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Permit ;, ELECTRICAL PERMIT - CITY OF TIGARD RESTRICTED ENERGY e ll s DEVELOPMENT SERVICES PERMIT #: ELR2004 -00352 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/12/2004 SITE ADDRESS: 10300 SW GREENBURG RD 460 PARCEL: 1S135AB -01003 SUBDIVISION: LINCOLN ONE /RED LOBSTER /CASA L ZONING: C -P BLOCK: LOT: JURISDICTION: TIG Project Description: Limited energy for data telecommunications. 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 COMMNET SERVICES ONE SW COLUMBIA ST #300 MICHAEL F KERN PORTLAND, OR 97258 7075 SW ARMITAGE CT WILSONVILLE, OR 97070 Phone: 503 - 412 - 4800 Phone: Reg #: LIC 97334 • ELE 1714LEA FEES Required Inspections Description Date Amount Low Voltage Inspection CITY OF TIGARD MEI\ 11/12/2004 $75.00 Elect'I Final [TAX] 8% State Surchari 11/12/2004 $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 foil _r les adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throu OAR 95 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699. Iss d by /.... /,�� ;ILL 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 Electr al Permit Application - FOR OFFICE USE ONLY ' 1 City o f Tigard Date (� Permit No.. EL, , s , . S p 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 - " Date/B : Other Permit: Inspection Line: 503.639.4175 o1 i Date Read /B I21 See Pa P � ` - Ready /By: Page 2 for g Internet: www.ci.tigard.or.us Notified/Method Supplemental Information . g '�`-� e imrP '+'mac- .g3area alt ar. y ,a n x.G; �r,-�s.,.. r,,.. � - •, '.. S�: -.° x!.•s t "... «.: a ,. k �., -,.. 4314M0,7 'SF1' � ti SAP+ l ° IW „ I ' krin- t' ^ki t`«' .:+ R K:� °. x• 0,,I<N,lll�H',:, W _ .. . >o^.,.K'� er�r'L:�.^e: 7,- �..�� 'is-- ��� ^�,� tTx 't�.?"�a� .._ .. __ •x. ._� n. ❑ New construction ❑ Addition/alteration/replacement Please check all that apply: [1 Demolition ❑Other: Service over 225 amps, comm'l Hazardous location ,._ ,,: . :.,:__ -:<e „rte >r w . w • ,._ amps rating ngov sq.f , EService over 320 a tali Build over l0 000 t. r" ` � . � g o wcw i sQl _ 2 ,, ,,„ "'�? ,, " of 1- and 2- family dwellings 4 or more new residential ❑ 1 and 2 family dwelling ,00 CommerciaUindustrial ❑ Accessory building ❑ System over 600 volts nominal units in one structure EBuilding over three stories ❑Feeders, 400 amps or more ❑ Multi family D Master builder 0 Other: ",:r,c ❑Occupant load over 99 persons ❑Manufactured structures or ` - JO$ R . O 66 O. t1T " e- . ' 07 E ess/li htin plan RV. park :,. _ 4 gym " ,m;. -, - -. <:-1 . ...,. r , ,, * , ,, . W', � ;_ , , , ❑ l g g P Job no.: Job site address: /p ,vv s r El Health-care facility ❑Other: .�GNap,' A40. Submit 2 sets of plans with any of the above. City/State /ZIP: �0� „ex J 9 6 , - The above are not applicable to temporary construction service. i ce,:. F S:H Suite/bldg./apt. no. / Project name: f�T1 //)l /� =, W� , :=_. .�:-, ' "<,-::<_.. ., no.: J l /'1-r-9 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 „�„ Limited energy, non - residential . 75.00 • 2 _.��T,s `. � � � � � Each manufactured or modular dwelling, service and /or feeder 90.90 2 G J - /� /Cif i7444/J 4yi,e,Aj/er. Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 $ w,, ,' a a 201 amps to 400 amps 106.85 2 �G 1 .-- O PROP S #01 : ham ° „'r l „ , �.,, *., ", rW ' k xt ,/ a .4- ''.'' '''. 401 amps to 600 amps 160.60 2 Name: / ? � 6 " j f f�© �c�� y' L. 1 6,_ /�C�� 1 ,) 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 Phone: ( •5) q a - (ion Fax: ( ) relocation 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 it '• .tip a , n 3 ` p si r �� a, `, = A. Fee for branch circuits with service or feeder fee, each 6.65 2 Business name: branch circuit Contact name: /2,464,'C- Xc /VV B. Fee ou service circuits without service or feeder fee, 46.85 2 each branch circuit Address: 707,---5 07 5 ,/ ,i4/u,'"A6. c'T: Each add'l branch circuit 6.65 2 City/State /ZIP: 4 4 .9je, 9 7 7 Miscellaneous (service or feeder not included) Phone: (59" 3 )cif. J Fax: ( ) Pump or irrigation circle 53.40 2 rt j - Sign or outline lighting 53.40 2 E -mail: � /CN,4 L , ICr e ,t 6) /11 �f Signal circuit(s) or limited - - v ` G'Liv et Yt :, : °' `r tam ,' energy panel, alteration, or dU extension. Describe: Page 2 (`.7 • 2 Business name: - 7 )4 ni Address: Each additional inspection over allowable in any of the above Per inspection 62.50 City /State /ZIP: } / Investigation per hour (1 hr min) 62.50 Phone: ( ) FaX ( ) 1 I l CI Industrial plant per hour 73.75 Paw' FL_ rCFarogoRIYI, FEES e ; m ma CCB Lic.: (7335/ Electrical Lic.: / //y 61 Suprv. Lic.: Subtotal '75 .60 Suprv. Electrician signature, required:') 7 L.,,,_,, Plan review (25% of permit fee) Print name: r /G� ,1a , ,/,,/J/ 7 Date: //i t� State surcharge (8% of permit fee) (p •b� � /ZO TOTAL PERMIT FEE l , 60 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. i:\ Building 'Permits\ELC- PernutApp.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* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* • ❑ Vacuum Systems* (l 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 El Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical El Nurse Calls ❑ Outdoor Landscape Lighting* El Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i:\ Building \Permits\ELC- PennitApp.doc 04/03 CITY OF TIGARD 24 -Hour BUILDING Inspection:! ine: (503) 639 - 4175 INSPECTION DIVISION Business Line: (503) 639 - 4171 MST BUP Received Date Requested ✓ I AM PM BUP Location ((3 0 C.) Suite 1 /6 1 MEC Contact Person / J .P Ph ( ) 53 9 - 7 S7 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC g Access: Ft Drain ELR oRa O 35 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 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 SS PART FAIL • LECT Service Rough -In UG/Slab •wTolir- L- E3 vv 2 Fire Alarm ma Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd. AS PART FAIL SITE El Please call for reinspection RE: 111 Unable to inspect - no access Fire Supply Line / ADA Q ' j Approach/Sidewalk Date Inspector sa.1 �'- e Ext Other: Final DO NOT REMOVE this inspection record from the j . site. PASS PART FAIL