Permit 4, CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00150
� DEVELOPMENT SERVICES DATE ISSUED: 3/26/04
c '`" 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 1S135AB-01002
SITE ADDRESS: 10220 SW GREENBURG RD 501
SUBDIVISION: THREE LINCOLN -TOWN OF METZGER ZONING: R-12
BLOCK: LOT : 009 JURISDICTION: TIG
Project Description: Job No. 4602
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: 1 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 WILLAMETTE ELECTRIC INC
ONE SW COLUMBIA SUITE 300 PO BOX 230547
PORTLAND, OR 97258 TIGARD, OR 97281
Phone: 503 -412 -4800 Phone: 503 - 624 -3631
Reg #: L1C 75059
SUP I965S
FEES ELE 34 -283C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 3/26/04 $53.50
[TAX] 8% State Surcharge 3/26/04 $4 Ceiling Cover
Wall Cover
Total $57.78 Elect'I Final
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speaalty 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: C 6- 11 Permit Signature: d
ff 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
Electrical Per Applica FOR OFFICE USE ONLY
F Received i Electrical
0 '� DateBBy: 0 PermitNo. 1 i-'4D /.SD
City of Tigard � EV Planning Approval Sign
y Date/By: Permit No.:
13125 SW Hall Blvd. 2op Plan Review Other
Tigard, Oregon 97223 tAAR Date/By: Permit No.: 6 w eRe- y -' /al-7
� IGA
Phone: 503- 639 -4171 Fax: 503 - 598 -19 . Post- Review Land Use
Internet: www.ci.tigard.or.us CITY O II 'U`N yu �l iLl' I lI h Date/By: Case No.:
24 -hour Inspection Request: 50312339-91‘77 p1 t'.� I Contact Juris.: Su See Page 2 for
P q Name/Method: Supplemental Information.
, �' -_ -"" r� `.'�s• "'"'" '-. �i .:: „ ,I'�." �' fl EX .,... eail - .�,:ar K iunc >•^r•-- �. • .�.' - .�. n,. ��� _ � � '_�'Y- �.��._,>WO >�.._ _ - .�- ��.ad�� ....�> E�� ..�. , �� h �le s eh ck�althat� �� .�.,.
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
® Addition/alteration/replacement El Other: commercial ❑ Building Hazardous over 10,000
_ CI Service over 320 amps- rating of ❑Building over 10,000 square feet,
j<. M ' l ;;1 CAT?✓ .00V lrt+' ®1 S (yT O r 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling .® Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
111 Accessory Building ❑ Multi- Family
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
3 ICP.M0RN1 USiti Cat T O: _ - > = s i Submit sets of plans withiny of the above.
Job site address: l c zz � c � � 1�,,�, �� The above are not applicable to temporary construction service.
Suite #: 5 ( Bldg. /Apt. #: S V �_: , .��.,:'..� :�W �� .G1��pU +�EO�; :�"_�''��`�.,�i ;��,�M,�,
t, wcvv /— Number of inspections per permit allowed
Project Name: (.00 ti 'T u. p Q _ -.e Description Qty Fee (ea.) Total
�� New residential - single or multi- family per
Cross street/Directions to job
J . dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Subdivision: Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
aX: a ,?.?+ ""> 1;
E�,;'��;,� t: ���,',- _�"�. <. DBE' S; G�tI :�T�O1�s�QE,WOI.?iFC�...�.�;�: �.��,� ,: . service and/or feeder 90.90 2
rl / , Services or feeders - installation, .
r> 1, D u t y t e:r i ( 2) Stet , T c k e( alteration or relocation:
200 amps or less 80.30 2
/
ge I Oct f e ( '3) Li C 1 -Cr S 201 amps to 400 amps 106.85 2
J 401 amps to 600 amps 160.60 2
n'&1 ,
r. ���tQP0RMOV�N€>�R�� ^ �;� TE1�A`` 1�t;::.:�n"�;;= ,���:��ilt�gA 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: 2 p Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85 • 1
Phone: Fax: 201 amps to 400 amps 100.30 2
g Ell 'Wtri- NF ..- v - 'll a ® C TA84 ERS®N ;± " :. Branch00 amps circuits - new alteration, or 133.75' 2
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 kr
service or feeder fee, first branch circuit ! / 46.85 L G 2
Phone: Fax: Each additional branch circuit J 6.65 6 2
E -mail: Misc.(Service or feeder not included):
A c' p ti GONsCTl73 -.w> r�v Each pump or irrigation circle 53.40 2
' "``` -4'�-' `)` ``` Via"' �`..Ra i :" Mf ` e, Each sign or outline lighting 53.40 2
Job No: y( a2_, Signal circuit(s) or a limited energy panel,
alteration, or extension e 2 2
Business Name: t,}, I I4 e qeemi C /." t;_ Description:
Address: ,s /,_ 2. K6 -Sy 7--
City/State/Zip: Each additional inspection over the allowable in any of the above:
i kl D �� 9 9- / Per inspection per hour (min. 1 hour) 62.50
Phone:071) E 2,4 - -4 431 Fax:(,S7-,3) bZit - 2rj 3 Investigation fee:
CCB Lic. #: ,,c103". p Lic. #: k 3 othe
. �� ;1 ,1 - ViE � .T1leeRR T'ermii E OS ��..r. ,.._ 1«1 ,
Supervising electrician Subtotal $ S-3, f U
signature required: / Plan Review (25% of Permit Fee) $
Print Name: I) Ai,, Ft c.#: ,y( 1 $ State Surcharge (8% of Permit Fee) $ y , Z e
TOTAL PERMIT FEE $ 3-
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 Tri- 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
n Garage Door Opener
n Heating, Ventilation and Air Conditioning System
In Vacuum Systems
n Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
El Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control
n Medical
n Nurse Calls
Outdoor Landscape Lighting
n Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all •
other installations
i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03