Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT #: ELR2004 -00381
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/21/2004
SITE ADDRESS: 10200 SW GREENBURG RD 110 PARCEL: 1S135AB-00900
SUBDIVISION: FIVE LINCOLN ZONING: C -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: Voice & Data.
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:
EQUITY OFFICE PROPERTIES TRUST OMNI WIRE INC.
ONE SW COLUMBIA ST #300 15621 SE MORRISON
PORTLAND, OR 97258 PORTLAND, OR 97233
Phone: Phone: 503 261 - 8789
Reg #: LIC 151222
ELE 26- 1132CLE
SUP 3525JLE
' FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 12/21 /2004 $75.00 Elect'I Final
[TAX] 8% State Surchart 12/21/2004 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OSJNC at (503) 246 -6699.
Issued by �• Permittee Signature
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Permit A s FOR OFFICE USE ONLY
City Tigard E. / Received q Permit No.:
131 Hall Blvd., Tigard, OR 97223 PlanReview
oC � J r � /�
Phone: 503.639.4171 Fax: 503.598.1969DEC ��iaoBp
2004 ia!I i y y DateB Other Permit:
Inspection Line: 503.639.4175 v I' Date Ready/By: INEI a See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
a ' .,� g> w , a _ # A (1F' (9I� >, r a " x 2 k : =:"r 1 s PLAN RE.s?IEW. _ .
a�,.�".�&t�r � �� �� �: �wE j'��'/ a °�. SA ' a�.,- , �- �;�. >,.. � ,aa.. ' ;. <.,. ,s . t ._ , . .
❑ New construction I ► �' Please check all that apply:
❑ Demolition ❑ Other: "r -04j n, ['Service over 225 amps, comm'l ['Hazardous location
;3 ~�` =" ``'" ;:' ' " "` '$ _ " " "'R' r r`w;N : Ua ... ['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
u , r ,. r f g b CATEGOR ' ®F CO` NSTRUC ,: ate„ M g r' ; of 1 - and 2 - family dwellings 4 or more new residential
❑ 1- and 2- family dwelling lg. Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi family ❑Master builder ❑ Other: ['Building over three stories EFeeders, 400 amps or more
'.t ;'� fi x, r•..� :m, °.:s -.� .:: ra;.°.., z> ss�?? .r?�.,.?°.4:,s�;���t v .= '-+rx� ��K'�' '
❑Occupant load over 99 persons ['Manufactured structures or x '.VI MA RV
tss. _ J IJOB M F ORMA, TION D y _ O A��TO I ;�� „, tlM ' ° ❑E gres s /lighting plan park
facility ['Other: Job no.: Job site address: i 2_00 Si.,..) �2� at /� Submit 2 sets of plans with any of the above.
City /State /ZIP: e0all - 01 The above are not applicable to temporary construction service.
uit dg. /apt. no.: e�i} Project name: V :.w =FREEMAttDT�LE Fee. <` `,: R `
Description Qty. ee Total
Cross street/directions to job site: 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
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential l 75.00 2
ASV .x , ,: 'l DES ,- iO:1, OF W.O K g o& 7,4 j , Each manufactured or modular
141 �� dwelling, service and /or feeder 90.90 2
/ Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
''` #Y:: ; tii i i iiir:,- .•:aisv�.-: �., -.r ' 'I ., . r - V �as. -;A ..;.:.. 201 amps to 400 amps 106.85 2
,, ,fly PROPERTY 0 1E R� , . ' a .:. n n Awl ( TE e l- P P
` �' ° �' " ` � 401 amps to 600 amps 160.60 2
Name: A e4-,1` 0 1 0,x/4 +._ / 1 r L 601 amps to 1,000 amps 240.60 2
Address: 1 OW S� 62eEJ v2 G A Over 1,000 amps or volts 454.65 2
9 — Reconnect only 66.85 2
City /State /ZIP: / / ZZ-3 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
IRTIV ,x €3.0146 sag *L,,,,7; r f l yµ OI'TAC it,A ONK ';iMo A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: Om �r W t p � ,,i branch circuit
B. Fee for branch circuits
Contact name: K 024,,i C4 without service or feeder fee, 46.85 2
(50,-,,,,,. each branch circuit
Address: 15 6 Z i S2 [ v� Each add'l branch circuit 6.65 2
City /State /ZIP: /? f LA,0 Oil- Cf -7233 Miscellaneous (service or feeder not included)
S 3 Pump or irrigation circle 53.40 2
Phone:
( ) 2.I P7�� Fax: )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
- ' e� =. �t=;� , . , rz =; :" l 'rx z "t=` - fi- '` zt . ', °: ; .y " 'r `
'�.'�sa -.�: ��f .� :..::- �� -'-,.� s ,.. ..ty.� ~.GO N �TR G�OR��.,° �.R_,.�m`�:,:;_ .��W: r�� .,��„¢.?::,� energy P anel, alteration, or
extension. Describe: Page 2 2
Business name: Ofi A.), 6,), / /le_ „
Address: 2( S LR , ‘co,,)
additional inspection over allowable in any of the above
/ /�� �t Per inspection 62.50
City /State /ZIP: 14(2.9 J 0a � —� 7 Z 3 3 Investigation per hour (1 hr nun) 62.50
Phone: (5 26 6, 9 Fax: ( ) Industrial plant per hour 73.75
y t�. ° *' ELECTRIG01r. M'I. ' - "_ -. e;`T.
CCB Lic.: / j 2.2.2._ Electrical Lic.: /3 LfSuprv. Lic.:(-?2,6 (...474 Subtotal
Suprv. Electrician signature, required: ._' Plan review (25% of permit fee)
Print name: k�� • Date: State surcharge (8% of permit fee)
•
TOTAL PERMIT FEE `j/ a
O t
Authorized signature: 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.
t. \Building\Permits\ELC- PetmitApp doc 12/03 440- 4615T(10 /02 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
`RESIDEl TLAI :41:07 7181M g . , . kk r
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
I I Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
n Vacuum Systems*
❑ Other:
VI p_y.:RC:' .. 9 §WOR:KONLY,., . - '. 7,_
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
i: \ Building \Permits\ELC- PemtitApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: g,.06 (1_ 0038(
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 hu lugot�i'
l
Inspection Requests (24 Hrs.): (503) 639-4175 fi
INSPECTION WORKSHEET FOR DATE: 3 _ q TIME: / PAGE:
SITE ADDRESS: / 0 � 0 D ' '- CL A l S S v
� � OF WORK:
SUBDIVISION: if OT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: fr 1 ) PHONE #: 3 O_ S 7 3 1
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments/ Instructions:
c
ti
PASS ❑ PARTIAL APPROVAL _ CANCEL NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: pv„.f v-- Date: �� "' �'� �� ✓ Phone #: (503) 718-