Permit A CITY OF TIGARD ELECTRICAL PERMIT •
* PERMIT #: ELC2004 -00393
T. _ s 1 ;411' DEVELOPMENT EN T I S ER CES (503) 639 -4171 DATE ISSUED: 6/29/2004
_`1�1 PARCEL: 1S135AB-04500
SITE ADDRESS: 10250 SW GREENBURG RD 201
SUBDIVISION: LINCOLN BUILDING PP1991 -055 ZONING. C -P
BLOCK:• LOT : 001 JURISDICTION: TIG
Project Description: 1 branch circuit.
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: 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 19655
FEES ELE 34 -283C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/28/2004 $46.85
[TAX] 8% State Surcharge 6/28/2004 $3.75 Rough -in
Elect'I Final
Total $50.60
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: L 44 ,Ze Permit Signature: 1j � 41 ,11
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
Electjthal.Eermit Application j .. , • • ` FOR OFFICE 'USE ONLY
City f Tigard ' D Received /a , P NO / 4' 3a3
J g COVED DateB */: , / J ' �/ "�U
13125 SW Hall Blvd., Tigard, OR •L <'' i - . I //u�nA Plan Review
Phone: 503.639.4171 Fax: 503.5 • :. • � N i 1 i Date/B : Other Permit:
Inspection Line: 503.639.4175 t P!' I ' . Date Ready/By: Juris• El See Page 2 for
g ,IUI� 5 200 �`'� __.. g
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
° -' �• {, ^<s :`.;�° wtg�i + , : ' ; t.G.. y `:.;� eu r,';ra ^- :t�.. °,. , : . . , ;-. i" ri .`� " ";a:`.";'` .s+ -te a* :..z':�C „r, -,,.� �-.:: .. a
I;. F `; ,;,,ror Y PE F - �,,,, s, YL AN REIFW
„' ����, �,_ �., ".. «��.�,�'.'e.:,�.�..�`�:a�a �;. � dP� ..,::: �< i;�,:�x =,' . »;'. ":t�S��.�. t'.. �e "t;:,M��.'�,...t..3.- .,?.x,;#s �"- ,. ...: . a a ».,,
❑ New construction V4 AWlltI t �� Please check all that apply:
��t a�yp cement PP
❑ � D I N ::: i piaw„iwitnw.,;' ��1 'I Pl hk ll h ❑Service over 225 amps, comm'l ['Hazardous location
❑ Demolition r: ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
', .,^ .;1,,,,'. - w` �" , TdrA " ,z' r`a;. , �'cr: as r,:�, :.., ;,�'.> 7 si,.. o,, q
: ,. , , `ri # _ -_. a : t:CA EG.ORY OF = " 4 „a,�_, ' 7 of 1 an d 2- family dwelli ngs or more new residential
a- .< =b.a�.:. , �: 8y =.�:*�u:.�a,,€.:*�,:.s.n._v .- sa »!= a � �� ..,:.e.»�a?cma,;,n:? €a = .6
❑ 1- and 2- family dwelling Ri Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi -family ❑Master builder Other: ❑Building over three stories ['Feeders, 400 amps or more
Y ❑ ❑ Manufactured structures or
r, ,h ,� , SIX yE � ; � „ -j6 �� ,. , � „ � Occupant load over 99 persons ❑
JOB $ITE;'.I1�IF07 ,MATION ANA LO T'M `” 1 ` 3 park
RV
���...����.�. _�- _,.- ,�,�:.,� -,..z: _ ... ,�_ .�,_., P_�. ���� _ - >_ ;:. i,�.:�� ❑Egress /lighting plan p
Job no.: V '3 Job site address: !0Z S v ¶ 4,; (r 6 rt - . / ❑Health - care facility ['Other:
C 'c tst Submit 2 sets of plans with any of the above.
3 / The abov are not applicable to temporary City /State /ZIP: A - A. 0 it_ � 1 Z Z � PP P n' construction service.
”
Suite/bldg. /apt. no.: Project name: r . -» ,li �.'E 5CHEDIILE a. _ **
/- 14/1 L° S �, r � L r Description Qty. Fee. ` Total
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
l i �..t � Cr✓ 3O Z41 f 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 75.00 2
.: w ' i s; - ; �,.�. : �, 'Y , ills : a'.tt ,, ,�.,„' i : ' s ' � ;"?``.,,�<::W,.« 4... % + 'r 4 ;t =` "° =`,` . 4,'. :
x « I)ESCRI'P - -. IOl ,,®,F t '. v Each manufactured or modular
�} dwelling, service and /or feeder .90.90 2
- ei1ti.- •--.- 1 ( "l /11(.4/4-1 Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
: E fi T P x ' ° "mil 201 amps to 400 amps 106,85 2
,_. d P ROBER,... .,.,. . .. , � TE 1VAlVT A ;
� . '�la� -:,�_ ». ' y _ . u .,:, t �. _ . 401 amps to 600 amps 160.60 2
Name: 6 ( 601 amps to 1,000 amps 240.60 2
�J��� r` cc/ �� Over 1,000 amps or volts 454.65 2
Address:
^ °� /L ( �„ G' Reconnect only 66.85 2
City /State /ZIP: p t2 ' 1 �,,," d Ovi q . Z s—cf Temporary services or feeders installation, alteration, and /or •
( 3 -03) ax. relocation
Phone: R' f -� � �� e.) Fax: (.,0�) °( �-� - � � S 3 200 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
„�,�- +�, , ', `:.a �r.:e� , �:� -:�' . °,.as�,�,.e:: ^::�3.�f� =� �c� � � � te a .
z; t ,� APPL e ,i n i &H tpT A;CT. PERSON ; ;: `i , 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, .....
46.85 81 2
Address: each branch circuit / Y� `"
Each add'I branch circuit 6.65 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 -
ai = ,x, , ? =" " „ '; , '_ ' energy panel' alteration, or
l'�;` „_ ��� . sz�v?'` ��' .... "GO1v�RACTOR ; � f ., ... ».. 3 gY P
rr .:- ,:..r �����.' �,.
r
/ extension. Describe: Page 2 2
Business name: ,f' e .t ( ( , e.c 7c jd t
Address: �t /� Each additional inspection over allowable in any of the above
�/ /� �� 0 S } Per inspection 62.50
City/State /ZIP: 7) 7 a G �-- C'.} 3 ( Investigation per hour (1 hr min) 62.50
Phone: (S(j3 ) i 2 it _ 3. 4 , s t Fax: (j'63 ) 6 z _ y _ L c ( E Industrial plant per hour 73.75
tit 'Y'I iii siftt PItICAL_PERIYI EES, :.- T ,-
CCB Lic.: 75 -� ElectricalLic.: 4 2�7c !
Su rv. /,‘ s--- Subtotal (f6 &
Suprv. Electrician signature, required:( G Plan review (25% of permit fee)
�;� State surcharge (8% of permit fee) ..... � --
Print name: V) N �� a Date: h, _ 2 3 _O 4/ 4
TOTAL PERMIT FEE 3D ---
Authorized signature: ! 1 �
gn ure: 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 :\Buiiding\Pemvts\ELC- PermitApp doc 12/03 440- 46i5T(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*
❑ 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
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
is\ Building \Pemits\ELC- PermitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection'Line: (503) 639 -4175
INSPECTION DIVISION •- Business Line: (503) 639 -4171 - MST
BUP
Received / Date Requested 7 4 2 1 AM PM BUP
Location /. 'Vi _ at Lao: Suite , / �d / MEC
Contact Person 4 Ph ( ) '�` - 9� 3/ PLM
Contractor Ph ( ) SWR , /
BUILDING Tenant/Owner iii i►�Coi.- / q ELC �"� `'( -� 3g3
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT AgIV
Post & Beam EMI
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation ep 12-011
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 RT FAIL _
CTRI
. ce
Rough -In
UG /Slab
Low Voltage
Fire Alarm
_i• - ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall tilp- PART FAIL
❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA y Approach /Sidewalk Date Inspectors frPPL Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL