Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1 DEVELOPMENT SERVICES PERMIT #: ELR2005 -00205
I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/26/2005
PARCEL: 1S135AB-01004
SITE ADDRESS: 10220 SW GREENBURG RD 420 ZONING: C -P
SUBDIVISION: TWO LINCOLN - TOWN OF METZGER LOT: JURISDICTION: TIG
Project Description: Limited energy for relocation of thermostat.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
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 MCKINSTRY CO.
ONE SW COLUMBIA #300 5400 NE COLUMBIA
PORTLAND, OR 97258 PORTLAND, OR 97218
Phone: 503 293 - 2745 Phone: 503 997 - 0234
Reg #: LIC 40981
ELE 26- 1190CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 7/26/2005 $75.00
[TAX] 8% State Surchart 7/26/2005 $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 fo : • opted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010
throu ; OAR 952 -001 I 10. Y. may obtain copies of these rules or direct questi ns to OUNC at 503 - 246 -6699.
Issu: d By: , /�� /� ; Permittee Signature: 1(
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.
Ele,rtrlcol Permit Application FOR OFFICE USE ONLY _
City of Tigard Received Date/B 7QQ� Permit No.: /S -EicUo
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 dr kitim $ i -4, Date/B . Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: M El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: . Supplemental Information
' TYPE OF WORK. PLAN •REVIEW
❑ New construction IKI Addition/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.,
CATEGORY OF CONSTRUCTION of 1 - and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi- family 0 Master builder r3 Other:
DOccupant load over 99 persons ❑Manufactured structures or
' JOB SITE INFORMATION AND ;LOCATION DEgress/lighting plan RV park
Job no.: 5 Job site address: 102 (rte L.)
❑Health -care facility ❑ Other:
Submit 2 sets of plans with any of the above.
City/State /ZIP: 7 l d � 0 FL, 7 ?2 '23 The above are not applicable to temporary construction service.
J r FEE* SCHEDULE
Suite/bldg. /apt. no.: L(0 Project name: LA Welg1�L LOSS Description I Qty. I Fee. I Total I "'
Cross street/directions to job site: 1 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.: Limited energy, non - residential d 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
'e1 Oe--Ol FC_ C "`-/ /°� Th e-rMO $A-7k4-
' S { rA l 1 ' dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
• ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
' 401 amps to 600 amps 160.60 . 2
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
fECI APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: Mcko 5_,1_ branch circuit
✓ B. Fee for branch circuits
Contact name: 50.50,` Y,\/C...` without service or feeder fee, 46.85 2
• each branch circuit
Address: '2-07_ \ N A , C 12''r u� r 5'4 Each add'I branch circuit 6.65 2
City /State/ZIP: Psi-- I MA t (A 722.0. Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ('t ) 2 ( 2 c( G 1 Fax: : (5,3) 5 31 6 t v(.. Sign or outline lighting 53.40 2
E -mail: ,) 6-5 C-4- Ac..kln 5-tr c , A Signal circuit(s) or limited-
. CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name:
IMckt/N 54 12.-7-.1 .1 NE Air Wu (p� G- Each additional inspection over allowable in any of the above
Address: 12.-7-.1 l � Per inspection 62.50
City/State/Z)P: P r 4 v l( 17 22v Investigation per hour (1 hr min) 62.50
Industrial plant per hour 73.75
Phone: ( 51,3) 3-3 I . v1 6 ( Fax: ( 5 - b1) 3 ) .b 10C, • ELECTRICAL PERMIT FEES* •
CCB Lic.: t16,81 I Electrical Lic. /1,,,J.,_____ : j I Li Suprv. Lic.: Subtotal ' t 75 'D
9 Suprv. Electrician signature, re uired: � y r W ere i,,;,„ htortt
,./
4,) Plan review (25% of permit fee)
s
State surcharge (8% of permit fee) to ,e
Print name: �Ja.��, 1M o l rh S Date: �� / S— TOTAL PERMIT FEE gr 04)
. Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: 'St.4. S J ,_ C y .,.„.., Date: 7 12.‘, / * Fee methodology set by Tri- County Building Industry Service Board
** Number of inspections per permit allowed.
. i:\ Building \Permits\ELC -Perm itApp.doc 12/03 440- 4615T(10 /02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
r_ RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK. ONLY: "
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- PermitApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005- 002055
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/26/2005
Phone: (503) 639 -4171 N ivi4i6
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/12/2005 TIME: 7:06AM PAGE: r
SITE ADDRESS: 10320 SW GREENBURO RD 420 CLASS OF WORK:
SUBDIVISION: LINCOLN CENTER/TWO LINCOLN LOT #: TYPE OF USE:
PROJECT NAME: LA WEIGHT LOSS
DESCRIPTION: Limited energy for relocation of thermostat.
OWNER: EQUITY OFFICE PROPERTIES TRUST, PHONE #: 503-293-2745
CONTRACTOR: MCKINSTRY CO. PHONE #: 503 - 997 -0234
Inspection Request Scheduled For: Date: 8/12/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
136 Low volta a 013450.01 503 -572 -1641 Y
I c E. ‘1
Corrections/Comments/Instructions
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•
•
' -ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
C FAIL ❑ CALL 'FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: qobt.)-E Date: 8. 12 'Of Phone #: (503) 718- Pig
•