ReadyBy: Sufis: ® See Page 2 for
Inspection Line: 503.639.4175 a V 2004 r^= ='� " "'" Supplemental Information
Notified/Method:
ard.or.us
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� +. ,max MUM/ �` .1i a9 9 0 , i � i, d , '! lig, �,f. , 'S00:.; I .s. ! 1. i i i P.1 "q�ii: r ..t:; S , A . , ... - .--' - .
=z i. -, 4 1l � -�' , e ° ,1� � ! . .px.,, o- t G, ii t :. •. -. Please check all that apply:
r r114 1 tr+.nc-ta -� •
Ad�itlon/alteratYOn/replacement 0 Service over 225 amps, conrn'l ['Hazardous location
_ ❑ New construction ' ~
❑ Demolition ❑ Other ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., .
s-Ic' "' 9 ,ry 4-rz.:; of 1- and 2- family dwellings 4 or more new residential
t t:; t � till amt r. ° d E S ti -' It, n t r r l 1 , 1, tI it units in one structure
r � � l , g .x t ei - =i S over 600 volts nominal
❑ 1 - and 2 - family dwelling �Commerctal/indusirial ❑ Accessory building ['Building over three stones ['Feeders, 400 amps or more
❑ Multi - family ❑ Master builder ❑ Other: ❑ Occupant load over 99 persons' ❑ Manufactured structures or
pu 1 r r , g `e�! ° r l at :u'
l ! { �s#`? a i DEgresslighting RV. park
ru :I- sil t 9ll R, � ra � a lgtu i oLiti ' nfil i ss� I n ,r% p I ;ith a � , ' 1il f :a 1 . ❑ Other:
❑Health -care facility
Sob no.: tit) Job site address: pL St..) 4. •i ti+ �� J � d Submit 2 sets of plans with any of the above.
The above are not applicable to temporary construction service.
City/StatelZIP: ti " ' .
Suite/bldg. /apt. no.: 1-(1 l O I Project name: R • p L . lvtni,L�'� r.� . � Description Qty. Fee Total
J New residential single- or multl- family dwelling unit.
Cross' street/directions to job site: Includes attached garage.
1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion I Lot no.: tion 33.40 1
Limited ; 5.00 2 Limited energy, residential
Tax map /parcel no Limited energy, non - residential 75.00 2
ni
a ,r �, z i a, ��s , i; V' a ; S' q . , h 1 E ac h manu ormodular
ik 1 l t t ...� 1 gtr 90.90 2
j� :1 rw "r "� ?.... �' F, dwelling, service and /or feeder
To w � v / j� f 6—A— p 4 44. Services or feeders installation, alteration, and /or relocation -
1 200 amps or less 80.30 2
,� . k4 T'• , 201 arms to 400 amps
106.85 2
4' h u� Y� 2 '�141q
� Ii a , ' li il l }te t�: 1N a, _„ 401 amps to 600 amps 160.60 2
1 ic e. ' til a aLIMII'di� ilt t "+ atei t kti RA . A�:. '
Name: t 'O p • 601 amps to 1,000 amps 240.60 2 Over 1,000 amps or volts
454.65 2
Address: Reconnect only 66.85 2 _
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) I Fax: ( ) relocation
200 amps or less 66.85 1
2
Owner installation: This installation is being made on property that I own which is not 2 01 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
Owner signature: Date: Branch circuits -new, alteration, or extension, per panel
r , ' e1al c i � ' i 1 t o ' in ' ,�,,. 4 t o sa ''j, A. Fee for branch circuits with
19 �12� i 't . ie�� " " i �i� � L '- k .F service or feeder fee, each 6.65 2
branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 1 46.65 11 2
each branch circuit I y
Address:
E add'l branch circuit 6 65 � 2
City/State/ZIP:
Miscellaneous (service or feeder not included) I
Pump or irrigation circle 53.40 2 I
Phone: ( )
Fax : : (. ) Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
E-mail: tp� t t i ' "" energy panel, alteration, or
ri ° "aiei�L i ' j ��'.5t i fia6 t: ie Page 2 2
'l'' S i�I , �{ •. ,a�"t extension. Describe:
Business name: 1., i f (4,04,„e at r�f c t t� j ,,,, L _ —
^ Each additional inspection over allowable in any of the above
Per inspection 62.50
Address: e a ,4 T-30 C Y r ii hour (1 hr nun) 62.50
City /State/ZIP: "T(5 L4R p e •'k-- e 9 7 2. i Investigation per 73 75
Industrial plant per hour
Phone: ( Ste) f y — 5'L s / I Far. (.$jj �) (>' t¢- ? ''r trirMi yi y . ,„ , V i
COB Lic.:
�.. o S - j \ Electrical Lie.: 5'41 -c!t' - Suprv. Lie.: /WS' - C • Subtotal /4 4 _ 1 7e,
Suprv Electrician signature, required ! �i w S surcharge (8% of permit fee) g c
Print flame: ..40 ttiu F A . 1 Date: to z z - 4, TOTAL PERMIT FEE r f s, z 1
Authorized signature: Tbls permit application expires if a permit is Dot obtained within 190
days after It has been accepted as complete
Date: " Fee methodology set by Tri-County Building industry Service Board
Print name: I •" Number of inspections per pemut allowed.
A doc 12/03 440- 4615T(10/02/COMoWEE
clBuildinglPecrcitalELC- Permit pp.