10250 SW GREENBURG ROAD STE 120 — - ........ .. ..................._ ................ ..........y.... ............ .. ....................................
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_ 5400 N.E COLUMBIA BLVD
PMILD. OREGON
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10250 SW GREEN BURC RI) #120
CITYOF T I G A R D CERTIFICATE OF OCCUPANCY
DEVELOPMENT SERVICES PERMIT#: BUP2003-00678
13125 SW Hall Blvd.,Tigard, OR 97223 (503)6394171 DATE ISSUED: 12/9/2003
PARCEL: 1 S135AB-04500
ZG NING: C-P
JURISDICTION: TIG
SITE ADDRESS: 10250 SW GREENBURG RD 120
SUBDIVISION: LINCOLN BUILDING; PP1991-055
BLOCK: LOT:001
CLASS OF WORK: ALT
TYPE OF USE: COM
TYPE OF CONSTR: 1 FR
OCCUPANCY GRP: B
OCCUPANCY LOAD: 22
TENANT NAME: ROGER BLYTHE
REMARKS: TI, new walls.
Owner:
EOP LINCOLN , LLC
10260 SW GREENBURG RD
SUITE 100
PPhoe ND2pR687Z
23n
Contractor: _
C SCHIEWE + ASSOCIATES
1024 NE DAVIS
PORTLAND, OR 97232
Phone: :34-6617
Reg #: I.IC 54105
This Certificate issued 1/28/2011.1 grants occupancy of the above referenced
building or portion thereof and confirms that the building has been inspected for
compliance with the State of Oregon Specialty C des fort a group, occupancy,
and use under whjFh the referenced permit wa 7ed.
BU L,DI G INSPECTOR BUILDIN�uOFFICIAL'
POST IN CONSPICUOUS PLACE
CITY OF TIGARD 24-Hour
BU:!.DING Inspection Line: (503)639-4175
INSPECTIOi4 DIVISION Business Line: ($03)639-4171 BST
1� up) C�Z� !cP
Received L � 1 5epDa�Requested. 2 �-' AM ..._— PM BUP
Location 2 A
,--T �--.__ suite MEC
Contact Person - 1 D 0 Ph( � - S ly 3 PLM
Contractor -_ Ph( ) SWR
BUILDING Tenant/Owner -_ ELC _........
Footing
Foundation Access: ELC
Fog Drain ELR
Crawl Drain ---"" "-�--
Slab Inspection Note SIT
> z;
Post&Beam --_ -- �'1i t.M •) ir? 1,cQr
Shear Anchors - -- --- -
Ext Sheath/Shear
Int Sheath/Shear --
Framing
Insulation
Drywall Nailing ------ ---
Firewall —.___..-------__-_--
Fire Sprinkler - - - —. --- ---_-__ - ----_-_--
Fire Alarm
Susp'd Ceiling -
Roof
her:: _
Fira
AS PART FAIL
PL BiNG� - -
Post&Beam —
Under Slab
Rough-In _--
Water Service
Sanitary Sewer
Rain Drains - - ---- ---- --� T -
Catch Basin/Manhole
Storm Drain — - — -
Shower Pan
Other: ---------
Final
PASS PART FAIL -
MECHANICAL _
Post& Beam -
Rough-In _
Gas Line
Smoke Campers
Final
PASS PART FAIL -- -- - -�- __
ELECTRICAL
Service --�
Rough-In
UG/Slab - -----
Low Voltage
Fire Alarm �-
Final Reinspection fee of� required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE:.__ _ 7 Unable to inspect-no access
Fire Supply LineADA +
Approach-'�aidewaik Date - -a �c ! Inspector �S L - _ Ext _-------.
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
LASS PART FAIL
__ MECHANICAL PERMIT
CITY
OF TIGARD
DEVELOPMENT SERVICES PERMIT#: MEC2003 00712
DATE ISSUED: 12/15103
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 P7,RCEL: 1S135AB-04500
SITE ADDRESS: 10250 SW GREENBURG RD 120
SUBDIVISION: LINCOLN BUILDING PP1991-055 ZONING: C-P
BLOCK: LOT:001 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS- VENT FANS:
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERSICOMPRESSORS _ HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP: WOODS'rOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTLI: AIR HANDLING UNITS OTHER UNITS:
FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: I:clucatc ducts and grilles fOr I'I. I'roiject Value: $+887.00
Owner: ___ FEES
EOP LINCOLN . LLC Description Date Amount
10260 SW GREENBURG RD NIIA'I I I Permit Pee 12/15/03 $72..50
SUITE 100 TAX I `t" ,State Surchari 12/15/03 $5.80
PORTLAND, OR 97223
Total $78.30
Phone:
Contractor:
MCKINSTRY CO
5400 NE SOLUMBIA BLVD
PORTLAND, OR 97218 REQUIRED INSPECTIONS
Duct Inspection
Phone: 331-0234 Final Inspection
Reg #: LIC 40981
This permit is issued subject to the regulations cont»ined in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is quspended for more than 180 days. ATTENTION. Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-00
(7�
l� Permittee Signature:
f c,
Is ed By: 9 __
Call (503) 39-4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application
--^---- --- Date received: /y s Q Permit no.: Y&A163-15V 7/
City of Tigard Project/appl. no.: Fxpire date:
Cat (!f Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receipt no
Phone: (503) 639-0171
Fax. (503) 598-1960 1 Case file no.: Payment type:
Land use approval' Building permit no.:
U I &2 family dwelling or accessory U Commercial/industrial J Multi-family Tenant improvement
U New constnlction J Addition/alteration/replacement U Other: _-
Q Job address: NJ 103OQ - R RR Indicate equipment quantities in boxes below. Indicate the dollar
�} Bldg. no.: 1_%W ., %_N I Suite no.: I ZO value of all mechanical aterials,equipment,labor,overhead,
Tax map/tax lot/account no.: profit. Value$ _- I G0
Lot: I Block: Subdivision: *See checklist for important application information and
Project name: RG F.R 5L.`ITAff_ jurisdiction's fee schedule for residential permit fec
City/county: 'PO ra TL.,^t.4 p I ZIP: '/,-?-!) -
Description and location of work on premises:
T 14 ANI' T-11FR0VE at4I Fee(ea.) foul
Est.date of completion/inspection: - --- Uescri tion — pts. Res,onis Res.outs
Tenant improvement or change of use:
Is existing space heated or conditioned?)(Yes U No Air handling unit _CFM
Air conditioning(site plan require ) _
Is existinit space insulated'ItYes J No Alteration of existing HVAV system_ _
Boder/compressors
State boiler permit no.:
Business name:
°� R CO' IIP Tons BTU/1I _
Address: AQO t,)& Q0U A 15Fire/smoke dampers/duct smoke detectors _
City: fJ(Z. L.AeAP State:Gl? ZIP: 4 cat pump(site plan required)
Phone: 3Fax:-tr'%(o°{Q(o E-mail: install/replace lumaccibumer_.-_ 147711
Including ductwork/vent liner J Yes J No
CCB ntr: q ( _ _s nsta -rep ace/re ocate healers suspen ee
City/metro lic.no.: 1119 _ wall,or Floor mounted
Name(please print): C t-rL- t �S llrL Vent forappliance other than furnace
e seration:
Absorption units_ f Il I if _
Name: _ tC3�_` �SC�l�rt�-I Chillers III`
Address: Compressors _ _ IIP
0 � F P' Environmental exhaust and ren A on:
City: QCir?_.TLA*l(D I State:QV-I ZIP: 9 Appliance vent
Phone: 4 Fax:331 fo10(- E-mail: Dryer exhaust
Iloods,Type I'll/res. itchewbazmai
hood fire suppression system
Name: Exhaust fan with single duct(bath fans)
Mailing address: Exhaust system a mit from heating or AC
Fuel piping an str ut on lop to 4 outlets)
City: IState: ZIP: - Type LPti _ NCI _ Oil
Phone: F,i I mail Fuc ,i,ici sac additional mer• out cis
Process piping(schematic required)
Number of outlets
Name: _ ter listed appliance or equipment-
Address:
qu pment-Address: Decorative fireplace
City: Slur %IP Insert type — -
Phone: Fax: I -ni.n Woodstoveipellet stove
Other:
Applicant's signature: )Atte: ter:
N ime(print): -- ---
Not ns
all judtaaccept cumarc nn
tnna credit cards,please cell)unsdicnn for tnfnaroo. Permit fee ..................... $
O visa LJ MasterCardcceptNotice. I his permit application Minimum fee................ $
expires if a permit is not obtained Plan review(at _
credit card numl+er — ---- -- within 180 days after it has been ) $
Exryres Y• o
State surcharge(8/o).... $
Name of—car�h (der ns shown on credit card accepted as complete, TOTAL... $
Cardholder atanature Amount
4404617 tMOCOMI
i
SEE 35MM
ROLL# 23
FOR
LARGE
DOCUMENT
CITY OF TIGARD - BUILDING PERMIT
PERMIT#: BUP2003-00678
DEVELOPMENT SERVICES DATE ISSUED: 12/9/03
zalum 13125 SW Hall Blvd., Tigvrd, OR 97223 (503) 639-4171 PARCEL: 1S135AB-04500
SITE ADDRESS: 10250 SW GREENBURG RD 120
SUBDIVISION: LINCOLN BUILDING PP1991-055 ZONING: C-P
BLOCK: LOT: 001 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 1 FR sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 22 BASEMENT: sf AREA SEP. RATED:
STOR: 3 HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT?: MEZZ?: _ READ SETBACKS _ REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: �ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 7,500.00
Remarks: Ti, new walls.
Owner: Contractor:
EOP LINCOLN , LLC C SCHIEWE + ASSOCIATES
10260 SW GREENBURG RD 1024 NE DAVIS
SUITE 100 PORTLAND, OR 97232
PORTLAND, OR 97223
Phone:
Phone: 234-6617
Reg #: LIC 54105
FEES REQUIRED INSPECTIONS
Description Date Amount Framing Insp
IBUILD1 Pemw I rr 12/9/03 $120.10 Gyp Board Insp
ITAX] 8%,Stair Surehar! 12/9/03 $9.61 Susp Ceiing Insp
�fit 1l'PLNj 1'In Its 12/9103 $78.07 Final Inspection
�i l sI FI.S 11111 16 12/9/03 $4B 04
Total $255.82 �~
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. ATTENTION: Oregon law
requires you to follow the 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 a copy of these rules or direct questions to OUNC by
calling (503)246-6699 or 1-800-332-2344.
Issued By:
'r
Pe nn tttee
Signature:
Call 639-4175 by 7 p.m. for an inspection the next business day
Building Permit Application FOR OFFICE
-- Received tS 111mhng
c
Date/By)1 - -U� �, Permit No. U 1'd U -,,,o �17�
City of Tigard Planning Approval Other
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other `
Tigard,Oregon 97223 Datc/ti -LD_;� Pcrnmit No.:
Phone: 503-639-4171 Fax: 503-598-1960 Post-Review Land Use
Internet: www.ci.tigard.or.us Date/By: _ Case No.
24-hour Inspection Request: 503-639-4175 ('.ontaC1 Juris.: Sec Page 2 for
Mame/Method -7 / Supplemental Information
TYPF.OF WORK REQUIRED DATA:
New—construction _ Demolition REQUIRED
&2 FAMILY DWELLING
Addition/alteration/replacement )ther: —
CATEGORY OF CONSTRUCTION Note: Permit fees*are based on the total value of the work performed. Indicate
1 &2-Family dwellin _ _ Commercial/Industrial the value(rounded to the nearest dollar)of all equipment,materials,labor,
Accesso Buildin Ll Multi-Family
overhead and profit for the work indicated on this application.
Master Builder TO Other: Valuation.........................•......................•........ $
JOB SITE INFORMATION and LOCATION No.of bedrooms: No.of baths:
Job site address: 0250 9W t� I�u (to Total number of floors....................•................ _
New dwelling area(sq.ft.)..............................
0
Suite #: 2Bid ./A t.#Linin-I tAdt Garage/carport areas ft. --
Pro
'ect Name: etr �� 't e — Covered porch area(sq.11.)..............•.......•......
—
Cross street/Directiol s to job Sik: Deck area(sq ft•)••••••.•••••••• .••••••..•..•.••.•.........
Other structure area(sq.ft.)............................
i
REQUIRED DATA:
— --- COMMERCIAL-USE CHECKLIST
Subdivision: � Lot#: ___ -- —
Tax map/parcel#: Note: Permit fees*are based on the total value of the work performed. Indicate
DESCRIPT1oi,4OF WORK the value(rounded to the nearest dollar)of all equipment,materials,labor,
e hAn't I re-Jeynevl't, /V F&J wit t6I overhead and profit for the work indicated on this application.
Valuation..............................................•.......... $ 7
-^- —
Existing building area ft. y -I
--- - N v buildin area(sq. ft.
_ Number of stories............................................
PROPERTY OWNER TENANT Type of construction....................................... -
Nalne: EGWITY OFFIaE P( C-F-TIES Occupancy group(s): Existing:
Address: OneSy Co(vrn bi a -Svi fe_ 3On New: p City/Stat /Zior ark O , 9 2Zg — --
Moms" 412-41800 1 Fax: NOTICE: All contractors and subcontractors are required to be
APPLICANT' CONTACT PERSON licensed with the Oregon Constriction Contractors Board under
provisions of ORS 701 and may be required to be licensed in the
Business Name: Gap Ar_ ite�ThG _ jurisdiction where work is being performed. If the applicant is exempt
Contact Name: Fz�(-. Glur from licensing,the following reason applies:
Address: 120 NW Couch St- S�� ' •
Ci!v/State/Zip: Porta► op' _ -- --- --
Phone:5o'b 224-9fo6to - Fax: —T--
E-mail: - - BIIILDINC.PiAMIT FEFS"`.
_ t - CO'T[tACTOR __,`�,,<rr $'lease trCei.>10 ice si hedu G.
Business Name: G. —c.- ewe C -t.
-- fees due upon application.............................. s
Address: O2 E DaVIx S -
City/State/ZiPor-C ')77,'5'2 Amount received.. ---
Phone$o3 21lo -6617 1 FAX: — Date received
CCB Lic. #: 5 q» O S
Authorized Notice: Thk hermit■ xpapplication eires if s permit Is not obtained witbin
Signature: _—_ >Z, -. Date:l2' .03 iRO days after it has been accepted as complete.
f=`a R. Glur
—-- -- --_`-�_ •Fee methodolop'set by Tri-County Building Industry Service Board.
(Please print name)
i 1DstsTemmit Forms\}lldgPermitApp.doc 01/03
Accessibility:
Harrier removal Improvement Plan
City t?f Ti'wii
REQUIREMENT: OREGON REVISED STATUTE (ORS) 447.241.
(1) Every project for renovation,alteration or modification to affected buildings and related
facilities shall be made to insure that the path of travel to the altered area and the restroom,
telephones and drinking fountains are readily accessible to individuals with disabilities unless
such alterations are disproportionate to the overall alterations in terms of cost and scope.
(2) Alterations made to the path of travel to an altered area may be deemed disproportionate to
thri overall alteration when the cost exceeds twenty-five per-cent(25%).
VALUATION: of all renovation, alteration or modification being done
excluding painting, wallpapering. [1] $��rJOC7."�_
multiply: 25% Barrier removal requirement. .25
BUDGET FOR BARRIER REMOVAL [2] $ 14f?1(5
In choosing which accessible elements to provide under this section, priority shall be given to those
elements that will provide the greatest access. Elements shall be provided in the following order.-
(a)
rder:(a) Parking lot restrirplrq,riew sJewovk 1-r�a-4a,' $ gLr�I5.ov ---
-to neL.r road(wnr , awl accerfible 6��(cli�..�
eL't✓aN-vJ
(b) An accessible entrani;e: $
(c) An accessible route to the altered area $
(d) Al least one accessible restroom for $
each sex or a single unisex restroom: �T —
(e) Accessible telephones. $
(f) Accessible drinking fountains: and $
(g) When possible, additional accessible
elements such as storage and alarms: $
TOTAL: Shall_egual line 2 of Value Computation $ 1,�j7Gj o0
i ldsts\fortrLAAccessibility doc 06/07/02
CITY`/ O1 TIGARD _ ELECTRICAL PERMIT
T PERMIT#: ELC2003-00710
DEVELOPMENT SERVICES DATE ISSUED: 12/9/03
13125 SW Hall Blvd., Tiqard, OR 97223 (503) 639-4171 PARCEL: 1S135AB 0450()
SITE ADDRESS: 102.50 SW GREENBURG RD 120 ZONING: C-P
SUBDIVISION: I-INCOLN RIIII DING; PP1991-055
BLOCK: LOT: 001 JURISDICTION: TIG
Project Description: Install 1 branch circuit.
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 HMI 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: IN PLANT:
601 - 1000 amp: _ _ _ PLAN REVIEW SECTION
1000+ amp/volt: 4 RES UNITS: >600 VOLT NOMINAL:
Reconnact only: — SVC/FDR—225 AMPS: _ CLASS AREA/SPEC OCC:
Owner: Contractor:
EOP LINCOLN ,LLC WILLAMETTE ELECTRIC INC
10260 SW GREENBURG RD PO BOX 230547
SUITE 100 TIGARD,OR 97281
PORTLAND OR 97223
Phone: Phone: 503-624-3631
Reg #: LIC 75059
`_ ------ SUI' 10055
_ FEES ELE 14-2830
Description Date Amount
�_— Required Inspections
CI I'Y OE'IIGARD MENU 12/9iO3 $46.85 `
11AN,19%StatcSill dwryc 11 ()'til $3.75 Rough-in
Elecl'I Final
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Muniapal Code. StatE of OR Spedalty 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 These
rules are set forth.n OAR 952-001-0010 through OAR 952.001-0100 You may obtain copies of these r^pa or direct questions to OUNC at(503)
246-6699 or 1-8007�32-2344
Issued By: � _ [k (� .�1 r. )_, Permit Signature: "T" 1 ( qtr J
OWNER !NSTALLATION ONLY __ _
The installation is being made on property I own which is not intended for sale, lease, or rent
OWNER'S SIGNATURE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: — DATE:__—___.-._—_ _
LICENSE NO: —
Call 639-4175 by 7:00pm for an ;nspection the next business day
Electrical Permit application
s Received Electrical ��/
Date/By: .� G Q3 PermitNo,,i vim Opel t�
CityLit of Tigard Planning Approval Sign
g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review other
Tigard,Oregon 97223Date B Permit No.:
,.-
Phone: 503-639-4171 �-iCt'1503-598-1960 Post-Review Land Use
Date/By: Case No.;
Inteimet: www.ci.tigard.or.us ( Contact _ Case See Page 2 for
24-hour Inspection Request: ppb 6*:41�5 r L Name/Method Su lementat Information.
Q tC ri R�n�f --
� ORK - PLAN REVIEW_iI'(ease check all that apply)
LJ New construction J Demolition Service over 225 amps- — Health-care facility
commercial ❑hazardous location
AddlUon/alteratlUn/re lacement Other: []Service over 320 amps-rating of ❑huddmg over 10,000 square feet.
CATEGORY OF CONSTRUCTION 1&2 family dwellings four or more residential units in
1 & 2-Famil •dwelling Commercial/Industrial ❑System over 600 volts nominal one structure
AccessoryBuildin Multi-Family ❑Building over three stories ❑Feeders.400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or RV park
Master Builder Other: O Egress/lighting plan ❑Other:
JOB SITE INFORMATION and LOCATION Submit_sets of purrs with any of the above.
The above are nota licable to temporary construction service.
Job site address: SZ/ -J FEE*SCHEDULE
Suite #: I L(,' Bid ./A t.#: Number of ins ections per ermit allowed
Project Name: IRI Description Qrl _Fee Ira.) Total
CCOSS 5tTee(IDIreC(I n5 t0 O Slte: New residentiai-single or multi-family per
J dwelling unit.Includes attached garage.
Service Included:
IOW 54.ft.or less 145.I S a
Each additional 500 sq.ft.or portion thereof' _ JJ 40 I
Subdivision: Lot#: Limited energy,residential _ 75.00 2
_ Limited enerily,non residential 75.00 2
Tax map/parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and or feeder 90.90 2
Services or feeder%-Installatlon,
—.__ t -_��-�j _ l•K _1^L_1l�2+"Y+-J� alteration or relocation:
/ 200 amps or less 80.30 2
-- -- — 201 amps to 4W arr-is _ ---- 106.85 _ 2
401 amps to 600 ams 160.00 2
PROPERTY OWNER TENANT 601 amps to IOW amps 240.60 — 2
-— - — Over IOW amps or volts 454.65 2
Name: _ _ Reconnect only 66.85 2
Address: Temporary services or feeders-installation,
--�--' alteration.or relocation:
City/State/Zip: 2W amps or less „— 66.85 I
Phone: Fax: 201 amps to 400 amps 100.30 2
APPLICANTCONTACT PERSON 401 it)WK,ams 133.75 2
_ Branch circuit%-new,alteration,or
Name: extension per panel:
Address: A Fee Ibr branch circuits with purchase of
__ service or feeder fee,each branch circuit 6.65 2
City/State/Zip: B Fee for branch circuits without purchase of
service or feeder fee,first branch circuit 46.85 1 2
Phone: — FaX. Each additional branch circuit 6.65 2
E-mail: Misc(Service or feeder not includedi
_ CONTRACTOR Each pump or irrigation circle _ 53.40 2
Each sin or outline lihtin __ 53.40 _ 2
Job No: Z Signal circuit(s)or a limited energy panel,
l t r j r alteration,or extension _ Pae 2 2
Business Name:
� 10.�+h 1 � k Description:
Addre
City/State/Zip:/Staff;/ZI T/ 9 J `7 } Z 7 Each additional Inspection over the allowable In an of the shove: _
�_ Per inspection r hour(min. I hour) _
Phone: 2 y 34 is Fax: 1.1 4- z''t Tf Investigation tee
CCB Lic. #: )%o `i Lic. #: 14 - i?Ir e' other.
Electrical Permit Fq+la*
Supervising electrician V. , Subtotal S
signature required: Plan Review 25°o of Permit Fee) Stl
_
Print Name: I'LL #; q t., - State Surcharge I8"o of Permit Fee) S
TOTAL PERMIT FEE S ; E'
Authorized Nntice: This permit application expires If a permit is not obtained within
Signature Date: 180 da%%after it has been accepted as complete.
.Fee methodolog% set by Tri-founts Building Industry Service Baird.
(Please print name)
i Dsts\Pernit Perim'ElcPernutApp.doc 01'03
Electrical Permit Application - Cif,, of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Feefor All systems........................................................... $75.00
Check Ts'pe of Work Involved:
ElAudio and Stereo Systems*
Burglar Alarm
Garage Door Opener*
Ileating,Ventilation and Air Conditioning System*
Vacuum Systems*
lJ Other
COMMERCIAL WORK ONLY:
Fee for each system.......................................................... $75.00
(SEE OAR 918.260-260)
(Beck Type of Work Involved:
Audio and Stereo Systems
[� Boiler Controls
Clock Systems
F-1 Data Telecommunication Installation
C� Fire Alarm Installation
HVAC
Instrumentation
FI� Intercom and Paging Systems
11 landscape Irrigation Control*
F-] Medical
Nurse Calls
Outdoor Landscape Lighting*
Protective Signaling
E-1 Other -- — i
__Y_—Number of Systems
* No licenses are required. Licenses are required for all
other Installations
t',bsts\PermttForms\ElcPermttAppPg2Aoc 01(1?
CITY OF TIGARD 24-Hour
BUILDING Inspection LI&639-4175 639-4175
INSPECTION DIVISION Business Lin 9-4171 MST
BUP
Received Date Reque ted AM--. PM — BLIP
Location Suite_ Z �� c��
0 Ph( ) _',�L�'- UJ (cz3 PLM
Contact Person --------------
Contractor _ _. J Ph( ) SWR — _-.--
BUILDING _ Tenant/Owner ZiL .tet V eA _ __ ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: ' l SIT
Post&Beam _-- ---- rCJ(A 1T
Shear Anchors -
Exi Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler —
AL
Fire Alarm
Susp'd Ceiling ----- - -._.--
Roof
Other:_ -- -
Final •
PASS PART_FAIL -- T�-- --
P_LUMBINQ --- - -- - -
Post&Beam
Under Slab —
Rough-In 40
Water Service - --
AL Mir—
Sanitary Sewer
Rain Drains - -------.----
-- ---- --
Catch Basin/Manhole
Storm Drain _ — -- --- --- - -- ... ----- --
Shower Pan
Other:
Final ---i__--
PASS PART FAIL ------- - __ _ .------ ---- - .—__— --- ---------- --_--
Post& Beam
Rough-In '�X
--- —--
(=as Line
Smoke Dappers --- — - _ --------- - --- ----- ----- --
f=i�al
PART FAIL. --- -- --- .-- - -- --------- --- ---- -- — --
TRICAL _
Service
Rough-In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of$_ __. required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITEi F] Please call for reinspection RE:,---___ U unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk
Date _ ` -_� Inspectorv � - Ext---------
Other:
Final DO NOT REMOVE this Inspection record from the fob site.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection, Lin% (503)639-4175
MST
INSPECTION DIVISION Business Line: (503)639-4171
SUP _.-- —_—_--
Receivedy• Z 3 Date Reque ted_ _l �M- PM----- - BLIP --
Location ___z L) _ � ' Suite MEC —
Contac! Person =—�---- PLM
Contractor Ph( G ) _ SWR
BUILDING Tenant/Owner
Footing — ELC —
Foundation Acc35S:
Ftg Drain ELR _
Crawl Drain
Slab Inspection Noiec• SIT
Post& Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
raming ---- _ - - —
Insulation
Drywall Nailing ---- - - ----- ------.-
Firewall
Fire Sprinkler -- - - - -----
Fire Alarm
- - - - -- -- --- - - --- _
usp'd Ceiling
Rr 3f
Other: - - - —
Final
PASS PART FAIL.
PLUMBING -- - — — --- -----
[lost& Beam
Under Slab - - -- - - ---- - - -
Hough-in
Water Service —---
Sanitary Sewer
Rain Drains — -- --- - ---- -
Catch Basin/Manhole
Storm Drain -
----
ShowerPan
Other: — -_- - - ---- - -- ----- - --
Final
PASS PART FAIL_ ---- --- ------ - ---------- - ----
--
MECHANICAL
Post&Beam
Hough-In --- ---
Gas Line
Smoke Dampers _ -- ---- -- ----- -- -- _ -- -- --
Final
PASS PART FAIL -- -
ELECTRICAL
Service
Hugh-
Low Voltage ------
FirpAMrat
F L_.J Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
PART FAIL
SITE Please call for reinspection RE: -_.. ... __ Unable to inspect-no access
Fire Supply Line
ADA /
Approach/Sidewalk Date 1 0 Inspector_ —__ -_ �"�`"''� Ext
Other:
Final DO NOT REMOVE this inspection record froni the jo site.
PASS PART FAIL