Permit C ITY OF T I G A R® ELECTRICAL PERMIT -
RESTRICTED ENERGY
At DEVELOPMENT SERVICES PERMIT #: ELR2004 -00217
13125 SW Hall Blvd., Tiqard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/20/2004
SITE ADDRESS: 10260 SW GREENBURG RD 385 3 7-S PARCEL: 1 S135AB 03400
SUBDIVISION: LINCOLN TOWER -TOWN OF METZGER ZONING: C -P
BLOCK: LOT: 014 JURISDICTION: TIG
Project Description:
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: :
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
EQUITY OFFICE PROPERTIES TRUST CASCADE DATACOM
10260 SW GREENBURG RD #100 RICHARD DEAN RUSH
TIGARD, OR 97223 PO BOX 90872
PORTLAND, OR 97290
Phone: 892 -2500 Phone: 761 -9459
Reg #: ELE 26- 113CLE
LIC 114408
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 7/20/2004 $75.00 Elect'I Final
[TAX] 8% State Surchar€ 7/20/2004 $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 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 • at (503) 246 -6699.
Issued by Permittee Signature -I^
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 7:00 P.M. for an inspection needed the next business day
Electrial Permit Application FOR OFFICE USE O Nv
City of Tigard C �� Receive r.. D Permit No. g / _a ) 3../ '
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 i y 'dlh iC „ ( ( tip Date/By: Other Permit:
Inspection Line: 503.639.4175 JUL �! • Date Ready/By: 1lids: j1 hJ See Page 2 for
Internet: www.ci.ti 8 ard.or.us Notified/Method: Supplemental Information
nn gfig.i41S1 n...0: ans+r. : ?t�:c;1x1x 0tt { +'
X New construction ' W`” t V t P l ease check all that apply:
❑ Addition/alteranon/repl tvt pp y
❑ Demolition ❑Other: ['Service over 225 amps, comm'1 EHazardous location
,- g; -. < „a K, . , , Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATNEGOROFC01STtRUCTON =; "s•• 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 0 ['Building over three stories EFeeders, 400 amps or more
_ ['Occupant load over 99 persons ❑Manufactured structures or
. JQB” SITE ,rR ON rAN 1 ,90AA TLON ' ,' _ . ❑ E /li plan RV park
Job no.: Job site address: 102.. 4/o s t✓ � mein lour ❑Health -care facility ['Other:
`I Submit 2 sets of plans with any of the above.
City /State /ZIP: 't 9 q - d G • 2, The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: 3 �p Project name: ' n /� Q,� /,� : ' .- t ° ^ s;':� ':' EE .SGHFs�DT=3LE',:;; i :,; `:< 11,--. * *
• r r �1L lit tom`"^ Description - Qty. Fee. Total
Cross street/directions to job site: 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
Tax map /parcel no.: Limited energy, residential 75.00 2
, energy, non-residential 75.00 2
Limited nergy non dential
K ,a : : ESCRIPT O p O E, ,WO „ .� , 4 4 11: Each manufactured or modular
r -� — � P La l t� L 1 r 1 dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
* l y° 201 amps to 400 amps 106.85 2
=' PROP'ERTY O W N ER "t ` ; v TE1tti ANT t w * `
� -� . _`�tw,�� �-F�a .��`�� w��, ' -v, ,�,. -� .x . :� , � w.e,� -,� a.ar .h ;�.x6:.. Gea,.x
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
' �'�� "" 16"10,‘ - i "t =mety A. Fee for branch circuits with
,i • _ APPLIC'.AN . eaCl } NT�CT PE RSON _ sS
n� ��- � �..��_,x��.�axk>r. � � �` � ��• � .., � .. u.�� ;� �'r�.���, >� service or feeder fee, each
Business name: C. o (-0,c,-e_ ` ckr6 co L.--- branch circuit 6.65 2
Contact name: !� L B Fee for branch circuits
� c_(" ra 2t,t S L without service or feeder fee,
,r� 5) each branch circuit
Address: 46.85 2
r , S / 2 Each add'l branch circuit 6.65 2
City/State /ZIP: Co, 4 , 0,--t__ e 7 2 y 0 Miscellaneous (service or feeder not included)
Phone: (Sa3) 1 0 3 0 - (y i k g Fax:: (5 - G3 ) (O 3 0 _ 6 g 7 Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: P t• k5 L. Q hJ f (oil a cc. 3'S X1`2'4-- • Co `"--. Signal circuit(s) or limited-
... .. . .. , e ., ..; , R, as. CONWRkiCTOR: " 5 `�.� !,:. ., 5 ,t ,,, .av energy panel, alteration, or
Business name: � a S c_0, c ) ck (_ON"� extension. Describe: Page 2 2
/ Address: � 3 7 Each additional inspection over allowable in any of the above
vJ � �S Per inspection 62.50
City /State /ZIP: ,o . F - ( G u d c Z 9 2 2- 0 Investigation per hour (1 hr min) 62.50
Phone:. ) G 3 C ) -( ( t(8, Fax: (co 3) ( 2 c3 L7 G ? ('j Industrial plant per hour 73.75
/ ei gl%E.KIRIC =uA L PE'R'1VIIT tMTA`' gin '
CCB Lie.: 11 t{40 $ Electrical Lic.: Z( - / 13 L L. a Suprv. Lic.: 2$ 2 EA
Subtotal
Suprv. Electrician signature, required: / —42 > Plan review (25% of permit fee)
Print name: f r t L t,�� , (As `-� Date: / r 2d (0 t./
State surcharge (8% of permit fee)
TOTAL PERMIT FEE n
Authorized signature: ,ez----- This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: < < r, _ d ( Z„,. L Date: 2/ ao I * Fee methodology set by Tri- County Building Industry Service Board
* * Number of inspections per permit allowed.
i:\ Building \PermitslELC- PermitApp.doc 12/03 440- 4615T(10/02 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES: .
RE 147.0„ TTA,L W®*T ONI Y 0 '=
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
❑ 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\Per nits \ELC- PetmitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection :Life: (503) 639 -4175
INSPECTION DIVISION ' Business Line: (503) 639 -4171 MST
p BUP
Received Date Req ested o J AM PM BUP
ll ,
Location � Ce d Jle.A_ L/ Suite MEC
Contact Person .t.l� Ph ( ) 30 - PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access: /
Ftg Drain ELR ��� r J ��` 3 � 7
Crawl Drain
Slab Inspection Notes: SIT _1�
Post & Beam
Shear Anchors
Ext Sheath /Shear 111/M
Int Sheath /Shear -
•
Framing
Insulation D A f ! IT g �C q �D t� ' �
Drywall Nailing T /T --
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
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
in Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SLIM PART FAIL
'— El Please call for reinspection RE: ❑ Unable to inspect – no access
Fire Supply Line
ADA Date` ° Inspector 4/bk
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL