10220 SW GREENBURG ROAD STE 390 3
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10220 SW GREENBURG ROAD #390
1999
.SAVE - HISTORICAL INFORMATIC N
BUILDINGS) NAME CHANGE
PER KIT CHURCH, ENGINEERING
1.0220 GREENBURG RD, LINCOLN II NORTH
CHANGED TO 10220 GREENBURG RD, LINCOLN III
1022E GREENBURG RD, LINCOLN II SOUTH
CHANGED TO 10220 GREENBURG RD, LINCOLN II
CITY OF TIGARD BUILDING INSPEC PION DIVISION MST _
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 _---
I / BUP
_ Date Requested` -s- AM---PM _ BLD
Location_ _4 7-2,o S Suite MEC
Contact Person _ _ _ Ph Z 3 f PLM
�ntractur Ph — SWR
_ ELC
BUILDING Tenan`!Owner .-- - --
Retaining Wall _ ELR --_------.--_-_�_
FootingI Access: FPS
Foundation ------- ---�-�
Fto Drain SGN
Crawl Drain Inspection Notes:
Slab — a.--— __ ._ T SIT -----------—
Post& Beam
Ext Sheath/Shear -
Int Sheath/Shear
I laming ----- ------
Insulation
Drywall Nailing --------- -- -—
Firewall
Fire Sprinkler --- -- - -- ----
Fire Alarm
Susp'd Ceiling - -- -- -----— -
Roof
Misc - --- - ---- —_ ---- - ---
S'
Fina!
PASS PART FAIL
PLUMBING __--
Post& Beam
Under Slab --
Top Out
Water Service _—
Sanitary Sewer
Rain Drains —
Final
PASS PART FAII
MECHANICAL
Post&Beam— ----- — --
Rough In —
Gas Line
Smoke Dampers
Final _-`--
pi"S_.-PARTS\ FAIL
U:CTRIC
Service - - _--
Rough In
UG/Slab - --- —
Low Voltage
Fire Alarm ------ `-
PASS ART_ FA!L —__---- -- --
si
BackfiliKirading -�
Sanitant Sewe
Storm brair I 1 Reinspection fee of$_ ^re4 sired before next inspection. Pay at City Hall, .3',25 SW Ball Blvd
Catch Basirrnable to inspect-no access
Fire Supph Line I ) Please call for reinspection RE U
-- ,, p
ADA /
Approach/Sidewalk / r
�� ��` G Inspector_ Ext
Other _ __ pate _ -_------�_--
Final
PASS PART FAIL. [10 NOT REMOVE this inspection record from the job site.
/� CIT' OF TIGARD
DEVELOPMENT SERVICES
13125 SW Hall Blvd, Tigard,OR 97223(503)639-4171 ELECTRICAL PERMIT
RESTRICTED ENERGY
PERMIT #: ELR98-0292
DATE ISSUED: 10121198
PARCEL: IS135AB-01004
SITE ADDRESS. . . : 102210 SW GREENBURG [RD #5390
SUBDIVISION. -TWO LINC01-N — "rOWN OF' METZGER ZONING:C—P
BLOCK. . . . . . . . . . . LOT. . . JURISD. CTN: TIG
Project Description: installation of data telecommunication.
A. _RESIDENT' B.
AUDIO & STEREO. . . : AUDIO & STEREO. . : INTERCOM R. 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: FEES ---
NORRIS BEGGS SIMPSON type Pkmol.kn-t by date recpt
10220 SW GREENBURG RD PRMT $ 40. 00 DLH 10/21/98 98-310185
SUITE 225 5PCT $ 2. 00 DLH 10/2 1/'38 98-310185
PORTLAND OR 97223
Phone #: 452-5900
Contractor:
CHRISTENSON ELECTRIC INC $ 42. 00 TOTAL
III SW COLUMBIA
STE 480 REQUIRED INSPECTIONS ------
PORTLAND OR 97201 Low Voltage Insp
Phone #i 241-4812 Elect' l Final
Reg #. . : 000458
This permit is issued siAbject to the regulations contained in the Tigard Municipal Code, State of Ore. 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 IPA
days of issuance, or if work is suspended for more tnan 180 days. ATTENTION: Oregon low requires you to follow rule adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-01-8888. You may obtain copies of
these rules or direct questions to OLINC at (563)246-1987.
PermittSinatitre
ee g . 1L119_14-_EC_t&1
Issi-ted by a t"/ --
A
4* /�1101104/t4�9 7740
INSTALLATION ONLY-----`-------------------
The installat.*.on is being made on property I own which is not intended for,
sale, lease, or, rent. DATE:
OWNFRIS SIGNATURE:
INSTALLATION ONLY---------------------...._._.__ _
SIGNATURF OF SUPR. EL.ECIN- DATE i
LICENSE NO:
.........4•...........................1-4...........................4...........4-+++4-+++
Call 639--4175 by 7:00 P. M. for An inspection needed the next bilsiness day
........4..........4.................4-+++-++4+4-++4•.......................f-++++'+-+ f-4 f
-J
CITY OF TIGARD RECf RESTRICTED ENERGY ELECTRICAL APPLICATION Recd by: /,,,,L//yy''//
13125 SVS'HALL BLVD Da.e Rec'd:-J �P
TIGARD OR 97223 i;CT �; _ 1y98 PRINT OR TYPE ;-� .
�I Permit
�zR98 -&29�,
V-503-639-4171 X304 /�
F-503-684-7297 j` INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:
TL
WILL NOT BE ACCEPTED
Name of Development Project _TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
o Restricted Energy Fee........................................ $40 U0
- (FOR ALL SYSTEMS)
JOB Street Address Ste# ?k ' Check Type of Work Involved
ADDRESS
ty/St to ip Phone# Audio and Stereo Systems
--- cz�1c1 l
Name F)P_c1L I GR. Burglar Alarm
Garage Door Opener"
OWNER Mailing Address :3u_`1
r Su rQ a ,' n Heating,Ventila'ion and Air Conditioning System'
�ityl5tat Zip Phone#
C Y (11 VN OC f Vacuum Systems'
Name �1L
Other
CONTRACTOR Mailing A�drejs WORK INVOLVED
i 'A � �
(Prior to issuance a +ty/State r TYPE OF EU -COMMERCIAL. ONLY
Zip ` Phone# Fee for each system.............................................. $40.00
1 "� (SEE OAR 918-160 260)
copy of all licenses
;,`�i}-�► y'r1c Exp Da e
are required if Oregon ntr. d Lic.#
r- � S 1' Check Type of Work Involved;
expired in C O.T.
data base). Eler rical ontr.Lion# i Cp i Ce ,/ L Audio and Stereo Systems
C.O.T or Metro Lic. Ex D to
�^ � Boiler Controls
Owner's Name E] Clock Systems
OWNER- Mailing Address
Data Telecommunication Installation
APPLICANT
City/State Zip Phone# f -I Fire Alarm Installation
This permit is Issued under OAE 918-320-370.This applicant agrees to l❑_J HVAC
make only restricted energy installations(100 volt amps or less)under thin
permit and to do the following �J Instrumentation
1. Only use electrical licensed persons to do installations where required Paging Certain residential and nlhcr transactions are exempt from licensing ❑ Intercom and g g S ystems
These have asterisks(') All others need licensing; Landscape Irrigation Control`
2. Call for inspections when installation under this permit are ready for a
inspection at 603-639.4176; Medical
3 Purchase separate permits for all installations that are not ready for an ❑ Nurse Calls
Inspection when the inspector is out to inspect under this permrt;
Outdoor Landscape Lighting'
4 Assume responsibility for assuring that all corrections required by the
inspector are done,and; Protective Signaling
5 Assume responsibility for calling for a final inspection when all of the Other
corrections are completed
Permits are non-transferable and non-refundable and expire if work is not Number of Systems
started within 180 days of issuance or if work is suspended for 180 days —
The person signing for this permit must be the applicant or a person
No li,ensee are required Licenses are required for all other installations
authorized to bind the applicant
�1 FEE3: Lc�e
ENTER FEt : -
Signa lire
5%SURCHARGE(.05 X TOTAL.ABOVE) _
Authority if other than Applicant TOTAL _ -
I Walsvesele.doc 7/67
CITYOF TIGARD BUILDING PERMIT _
PERMIT#: BUP2001-00070
DEVELOPMENT SERVICES DATE ISSUED: 2/23/01
1312.5 SW Hall Blvd.. Titiord, OR 97223 (503) 639-4171 PARCEL: 1S135AB-01004
SITE ADDRESS: 10220 SW' GREENBURG RD '390
SUBDIVISION: TWO LINCOLN - TOWN OF METZGER ZONING: C-P
BLOCK: LOT: JURISDICTION: TiG
REISSUE: FLOOR AREAS _ EXTERIOR WALL CONSTRUCTION
CLASS OF WORE: ALT FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?_
TYPE OF CONST: 2FR sf N: S. E: W:
OCCUPANCY GRP: B TOTAL AREA: 000 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 10 BASEMENT sf AREA SEP. RATED:
S1 OR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT?: MEZZ?: READ SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: _ ft RGHT: �ft FIR SPI(L: Y^ SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:U
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE:
Remarks: CorInmercial TI.
Owner: Contractor:
KNICKERBOCKER PROP, INC XXIV C SCHIEWE & ASSOCIATE'S INC
BY NORRIS, BEGGS + SIMPSON 1024 NE DAVIS ST
10pp300 SW GREENBURG RD STE 200 PORTLAND, OR 97232
PPhone ND, OR 97223 Phone: 503-234-6617
Reg#: LIC 54105
F FEES_ _ REQUIRED INSPECTIONS
Type✓ By Date Amount Receipt r Mechanical Permit Require
PRMT CTR 2/20/01 $139.30 27200100000 Electrical Permit Required
Sprinkler Permit Required
5PCT TR 2120/01 $11 14 27200100000
C
Framing Insp
PLCK CTR 2/20/01 $90.55 27200100000 Gyp Board Insp
FIRE CTR 2/20/01 $55.72 27200100000 Susp Ceiing Insp
Final Inspection
Total $29671 --- — - --�
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable law. 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. AT7 ENTION: Oregon law
requires you to follow the rules adopted by the Oregon Utility Notification Center. Thane rules are set forth in OAR
952-001-0010 through OAR 952-001-1987. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246-1987.
Pennitee
Signature:
Issued By:
Call 639-4175 by 7 p.m. for an inspection the next business day
w
Building Permit Application
r
Date received: o ?d/// Permit no.:_'���e2GD/'/J00 7 `^
City of Tigard
City of Tigard l'`
Address: 13125 SW Hall Blvd,Ti cad,OR 97221 Project/appl no.: Expire date:
�
Phone: (503) 639-4171 Date issued: j gy:4, eceipt no.:
Fax: (503) 598-1960 Case file no.: Payment type: S'
Land use approval: I&2 family:Simple Complex:
O 1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U New construction U Demolition
U Addition/alteration/t-epl ice►nent )(Tenant improvement U Fire sprinkler/alarm U Other:
Job address: 00Z'Z )
�1 — _�'�� Bldg.no.: aJ�
Suite 1p
Lot: y I Block: Sutxiivision; Tax map/tax lot/account no.:
Project name: 9U1_TM '!#')fl RA?'ljJ& A" j%N ' /0 •7Fni111117 —"Descriptiond location of work on premises/special conditions: ( '5otO�j ._ SIU�. 1�/`�cit%7N
C4gj&57Z L9—_ G
Name:5 S ►4v---> 41bo
Mailing address; QQ,(pp vAj r` ib"(_— VZO 1 &2 bmily dwelling:
City State: OIQ IZIP: ,, Z3 Valuation of work........................................ $
Plione: e- Fax: E-mail: No.of bedrooms/baths.................................
Owner's representative: K'R.I.S C-.t.oMMA-LTotal number of floors....................
------------Phone: ---
Fax: l ns it New dwelling area(sq.f.. .......................
Garage/carport are ft.).........................
Name: �/0�.vtti� �tt..� (�_ 3'Tj21�t� 7•(L_ Covered po rea(sq.ft.) ...............I.........
Mailing address: Deck Wa(sq.ft.) ................•.......................
T --
City: I State: ZIP: ter structure area(sq.ft.).........................
Phone: Fax: E-mail: (,ommerclal/industriai/mniti-fauilly:
Valuation of work........................................ $ '.
Business name: C . 'SC_ 41D►Aja A�;;&(. Existing bldg,area(sq.ft.) .. .................}....
Address: i tj New bldg.area(sq.ft.).......... �.�.:.. ... �1 l
City Statep ZIP: 7 -Z Number of stories ..... .......................... .... N�W."Tt
— Type of construction....................................
Phone: . (a(p/ Fax: Z, b, mail:
�'—� - Occupancy roar s
te
CCB no.: (��01 ! Y g P( ): Existing: �' —-
New: _—��---—
City/metro lie.no. Notice.All contractors and subcontractors are required to tx
OTT==I W 11119 a licensed with the Oregon Construction Contractors Board under
Name: _ prov.sions of ORS 701 and may be required to be licensed in the
Address: Ju indiction where work is being performed.if the applicant is
City: State: LIP: exempt from licensing,the following reason applies:
Contact person:— ---- Plan no - — - -
Plinnr I a• 1 ;n;ul — — ----
1311110111
Name: _ I Contact person: Fees due upon application ........................... $
Address: 30/ Date received:
City: tat ZIP: _ Amount received ......................................... $_
Phone: _ x: Email (_ Please refer to fee schedule.
I hereby certify 1 ve read a ea".nined d)s applicatio and the Not ail jurisdictions resp credit cards,tdwe cUl jurisdiction for roots infoemation
attached chec st.All prov' ions of laws,tfnd ordinanc governing this U Visit U Mastercard
work will omplied wi ,whethe tied re' or not. ..��//ss Credit cord number
Authorized SigllatUre: ale: ~Narrr of cardholder u shown on credit cud
Print name: �c —
Cadholuf siprature Mnouni
Notice:This pe it application expires If a permit is not obtained within 180 days after it has been accepted as complete. 4141611(6uvCOM)
/h t• a ,fs'ur� � ,R, !C<' .S-S
y<.
COMMERCIAL. FLAN SUBMITTAL
REQUIREMENT MATRIX
Plan review is dependent upon submittal of a completed application and pl:5ns.
After plan review approval, the Plans Examiner will contact the applicant to
request additional plan sets for distribution purposes (for Contractor, City of
Tigard, Washington County, and Tualatin Valley Fire & Rescue).
Total # of
TYPE OF SUBMITTAL Plans KEY:
Submitted
S == Site Work (must include
S (New, Add or Alt) 4 location of all accessible parking)
D (New, Add or Alt) B = Building
F (New, Add or Alt) 3** F = Fire Protection System
M (New, Add or Alt) — 2^� M = Mechanical
P (New, Add or Alt) ^ 2 P = Plumbing
E (New, Add, or Alt) 2 E = Electrical
�_._-.-------� New = New Building
Add = Addition
Alt = Alteration to existing
building
*For over-the-counter commercial tenant improvements, submit 2 sets of plans.
**"New" requires that plans bear the original seal of an Oregon licensed fire
suppression engineer, or NICET level technicians.
I:\dsts\forms\matrxcom.doc 10/27/00
CITY OP TIGARD
Approved.
...........rte
ConditlonsllY APP in:....
For only the word PO 1_
PERMIT NO._►7—u-- ..........( )
See letter to:Follow....-••` ( )
.
Job Address: Opts:_.��� _ �! .� t
v v x i
�U ITEE _
`j 390
/ QP=N10 M FACtIlt"M - -
goz- V14
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at" jLetO&�- , h -1 W
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• DU mo SwOM 04�e_�Z_, 4' 0 2' 4'
• Caa-pc.� —� ,� , �.�..
. o�o�.,al �� oda re G k -'� �ar�C o-F4'►�cam- (Pn ce? ) —
,��►,� LINCOLN `ENTERtiuite iso
�� Two I_incolit — Third Floor APRIL 28, 19 9 i
CITYOF T I G A R D Y ELECTRICAL PERK41T
DEVELOPMENT SERVICES DATE IS UIED: 3/5C 1001-00131
13125 SW Hall Blvd., Tigard, OR 57223 (503) 639-4171 PARCEL: 1 S135AB-01004
SITE. ADDRESS: 10220 SW GREENBURG RD 390
SUBDIVISION: TWC LINCOLN - TOWN OF METZ_GER ZONING: C-P
BLOCK: LOT : JURISDICTION: TIG
Proiect Description: Installation of branch circuit for commercial TI.
_
RESIDENTIAL UNIT TEMP SRV_C/FEEDERS_ MISCELLANEOUS
1000 SF OR LESS_ 0 - 200 amp: PUMPARRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL.
MANF HMI SVC/ FDR: 601+amps - 1000 volts: MINOR LABEL (10):
_ SERVICEIFEEDER 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/vol:: -4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect on!v: SVC/FDR >=225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
KNICKERBOCKER PROP, INC XXIV Wit LAMETTE ELECTRIC INC
BY NORRIS, BEGGS 4 SIMPSON PO BOX 2°0547
10300 SW GREENBURG RD STE 200 TIGARD, OR 972.81
PORTLAND, OR 972.23
Phone: Phone: 624-3631
Reg #: LIC 75059
SUP 1965S
ELE 34-283C
FEES _ _ Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT CTR 3/5/01 $46.85 2720010000( Elect'I Final
5PCT CTR 3/5/01 $3.75 2720010000(
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 acoordancr-,!,.irh approved Flans. This permit will expire it 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 adooted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952-001-0010 through OAR 952-001-Op80 You may obtain copies of these rules ordirect questions to OUNC at(503)
246-1987 I
PERMITTEE'S SIGNATURE I ISSUED BY: ',-1r��s �'
/6WNER 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 INSTALL.'kTION ONLY
SIGNATURE OF SUPR. ELEC'N: _ DATE: 3 S C1
LICE14SE NO:
Call 639-4175 by 7:00pm for an inspection the next business day
Electrical Permit Application
-- Date received. 0 Permit no.:r
City of Tigard Projecdappl.no.: fExpiredate:
City of Tigard Address: 13125 SW Hall Blvd,Tigard.OR 97223 Date issued: B Receipt no.:
Phone: (503) 639-4171 —
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval:
VYPX OF PERMIT
U I &2 family dwelling or accessory O Commercial/industnal U Multi-family ,Q Tenant improvement
U Now constniction U Additionlaltnralic;,!rcplaccmcnl U Other: __. U Partial
11 SItE INFORMATION
Job addiess: t h,r, IVI Bldg.no : Suite no.:377 Tax neap/tax lot/account no.:
Lot: Bock: Subdivision:
Project name: Ve rL Ery„ Description and location of work on premises: RT(o r,_, 5�.�, j c•1�
Estimated date of co t:let ion/inspection:
CONTRWIAIR 1 So 1
Job no: cy y y lar
Business name: �� ,�t r �r t _ Descrfptiun _ Qty. (ca.) 7btal no.insp
New residential-single or muni-family per
Address: Q ,.,i Z s'C ; dwellbrgunh.includ s atinclKrl garage.
City: , AAn State:(k ZIP: y�Z�// Service Included:
Phone: ; {, Fax:bL s(-2q E-mail: 1000 sq n.or less ^_ a
Each additional 500 s .ft,or portion thereof
CCi,no.: Esc t qElec.bus.lie.no: j4 2S ;( Limited energy,residential 2
city/warolic.no.: !j l.tmited energy,non-residential 2
I Each manufactured home or modular dwelling
Si a urc of su rvi g electrician(required) _Dale Service and/or feeder 2
Sup.elect.name(print): O A,,, F, c- License no: I y S Services or feeders t Installation,
alteration or relocation:fon:
i 1 ,
200 amps or less 2
Name(print): 201 amps to 400 amps 2
-—— - --- 401 amps to 600 amps 2
Mailing address 601 amps to IOW amps 2
City; I Slate: I ZIP: Over 1000 amps or volts 2
Phone: I E-mail Reconnect onlyI
Owner installation:The installation is being made on property I own i'emponry services or feeders-
which is not intended for sale,lease,rent,or exchange according to Installation,alteration,or relocation:
ORS 447,455,479,670,701. 200 amps or less _ —2
201 amps to 400 amps 2
Owner's signature: _ Date: 401 to 600 ams — 2
&ancl clrcalu•new,alteration,
or extension per panel:
Name:_ _— A. Fee for branch circuits with purchase of
Address: _ service or feeder ft:,,each branch circuit 2_
City: Stale: ZIP: B. Fee for branch circuits without purchase
of service or feeder fee,first branch circuit: yf:6� �� 2
Phone: I it, E-mail: Each additional branch circuit:
Misc.(Service or feeder not Included):
7vice225anips-commercial UHcahhCarr facility Each ump or irrigation circle 2
320amps-ratingof 1&2 U Hazardous location Hach sign or outline lighting 2
ngs U Building over 10,000 square feet four nr Signal circuit(&)or a limited energy panel,
U System over 600 volts nominal more residential units in one structure alteration,orexlension• 2 _
U Building over three stories U Feeders,400 amps or more •Iks r.��.n: _
U Occupant load over 99 persons U Manufactured structures or RV park Each additional inspection over the allowable in any of the alcove:
U Egrtss/lightingplan U Other: _A PerinsprcHon E-7
Suhm11 eels of pians with any of the airmve. Investigation fee _
The above are nut applicable to temporary construction service. Other
Na all Jurisdictions accept crectit cards,please call Jurisdiction fotmore Information. Notice:This permit application Permit fee.....................$ (� I
U visa U MasterCard expires if a permit is not obtained flan review(at _ %) $
Credit cud number:__ �_ within 180 days after it has been State surcharge(8%)....$
iiapires accepted m complete. 'TOTAL $ `Y@ •A
Nurse d o f r u shown on credit c
S
` Cardhddrr siarumreAmount
1404613(6MCOM)
Electrical Permit Fees; Limited (Energy Fees:
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: — —
p Restricted Energy Fee...................................................... $75.00.00
Number of Inspections per permit allowed
)I (FOR ALL SYSTEMS)
Service included: Items Cost Total y Check Type of Work Involved:
Residential-per unit
1000 sq it or less $145 15_ 4 Audio and Stereo Systems
Each additional 500 sq.It or
portion thereof — $3340_—� 1 Burglar Alarm
Limited Energy _ $75.00
Each Manufd Hume or Modular ❑
Dwelling Service or Feeder $90.90 2 Garage Door Opener'
Services or Feeders Heating,Ventilation and Air Conditioning System'
Installation,alteration,or relocation
100 amps or less $80.30 2
201 amps to 400 amps $106.85 W_ 2 Vacuum Systems'
401 amps to 600 amps $160.60 a
601 amps to 1000 amps $240.60 2 Other
Over 1000 amps or volts $45,465 2 ----- -
Reconnect only $66.85 _ 2
Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Installation,alteration,or relocation
200 amps or less $66.85 2 Fee for each system.......................................... ............... $75.00
201 amps to 400 amps — $100.30 2 (SEE OAR 918-260-260)
401 amps to 600 amps $133.75 2
Over 600 amps to 1000 volts, Check Type of Work Involved:
see"b"above.
❑ Audio and Stereo Systems
Branch Circuits
New,alteration or extension per panel
a)The fee for branch circuits ❑ Boiler Coutrois
with purchaaa of service a.
feeder fee. Clcck Systems
Each branch circuit $6 f)
b)The fee for branch circuits Data Telecommunication Installation
without purchase of service
or feeder fee. Fire Alarm Installation
First branch circuit _ $46.85
Each additional branch circuit —^ $6,65 ❑
HVAC
Miscellaneous
(Service or feeder not Included) ❑ Instrumentation
Ea.h pump or irrigation circle $53.40
Each sign or outline lighong $53 40 ❑ intercom and Paging Systems
Signal circuits)or a limited energy
panel,alteration or extension $75.00___
Minor Labels(10) $125.00 _ Landscape Irrigation Control'
Each additinnal Inspection over ❑ Medical
the allowable In any of the above
I'er inspection $62.50 Nurse Calls
❑
Por hour — $62.50
In Plant $r,,75
—' -- L� outdoor Landscape Lighting'
Fees:
Protective Signaling
Enter total of above fees $
8%State Surcharge $ tither_ _
2s%Plan Review Fee Number of Systems
See"Plan Review"section on $
front of application - _ No licenses are required Licenses are required for all other installations
Total Balance Due $ Fees:
❑ Trust Account# Enter Intal of above fees
8%State Surcharge $
Total Balance Due $
i:wsls'%fornuklc-fces.dm I0t09/00
CITY OF TIGARD BUILDING IN}PECTION DIVISION
24-14our Inspection Line: 639-4176 Business Line: 639-4171 M3T
_ -Date Requested B U P
—_.� _-- -- -`_AP1_ PM ___— BLD
Location
�G LA- 49 J`^ _/ �•^�G y � i:iNY�.. i4Ite- _2. __ MEC
Contact Person y _ �' ,w{ ph ,3C��r GS_L - PLM
Contractor Ph — SWR _
Tenant/Owner ELC _
Retaining Wall --- — - EL.R '---- -
F Ming Access: ---------------
Foundation FPS
Ftg Drain -----------
Crawl Drain Inspection Notes. SGN
Slab --
Post& Beam - ----- ----- - - --- - SIT
Ext Sheath/Rhaar --
Int Sheath/Shear ------- ----- -----_
Framing
Insulation -------- ---- --- - ---- ---- --
Drywall Nailing --_--
firewall
Fire Sprinkler
Fire Alarm ------__._-. - ------------ - --- -- -
Susp'd Ceiling
Roof -- -- - --- - ----
WASSTPART
— - - ---
FAIL
BING -, --- _-
Post&Beam
Under Slab
TopOut _- — -- ------------- ------- ---------- -
Water Service
Sanitary Sewer - --------- �---
Rain Drains
Final ---
PASS PART FAIL
MECHANICAL ---"- - -._-------
Post& Berm
Rough In
Gas Line -------- --- ---- -----
Smoke Dampers
Fi-ial - ------..----...
PASS PART FAIL ------- --- ---------_ ----__
ELECTRICAL - -- -- -- --------- - -
Service
Rough In
UG/Slab
Low Voltage -- --
Fire Alarm
Final - - - -
PASS PART FAILSITE - -
Backfill/Grading --------- ----- --
Sanitary Sewer
Storm Drain [ ] Reinspection fee of$ _ required before neap inspection Pay at pity Hall, 13125 SW I fall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE. �— [ ] Unable to inspect-no access
ADA
Approach/Sidewalk Date
Other l/ Q� Inspector V_ _—-�—"-- Ext
r ina
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
�e�