Permit ' CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00318
DEVELOPMENT SERVICES DATE ISSUED: 6/7/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S135AB-04500
SITE ADDRESS: 10250 SW GREENBURG RD 200
SUBDIVISION: LINCOLN BUILDING PP1991 -055 ZONING: C -P
BLOCK: LOT : 001 JURISDICTION: TIG
Project Description: JOB NO. 638 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: 3 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 6/7/2004 $66.80
[TAX] 8% State Surcharge 6/7/2004 $5.34 Ceiling Cover
Wall Cover
Total $72.14 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: 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: 7 - 5
LICENSE NO: / ' 'd S
Call 639 -4175 by 7:00pm for an inspection the next business day
Eleetr>LCaI Permit FOR OFFICE USE ONLY • '
L City of Tigard Date/By Permit No. ,, Ai -od _ _
13125 SW Hall Blvd., Ti ard, OR 972 j K w/ 1 004 y � �
_
g .��{j L L Pl an R eview
Phone: 503.639.4171 Fax: 503.598.1 G , � l 0 1 Received / Other Permit: y Date/B :
Inspection Line: 503.639.4175 NP e∎ I Date Ready/By: Surfs: E7 e Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: Supplemental Information
,.�'�ax! :'2 «T '?"� "_'= l� "'s°;�'.` °;q"tT "ate;- ::.'e:° �'�"�;ti ��.,�s,' . x�n.,r�«5 ..._�f �,,,�
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t z „ a1 Siik: : , I'MPa. ' <.a�-. ff,, , n, , _,t.=, c _iAgal. 'nNIT5'i`', ` ,,,�.,_4, w . _ttr - > . -,�. .,, w _ ._
❑ New construction ❑ Addition/alteration /replacement Please check all that apply:
❑ Demolition I=1 Other:
Service over 225 amps, omm' Hazardous location
;� -. .R _,.: =- =;� aF - — ft.,
c 1
PP r _s_ -, - . ,,,,; _ ,,tee . _ SO over 320 amps rating ❑ Buildng over 10 , 000 sq. ft.
L'.4 � ';11,.: , -: , � �, GA TEG O RGY OF 'C ONS ;1 T'RKRJ? r V5V AV 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
❑ Multi family ❑ Master builder 111 Other: ❑Building over three stories EFeeders, 400 amps or more
_ ,, Multi
at1< , ..VVM. •,� Master .,:xi a� .. ",: b L O th e = :. ,. persons red structures or
❑Occupant load over 99 e Manufactured
. 3'. a OB SITE LO@ O : ; . , ❑ EP. ess /lighting plan RV park
Job no.: Job site address: -.�
EHealth-care facility ❑Other:
6 -1 I G z s _ t) "e �' e'er r wt Submit 2 sets of plans with any of the above.
City /State /ZIP: �
T/111 C . f The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: 2414. 1 Project name: � r C 7` it= F_EEt w :. ,
(' Description Qty. Fee. Total
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
7 ..t , ...._.... t on e'. ,....."--,-1.- 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.:
s,sr,..IT,,,,A,,,Rs,,E,,r - ,�, Limited energy, non - residential 75.00 2
' _',,, . AESCRIPTI „,„ ; MWORK � - , t Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
, : t, >t; . . : ,� �. -- : �:, F� j ° �: s,;p ,a : <: E 201 amps to 400 amps 106.85 2
# k-awm � PRQEERTY , O W NER _ ` ` . : ... .�°r� ®TE i , A�1 T 77, „ _ s a =A M:
"` °�'�"�'�`� � `°'���"""`�""`� � �� � �' '° �1
`�'= 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
' le ® AP'P IGAtNT , s , ;, £ ifraft 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 f 46.85 Y ` 2
Address: ST
Each add branch circuit Y 6.65 / y 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
m a ' "`' i` gGON RACT mit . `y'°`, ' gg energy panel, alteration, or
extension. Describe: Page 2 2
Business name:
L t ( (1,,,_c ti 0 , I .+c /--,.
Address: 6 / x ? 3 0 y , r Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: `� ` I S Cr_ ?-/ Investigation per hour (1 hr mart) 62.50 Fretri
Phone: ) ( „, z , _ 36 3 t Fax: (s7��) & Z i� -2.- 3,5-- Industrial plant per hour 73.75
3 ;:._ . .' s E1 ECTRIOUVI OODY_EE S -17t' n
^F
CCB Lic.: Electrical Lic.: Suprv. Lie.: Subtotal 44 d
Suprv. Electrician signature, required: ,(ls_ 7,.....e
Plan review (25% of permit fee) 3
Print name: n �'""`^' Date: State surcharge (8% of permit fee)
TOTAL PERMIT FEE 7 ( y
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.
iA. Building \Pemuts\ELC- PermitApp.doc 12/03 440- 4615T(10 /02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
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:
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
n Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
is\ BuildingPermits \ELC- PermitApp.doe 04/03
CITY OF TIGARD 24 -Hour ,
BUILDING Inspection Line; (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received 7/ a Date Requested AM PM BUP
Location IO .aSV 560 1A.0..a_ Suite atrO MEC
Contact Person Ph ( ) loo? 4 96 3 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 3! d
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
star
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation pre') Lax/ v G� J Ft F A' frt
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
ECTRICAI�
ice
Rough -In
UG/Slab
Low Voltage
Fire Alarm
PART FAIL
0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
Ei Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA 7 — Z/ _� Approach /Sidewalk Date l Inspector ` /44 Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL