Permit ,., CITY. OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00719
� � � DEVELOPMENT SERVICES DATE ISSUED: 11/9/2004
. ��- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1 S135AB -03400
SITE ADDRESS: 10260 SW GREENBURG RD 960
SUBDIVISION: LINCOLN TOWER -TOWN OF METZGER ZONING. C -P
BLOCK: LOT : 014 JURISDICTION: TIG
Project Description: Electrical TI, (10) branch circuits.
Job No. 749
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: 9 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
ONE SW COLUMBIA ST #300 PO BOX 230547
PORTLAND, OR 97258 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 11/9/2004 $106.70
[TAX] 8% State Surcharge 11/9/2004 $8.54 Rough -in
Elect'I Final
Total $115.24
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 fo h_in_OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions • OUNC at (503)
246-6699-61 -800-332-23'44.
Issu d By: k /l , r, / Permit Signature: ( X Q ,�
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 Permit Application / // 'FO R.OFFICE USE, O . • Received ONLY
of igard Date/By: �( 7 6 € Permit No.: „ e x) 13125 SW Hall Blvd., Tigard, OR 97223 - �� ed,
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Nl lp I i Date : Other Permit:
Inspection Line: 503.639.4175 1 I' •• B Date Ready/By: Juris: El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: 'a. Supplemental Information
A ,, �:,_, -" :,. Wink. rc.) -' • *..its-. #,•:aFae;r, =.R "sw _ �"n?„c .:;a -� - ;:.�A<-'a - -
,d`?3` F 'TT _ - „.,� � PTi A . Nha R EVIE.
F,rf� ' -`� " :�'?k' t i � ORI. w - .RR' "' �'i� , v:,•�a
r
, m .., mo , 1n r. , ., ° Y �r:..� r �.�n . . '7 °- . .
. �;.> ,tea ' &' "';. .�'�?t��""��'�� .s , �. .. _ a .., .
- - �:• �v 3as�: - » : n: �r:;«€:",. �:a3 ":�`r ^Z: Sicd�'n.�tt 3t,°�c�::cxti
❑ New construction RAddition /alteration/replacement Please check all that apply:
❑ Demolition El Other: ❑Service over 225 amps, comm'l ❑Hazardous location
<.r< «`" c .,s..:: > . ate ; a i i ; ; ' •;J . `a: :=:rte ss* . .. «. Er.. .. . ., g
Service over 320 amps rating Buildng over 10 000 sq. ft.,
, � v GAT 9 RY Oi t 3 ` r ° y °z � "> „ 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 ther: ['Building over three stories EFeeders, 400 amps or more
❑O
� d , . 1 , ['Occupant load over 99 persons ❑Manufactured structures or
*J @B - If SIN �OO RN akA ,I fV, r,.5r rl' i i6 : li " p l E RV park
, ° ",ems. . . , r _ t,�z , z,,r. ., ", s k , ait .� . ki tuo ❑ Egress/lighting htin g g P Ian
Job no.: 44 Job site address: / 0Z bG ❑Health - care facility ['Other:
S�✓ t°f Submit 2 sets of plans with any of the above.
City /State /ZIP: �� � al C 9). lit 3 ! The above are not applicable to temporary construction service_
Suite/bldg. /apt. no.: G4 0 C " L'i Project name: V HF � - ":�k `a IEEE *v,SCIIEDIjIE '_' **
f( `!J Descri ption Qty. Fee. Total
Cross street/directions to job site: 't New residential single - or multi - family dwelling unit.
/ Includes attached garage.
L-, r c,-(..,— � u.' SU 5 7 f- Q 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
Limited energy, non - residential 75.00 2
•- -,x, ">;c s ,. u- " "` k .. _ .:. a' `*,' `.1k y )'. • 1 , •. , '`4 iz1 : `f3iX0V.,.' '3' 5 , '. A
;fi .,,: , „ nESC o l ,
�� F
°` - . �� .� � � � x � -.,>,� �..� � . „ „,� .;��°�... , m, d .� r:� ..��" Each manufactured or modular
dwelling, service and /or feeder 90.90 2
. i �l 9 dt� Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
•s , .
" .'f':'a;:s .€$ „° _' . :.ssr >,:- :. ; i.: z t ,�•,;,, .. , - iT-x ,;,;�,. ; ; •;'<„r :: 3 ; ". 201 amps to 400 amps 106.85 2
A y - E OWNER`°• § y ¢. ' ... ENAN -” 9,da.
'""�"'° `� °'' ��° '��� �� '�`�` °" °''�`�`"' 401 amps to 600 amps 160.60 2
Name: 0),
E/ c a,�� 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
g ) ill t Z ` �,O relocation 00 m
Phone: (s amps � -r 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
r
" ert `” ;m;g m R - '°� h A. Fee for branch circuits with
; : . �APPI ICANT A g GdNT ACTFERS O: ,
" service or feeder fee, each 6.65 2
Business name: ' branch circuit
Contact name: B. Fee for branch circuits Y C without service or feeder fee 46.85 . 7 — 2
each branch circuit
Address: Each add'l branch circuit 7 6.65 55 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 - •
=:ta�;,: e , it v ; s a = =' - ;:ra, ;a .r .'?f" r ; ', -p di energy panel, alteration
Wit'°» „, �,;, ui °;.�:.._ ., ;GON�IAtCf'I'OR�:�'��. >.,,,. ;'�: .,� ` �= `„� - gY P ,
or
::t _� .��� e,a �a •.:,..�.�. ,a�:;�,�.R,. extension. Describe: Page 2 2
Business name: , , 6.6, � �,- C -
2 6 2 Each additional inspection over allowable in any of the above
Address:
P A � Z S4 Per inspection 62.50
City /State /ZIP: 7,..i N / C• 9 I- z Investigation per hour (I hr min) 62.50
Phone: (r(`(j"j) 62 4 3 k / 1 Fax: ( 4) 6 4 - a' i'c? Industrial plant per hour 73.75
. _ �;,. .i 'I'RIGAtin.PERNTTtFEES *':.� ". •t` `� {
CCB Lic.: 7s c o Electrical Lic.: 3y_ z - Suprv. Lic.: %9iS _ -5 Subtotal l4 ~ ? 7 "
Suprv. E signature, required: i Al L Plan review (25% of permit fee)
44....77 Ai + - 1
Print name: C I Dater (. 9 _ ay State surcharge (8% of permit fee) 4$ i t ;1
TOTAL PERMIT FEE ( f S I a V
Authorized signature: This permit application expires if a permit is not obtained within 150
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:\ Building \Permits\ELC- PetmitApp.doe 12/03 440- 4615T(I0/02 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information '
LIMITED ENERGY PERMIT FEES:r ?
i0140ENTI*45040:WW10,13/1a. WIC
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ A udio and Stereo Systems*
f] B urglar 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
i: \Building\Pemtits\ELC- PermitApp doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISJON ' Business Line: (503) 639 -4171 MST
BUP
Received Date Requested I l Z AM " PM BUP
Location 1 a C 'l� 0� l'>�vl.t Suite `76 4 MEC
Contact Person Ph ( )c.3 06723 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC. o % - 0071
Footing
ELC
Foundation
Access: -
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: — SIT
Post & Beam ' L-f 4
Shear Anchors �l
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
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
n 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
❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
--0:r PART FAIL
SITE : - Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
Approach /Sidewalk Date %/ Inspector - X1/ ' / ct
Other:
Final DO NOT REMOVE this inspection record fro the job ite.
PASS PART FAIL