Permit RESTRICTED E
CITY OF T I G A R D ERG
RESTRICTED ENERGY
-�41 M1 ��li DEVELOPMENT SERVICES PERMIT #: ELR2004 -00259
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/2/2004
SITE ADDRESS: 09900 SW GREENBURG RD 220 PARCEL: 1S126DC -03300
SUBDIVISION: LEHMANN ACRE TRACT ZONING: C -P
BLOCK: LOT: 005 JURISDICTION: TIG
•
Project Description: Low voltage for Voice /Data. MIINIIIIIIIEMIIIIIIIIIMIIIIMIIIIIIMII
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:
ATHERTON REALTY PARTNERSHIP LIMITED ENERGY NW
MARTHA ATHERTON P.M.B. 190
2100 S WOLF 3439 NE SANDY BLVD.
DES PLAINES, IL 60018 PORTLAND, OR 97232 '
Phone: 847 - 298 -8600 Phone: 503 -810 -7331
Reg #: LIC 131668
ELE 26- 1012CLE
SUP 353LEA
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 9/2/2004 $75.00 Elect'I Final
[TAX] 8% State Surchari 9/2/2004 $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 follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through OAR 9 - 001 -0100. You may obtain copies of these rules or direct questions to 0 C at (503) 246 -6699.
Issued by Permittee Signatu
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
Electric Permit ` ��icat, o °l ;} FOR OFFICE USE ONLY '
i f Ti an e g DateBed• Permit N.. /D e
Ci y o g �J� '�
13125 SW Hall Blvd., Tigard, O , 9 •22 y `
g l P lan Revi:
Phone: 503.639.4171 Fax: 50 1V, .19 2004 y tittdl '�I+I Date/B : Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: a See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: I I Supplemental Information
: �.�. I�` R'�RK c tK�:�,'.. : ���t , , � �� . �`r� < . �.� PI;ANh
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❑ New construction Addition/alteration /replacement Please check all that apply:
❑Service over 225 amps, comm'l ['Hazardous location
❑ Demolition ❑Other: ['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
:a, '4 aa.•„ ki;_r <.3 ',,” "' � t- W a �.=u -xY . itga . 65 e.:o , a v : =° itol:i�:`:fl + ^Ma?: .i',:sY:.er:a
1„ 0 y 0 „ .4 A.> I ,TEGQ '• OF C ONS 'RUC , _N 4 ii I4 , , of 1 -and 2- family dwellings 4 or more new residential
ID 1- and 2 family dwelling [ V Commercial/industrial ❑ Accessory building ESystem over 600 volts nominal units in one structure
EBuildin over three stories [Weeders, 400 amps or more
El Multi family ❑ Master builder ❑ Other:
� , ❑Occupant load over 99 persons ['Manufactured structures or
�, ,' 4 S AiNE (3A O ON i - '' ❑Egress /lighting plan RV park
Job no.: (4 O. Job site address: ' oh sit) G vte,Avr i g Z2-0 EHealth-care facility ['Other:
Submit 2 sets of plans with any of the above.
City /State /ZIP: ftsn- n4 .a/ co_ . q 72-2-3 The above are not applicable to temporary construction service.
Suite/bldg. p Project name: #' „ ,�; > , „ r„� - F `HEULfiE: -, .;- . . *:
Description Qty. Fee. Total
Cross street/directions to job site: Z t T e G:.e g.., 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
Limited energy, residential 75.00 2
Tax map /parcel no.: 5 2
�� Limited energy, non-residential 75.00
A DE OF, x r u a : ; .
, � , Each manufactured or modular
�OICE � r4 dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
.,..,,:r = ,: �e�. ; f. , ;1, g . s E:ti; 201 amps to 400 amps 106.85 2
F P- ROP :,:.OWNER„ ' :. L. g ,%14'-',”, ;'; l ` 0" TE1 ANT > } 401 amps to 600 amps 160.60 2
Name: 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
relocation
Phone: ( ) 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 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
v` },, " -�s: t A. Fee for branch circuits with
�d , a:� ��.�. �r1PP�IG��. , '�.��;1� � 1�;� .y CO�rTAC„�'PE R �ON v:rrs� -, "1
service or feeder fee, each 6.65 2
Business name: r eft_ S 5 , branch circuit
B. Fee for branch circuits
Contact name: J err J without service or feeder fee, 46.85 2
Address: I Yo $tv oreekOyr) A l ZF(J each branch circuit
Each add'1 branch circuit 6.65 2
City /State /ZIP: ear r[AAA 0 , q 7 2 2-3 Miscellaneous (service or feeder not included)
r
Phone: (g 3) 7(� �Q / 16 7 Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
-, _ Q 2 � energy panel, alteration or
" gy p, ,
���=� ' k rr:�:. .i. �:: " .s,�'� ��fr° . '. �w � �«.;K� 'sue v� )
extension. Describe: 1 Page 2 2
Business name:
L40.1i F Ne•-; y ,v, w
Q Address: 3 1. 3 5, p° E s,4,..,-.4./ Each additional inspection over allowable in any of the above
I Per inspection 62.50
City /State /ZIP: - 7 - (4) Q/L _ ql 7 L 3 2- Investigation per hour (1 hr nun) 62.50
' Industrial plant per hour 73.75
Phone: (gt} 3 ) g/ 0 — 7 33 J Fax: ( )
a.: <.<: < : ..0.0flAIGAiriftR FEES# ,-.,p.•
CCB Lie.: / 3 / G 6 Electrical Lic.: Z6 —/O/lieriel Suprv. Lie.:) fJ Z4. Subtotal
•
Suprv. Electrician signature, required: CL.(� / Q — i —bg Plan review (25% of permit fee) 7`
Print name: 60 ttAte d i� *L' , Date: —Z —a y State surcharge (8% of permit fee) 6
TOTAL PERMIT FEE O . 00
Authorized si `�'t4"' R ,(' j 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- PcrmitApp,doc 12/03 440- 4615T( l0 /02 /COM /WEB
Electrical Permit Application - City of. Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
�:g.9s�Y�T,a°,.�.... ':xzFL� ..n �.'� »i es�.�� '. E°'k4�`�6." -'. F ..... x re.,.a.:.x� :. &. k.�> �.:- a,;;; -; ., -..,�. ��
RESIDEN;T'.IA 7W0 0 Y i k• -1,
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:
' CO -� A,_F,.. RCIAL °;W RI :( .. _i i g t x
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ C lock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑
•
Instrumentation
❑ Intercom and Paging Systems
❑ L andscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n O utdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
is \Building\Pernuts\ELC - PeimitApp doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING InspectionfLine: (503) 639 - 4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
/�
,/ .� BUP
Received 6' �f
1 0 % -^ Date Requested �� b AM PM BUP
Location j/ht � L) li'hP r //L.4� Suite 2-- MEC
Contact Person .� ( Ph ( 3) 9/0 7e ? / PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 1 ')n ' � 2it—' ELC
Footing ELC
Foundation Access: .�
Ftg Drain ELR C:2,0
2- �
Crawl Drain —
Slab Inspection Notes: + ,� t � ��(� SIT
UV Post & Beam /
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall F 7L L
Drywall Nailing [� }^= AtArZ._
Firewall
Fire Sprinkler
Fire Alarm !
Susp'd Ceiling L
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
ELECTRIC AL
Service
Rough -In
UG /Sli
(LOV�Vnitage
Fire Alarm
111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
A pproach/Sidewalk DA Date v fro- Inspector 1 `i t''v )
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL