Permit ' OF TIGARD RESTRICTED ENERGY
Apr DEVELOPMENT H PMENq Tigard, � 639 -4171 DATE SSU E%30/0 0366
- 13125 2004
SITE ADDRESS: 10260 SW GREENBURG RD 530 PARCEL: 1 S135AB 03400
SUBDIVISION: LINCOLN TOWER -TOWN OF METZGER ZONING: C -P
BLOCK: LOT: 014 JURISDICTION: TIG
Project Description: Low voltage for card access.
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: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: CARD ACCES X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
EQUITY OFFICE PROPERTIES TRUST TELDATA SYSTEMS
ONE SW COLUMBIA ST #300 PO BOX 88983
PORTLAND, OR 97258 SEATTLE, WA 98188
Phone: Phone: 206 - 682 - 8721
Reg #: ELE 37- 706CLE
LIC 114991
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 11/30/2004 $75.00 Elect'I Final
[TAX] 8% State Surchart 11/30/2004 $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 questio o OUNC : 1503) 246 -6699.
Issued by. , L ,1 f/ 1 Permittee 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:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
w ,
Electrical Permit Application - FOR OFFICE U SE ONLY - • .
.
City Tigard Received ; • Pernuto.: (f �,/
13125 SW Hall 'Blvd., Tigard, OR 97223 DDate/By: I ,I,„, ,I,„, # N ! - 00
g Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 dr ,rNi Date/ : Other Permit:
Inspection Line: 503.639.4175 �, 1i `1 Date Ready/By: ISM RI See Page 2 for
'ntemet: www.ci.tigard.or.us Notified/Method: Supplemental Information
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._., . .: . .«. ,,. ,. - 4 ,. .,, , al:. , , " - i`x,, ,c.,
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. - .,.,.... ,..�.... TYP . E s OF,. A _. r.. ,.4 .: , ��PLA:
❑ New construction ❑ Addition/alteration /replacement Please check all that apply:
El Demolition ❑Other: ❑ Service over 225 amps, comm'l ❑Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
:? la , v;cr '.:� ;4s. w 'tp,: ; .:,. CATEGORY``OE.`CO -^ = e :: ~a'" i : ": - i ', of 1- and 2-family dwellings or more new residential
x._..�o-�,.�>=a;a �aa�;. �.<>.�+u�,�E:,�_., -- � � �:: �„r��,rt v�,:'v�k��:��ti >�:�� ;, � :,,,..�.,N�ta. ... �:. > Y gs 4 o
El 1- and 2- family dwelling [ V'tommercial /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
. ,, :,. A MA >A: . .;,,:; F . r =,, - ;.F , °.,. .3 ,' ,.°
wy ",,,i • ❑Occupant load over 99 persons ❑Manufactured structures or
;;5':: '.t-= . ,,,`: B =l 4 kE., K :. ' 3 park
:,, f „: , I Q °s ,,,,,- OI2IYIATIOl�1;,„,,,,, LOCATION t +g "�. ' ❑E ess /li htin lan RV P
-�L x",.- a€l?:: ,.:� a+_wxv° �'i ��.5��i�x-ccrc -: <e.�v? =�� a .u�a�^as..xaK;xxt =,�vna �. W _�.w�.'�s..:�:.�s„:'� <;, �_. ,.. L- +.S.•:r."�:ar, t� §, � g g P
Job no.: Job site address:) 03k0 St 6 1U\2G ❑Health -care facility
❑ Other:
Submit 2 sets of plans with any of the above.
City /State /ZIP: The above are not applicable to temporary construction service.
Suite ldg. /apt. no.:S 3 D Project name: � rA- 6 . C K� -, .. �� � ` ' ,'' °; .,, ,. r .. <y,.... , ,,. . ' : `. -
' .,
Description Qty. Fee. Total
Cross street/directions to job site: L, cj L., C_ j 't7- d f _ _ 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') 500 sq. ft. or portion 33.40 1
•
Tax map/parcel no.: Limited energy, residential 75.00 2
p�., r , °, eM , m4 ",, Limited energy, non- residential 75.00 2
`." { :*cs`; , ' M r; + �'`,.a,� - •; ! r ` .> " �'u 3 ` ":'�..i'°' .. i � a; i,' - "?x�
: r. ; : 'a l y 40,1017b% l O > ®F' W r. °d '�r: ; t `
:.. �., �; �m, ��ls :�.� �r - �>.r T �. lY`:: ��c?:��.:'�- •':ate,: >. w'�'s.,.,�4 ��.: , >..>, . R',:,.r._ Each manufactured or modular
� ` n (�/� j� t dwelling, service and /or feeder 90.90 2
l� 1 ` r G/'!/ `' t eac;s lJ � ��� 4_.1 Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
, .,,...� , �� ,,,, i i ii tie, r.,:'. :s�.v' ; 5 "�rer - ; ,a ye+R:rsT-- re,`: +;�;s.e Vis 'a,�,., gi :51, r. ^;: ",z`edZ' 201 am s to 400 am
P
��`I tK^,,M €�, � 4 ''`� _ a.�� :�: a„� - " '` � �?� -� , ��w,� p s 106.85 2
t = PROPER. ,OWNERM ' - ,d r ENAIV1. Iii ,s,. ,
,s a> F >� _4r.> �k. =,n ,,, i a .3..rS,u, i < „ «`'.,r . ,,_ =.r:�.. .? s 401 amps to 600 amps 160.60 2
Name: k jk_ e_Cs 601 amps to 1,000 amps 240.60 2
ddress: 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
. ' yak« -- �;;:�, -�; ��s:�. .�.. .,, gar, ,�, "� •,��;a �.� fi�.. . �,.,,;
'""c ; ?. 1 z g 147,1 . -°" ; q, �, fir, . A. Fee for branch circuits with
1 3 r ., t,' , APP. I.CGt r roc w. ^- ,. 't ' '' r "` :,
s.wra� :. .. r -: _. +te 3.r _.,OIVTAC : e; _ z
service or feeder fee, each 6.65 2
Business name: ci S branch circuit
Contact name: �O� WrS� B. Fee without service circuits
without service or feeder fee, 46.85 2
Address: 3 03 ` Ss Mc._ , each branch circuit
Ea ch add'1 branch circuit 6.65 2
City/State /ZIP: c. c ._ ( qg ( 3 4 Miscellaneous (service or feeder not included)
Phone: Fax: : clot) 6ga- b7DZ Pump or irrigation circle 53.40 2
a Sign or outline lighting 53.40 2
E -mail: _ 7 &S- 60 f . Signal circuit(s) or limited -
;.,� ;,,,;� },: ,;�"i'.'tn. ' +; i::"�,; :,si*- - `B�''° a.�.r. x;,: ; •4 's(;:r�`- wc>nr il l
., TW ` _ ,t. ,x ; . I 4' i.*'`�'s'.•.. { a.: ^,'. 5w .Si�^", -r :ri,.
,.,� - _ ,, �^ � Y' ener Panel' alteration, or
r ,..:,�>,.;_:f,�"�'�:.:rT';'s`<� �;� `�s�€'�:i�':k:i�s`', - ':C,ON`>PR:ACTO .�.�;..�.t, ".� = ;::;M:�.���`�: E"`� a+'� � `,i�%,yy'„ : t` gY P
r "� «��� extension. Describe: Page 2 2
Business name: [ C. 0 (\ g9c, -h f0
(5` � - 3 I Sj - Ct v Each additional inspection over allowable in any of the above
Address: _
is-
/ tz Per inspection 62.50
City /State /ZIP: S £ M1 I / Investigation per hour (1 hr min) 62.50
Phone: (91 vc ga _ D v , Fax: (. C(,) (e3 -2 -- 0,70,2_ Industrial plant per hour 73.75
';n =iNian LE;CTRIGAWERN :15 S* _''
A _` r '
CCB Lie.: 1 I 1.4q01) � Electrical Lie 5L L-8 Suprv Lie.: "
Subtotal
Suprv. Electrician signature, ,rv, required: Plan review (25% of permit fee)
Print name: � �1�/A,, ,�� Date: 3 Q0 tate surcharge (8% of permit fee) `� TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: ` Cr l Date: • Fee methodology set by Tri -County Building Industry Service Board
" Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PermitApp.doc 12/03 440- 4615T(10 /02 /COM/WEB
CITY OF TIGARD. 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: -(504639 -4171 MST
BUP
Received Date Requested / — .R 6 AM PM BUP
Location !'6 a (C) Suite S 6 / MEC
Contact Person Ph ( 1 7 0 (0 ) �3 ' 7 a (� PLM
Contractor U Ph ( ) SWR
BUILDING. Tenant/Owner ELC
Footing
ELC
Foundation Access:
Ftg Drain ELR e DO
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm /^
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL )4
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
tizECTRICAIL •
Service
Rough -In
UG /Slab •
Low Voltage
Fire Alarm
ina Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SS> PART FAIL
SITE , ❑ Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line ` 1
ADA � �� Inspector 1 ` \N s �L \le X11 Ext
Approach/Sidewalk D a t e P J
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL