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Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT 6 DEVELOPMENT SERVICES PERMIT #: ELR2006 - 10019 -- 1 3125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171 DATE ISSUED: 3/21/2006 PARCEL: 1 S135AB -01003 SITE ADDRESS: 10300 SW GREENBURG RD 190 ZONING: C -P SUBDIVISION: LINCOLN CENTER /ONE LINCOLN LOT: JURISDICTION: TIG Project Description: VOICE AND DATA WIRING 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: 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: Contact #: PRI 503 -539 -1851 FEES Reg #: ELE 1714LEA LIC 97334 Description Date Amount [ELPRMT] ELR Permit 4/5/2006 $75.00 [TAX] 8% State Surcha 4/5/2006 $6.00 REQUIRED ITEMS AND REPORTS 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 s to OUNC at 503 -246 -6699. of Issued By: .. .. 4 Permittee Signature: C/7"- 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 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. 1 Electrica 1h�-l :; i �, E ,� 1(11t cq I 1(,1.1 51 o_)1,, � " AFerinria 1 • .`. r^ -; '� > ' ' '�' ; x - N + " . ,. ::, , ximai'+t+a+ .1'I:Ir ° f �n City of Tigard 6 Date/ /By. 3/A4/96, 4)5 Permit No.: '�€ , _l /'i i{ 13125 SW Hall Blvd., Tigard, OR 972 NAP 9 200 Plan Review Phone: 503.639.4171 Fax: 503.598.1' b6 ` ,2 .� l ',�� p ! I `'r Date/By: Other Permit: Ins ection Line: 503.639.4175 ?!;i ?14 Date Read B orr El See Page 2 for p ;_. Y Y g Internet: www.tigard - or.gov CITY,, Notified/Method: L\ Supplemental Information B�E'OF WORK PLAN REVIEW I Pl ] New construction ❑ Addition/alteration/replacement Please check all that apply: ❑ Demolition ❑ Other: ❑Service over 225 amps, comm'I ❑Hazardous location ❑ Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., CATEGORY. OF CONSTRUCTION of 1 -and 2- family dwellings 4 or more new residential ❑ I - and 2 family dwelling ..J Commercial /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 ❑Occupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION • ❑Egress/lighting plan RV park Job site address: ,� ,SC p ❑Health -care facility DOther: Job no.: I 30 aeiz ,/d/A -' /I Submit 2 sets of plans with any of the above. City /State/ZIP: The above are not applicable to temporary construction service. 'hi Suite/bldg. /apt, no.: / /�� e ,� . A j r \� \ D FEE* SCHEDULE no.: g/9a I Project nam 1 YlX - + D✓� �9[.0 Description I Qty. I Fee. I Total , •• Cross street/directions to job site: New residential single- or multi- family dwelling unit. S /� Includes sq. ft. garage. C I/ � . � A � 1,000 sq. . or r less 145.15 4 Subdivision: ��//y�)) / Lot no.: _Ea. add'I 500 sq. ft. or portion 33.40 1 ��v`�YJ �+� / Limited energy, residential 75.00 2 Tax map /parcel no.: Limited energy, non - residential 75.00 2 DESCRIPTION OF WORK Each manufactured or modular r - dwelling, service and/or feeder 90.90 2 ////C Y .� //e /�� f"U� !t' "<J /��10/ Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: - 4// i y I le, // ry 601 amps to 1,000 amps 240.60 2 Address: / SCd 6oLd�� /_ -5„, Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/State/ZIP: 9 7z Temporary services or feeders installation, alteration, and/or relocation Phone: (6 3) V/ /Z - Yd/c/o 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 70 401 amps to 600 amps 133.75 2 Owner signature: Date: Branch circuits - new, alteration, or extension, per panel ' a APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with ' service or feeder fee, each 6.65 2 Business name: G ' p y J „ 0 , , J 6 - T — 5 , /x -,":5- branch circuit B. Fee for branch circuits Contact name: ,/1/, /�c �Lr. ,q/C) without service or feeder fee, first branch circuit 46.85 2 Address: 76 75-- 5 Ste-' ,41E � 1, i6 t( (i Each add'I branch circuit 6.65 2 City /State/ZIP: / 5. 'f/U/ 4./4 i © 70 70 Miscellaneous (service or feeder not included) _ / Pump or irrigation circle 53.40 2 Phone: (5 a.) ,S3 7 /'�,/ Fax: : ( ) Sign or outline lighting 53.40 2 E - mail: Zif /Cf/iys --. , /( /q 777 4/6 -- / -1.---- Signal circuit(s) or limited- CONTRiTOR energy panel, alteration, or rVVVVVVJ •\ r/- � h extension. Describe: Page 2 2 Business name: 6��-- Address: Each additional inspection over allowable in any of the above Per inspection 62.50 City /State/ZIP: Investigation per hour (I hr min) 62.50 Phone: ( ) 3 3 3 Fax: ( ) Industrial plant per hour 73.75 ' ELECTRICAL PERMIT FEES* CCB Lic.: Electrical Lic.: /7 /5/LE,9 Suprv. Lic.: Subtotal Suprv. Electrician signature, required: Plan review (25% of permit fee) Print name: / x/ 6 - - X6 7 Date: State surcharge (8% of permit fee) // j L /' � TOTAL PERMIT FEE ! Authorized signature: /7 /n This permit application expires if a permit is not obtained Aithin 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 \Pennits\ELC- PermitApp.doc 12/30/05 44 0-46 15 T( 1 0/02/COM/W EB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information. LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: 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* ❑ Other: COMMERCIAL WORK ONLY: 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 1:\ Building \Permits\ELC- PermitApp.doc 12/30/05 CITY OF TIGARD , ! BUILDING DIVISION PERMIT #: 2 006 - (Old ( 7 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 gop ∎j' Inspection Requests (24 Hrs.): (503) 639-4175 WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: / 6300 41,,e€ii 0 CLASS OF WORK: SUBDIVISION: T #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date:3 a3 D w Pour Time: od •`> Inspection Description Confirm # Contact # Message et c\ Corrections/Co rr i�ri nts/Ins tructions: PASS H PARTIAL APPROVAL CANCEL I NO ACCESS FAIL I I CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED Inspector: ' V " Date: St f 23JOb Phone #: (503) 718- VILA,'