Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00292
I� DEVELOPMENT SERVICES DATE ISSUED: 5/22/03
`�'` F,� ��. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171
PARCEL: 25101 DA -00102
SITE ADDRESS: 13221 SW 68TH PKWY
SUBDIVISION: TRIANGLE CORPORATE PARK ZONING. MUE
BLOCK: LOT : 002 JURISDICTION: TIG
Project Description: Install 4 - 60 amp feeders and 14 branch circuits.
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: 4 W /SERVICE OR FEEDER: 14 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
TIGARD TRIANGLE I LLC GREENWAY ELECTRIC COMPANY
4650 SW MACADAM AVE STE 220 15145 SW GULL DR
PORTLAND, OR 97201 BEAVERTON, OR 97007
Phone: Phone: 503 - 579 - 8054
Reg #: LIC 153421
ELE 34 -617C
FEES SUP 4210S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/22/03 $414.30
[TAX] 8% State Tax 5/22/03 $33.14 Elect'I Service
Rough -in
Total $447.44 Elect'I Final
This Permit is issued subject to the regulations contained in the Tigard Munidpal 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 d' ect questions to OUNC at (503) 246 -6699 or
1- 800 - 332 -2344.
Issued By: & 452/&4 Permit Signatur . w,,
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lea , or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:OOpm for an inspection the next business day
i
Electrical Permit Application L :1: t l 1
r T Date received C- 1
- Permit no.: t Co 7O, -
I i C l of 11d Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: CIM Receipt no.:
Phone: (503) 639 - 4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
1%pl. or 1'1.1? \1Li .
0 1 & 2 family.dwelling or accessory Commercial /industrial 0 Multi family 0 Tenant improvement
0 New construction .I ddition/alteration/replacement 0 Other: 0 Partial
• •• .11)13 'NH I. I \I l)It\l \'I•I( ►\
Job address: 13221 SW 68th Parkway Bldg. no.: Suite no.: 200 Tax map /tax lot/account no.:
Lot: I Block: I Subdivision:
Project name: Health Net UPS !Description and location of work on premises: Second Floor
Estimated date of completion/inspection: 5/23/2003
• ( ' () \ ' I H \ ( ' I O I t \1311/1 It \ 1111\ 1 .'( I.t:
Job no:
30325 -1 Fee Max
Business name: Greenway Electric Company (ea.) Total no. ins , New residendsd - dm/barmaid-family per
Address: 15145 SW Gull Dr.
City: Beaverton I State: OR I ZIP: 97007 503_5794054 579 - 8056 m .roorte ?verizon
Phone: Fax: E -mail: III1
Each additional CCB no.: 153421 Elec. bus. lic. no: 34 - 617C
Limited City/metro lic. no.: s at ttr►>P 3 ■■ Si lure of supervising elecdfcian (required) Date 2
Sup. elect. name (pmt): James V Ronne License rro: 5025S Sere :, n " n'
alteration . -- . don:
. I' I(() i' I : It 1 1 1111 \ d. It 200 amps or less % "
Name (print): 201 antes to 400 amps amps
Mailing address: • 60 to � 1OW
as
City: I State: [ZIP: Over 1000 amps or volts
Phone: I Fax: 1E-mail: Reconnect only
Owner installation: The installation is being made on property I own Temporary services orfeeders
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orre1ocation
ORS 447, 455, 479, 670, 701. 200 amps or less
201 amps to 400 amps
Owner's si _. : ture: Date: 401 to 600
1. .N' 1; I \ lilt It Braneb circuits - new, alteration,
or extension per panel:
A. Fee for branch circuits with purchase of
• r r service or feeder fee, each branch circuit i
B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit:
Phone: Fax: E
Each additional branch circuit:
• 1 ' 1 . \ \ I l l \ I I. \\ • (I'Ica.0 rltt•rk :111 111:11 :lpltit I Misc. (Service or feeder not included):
O Service over 225 amps-commercial 0 Health-care facility Each pump or irrigation circle 2
O Service over 320 amps- rating of 1 &2 0 Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
0 System over 600 votes nominal more residential units in one structure alteration, or extension* 2
O Building over throe stories 0 Feeders, 400 amps or more *Description —
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable In any of the above:
0 Egress/lighting plan 0 Other: per inspection 1 1 1 l
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $ (//Y. 3o
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application $ f
O Visa O MasterCard expires if a permit is not obtained Plan review (at B %) J 3
Credit card number: / / within 180 days after it has been State surcharge (8 %) $
Expires accepted as complete. TOTAL $ YY7. Yy
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440.4615 (6/00 /COM)
CI,TIr OF TIGARD 24 -Hour -
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requeste• AM PM BUP
Ilizaajp
Location � �► 4P -mm Suite MEC
Contact Person Ph ( ) PLM
Contractor �'I�17 L c- Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC '� - Z92--
Foundation Access: • t�
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation -, j - 10/ RI H _• C /�
Drywall Nailing ( �!
Firewall
Fire Sprinkler
Fire Alarm (f r
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
PASS PART FAIL
ELECTRICAL
Service
Rough -In ,i! =
UG/Slab
Low Voltage
Fire Alarm
. Ina \ ❑ 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 �j l
Approach/Sidewalk �j p/ - Inspector Air_ - �: L. _ / a�
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL