Permit r, CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
i mr i DEVELOPMENT SERVICES PERMIT #: ELR2005 -00007
�'' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/6/2005
SITE ADDRESS: 10220 SW GREENBURG RD 125 PARCEL: 1S135AB-01002
SUBDIVISION: THREE LINCOLN -TOWN OF METZGER ZONING: R -12
BLOCK: LOT: 009 JURISDICTION: TIG
Project Description: Installation of limited energy for HVAC.
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: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
EQUITY OFFICE PROPERTIES TRUST AMERICAN HEATING
ONE SW COLUMBIA ST #300 1339 SW GIDEON ST
PORTLAND, OR 97258 PORTLAND, OR 97202
Phone: Phone: 239 - 4600
Reg #: LIC 33135
ELF. 26- 993CRE
SUP 2640LEP
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 1/6/2005 $75.00 Elect' Final
[TAX] 8% State Surcharl 1/6/2005 $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 t. • o • -s adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
thr. gh OAR 952-.• 1-0100. ou may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
Is ued by • ,1,, Permittee Signature X 1r N G✓crV(�J �''''"
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
€ E rival Permit Application - -_- - ..--..` - - -- -FOR-OFFICE-USE-ONLY-'--_ ---- _
City ot Tigard
Received '� c
Rec _ Permit No.: -„ ,. 7
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 , y, ive Plan Review
�� ���� ��� Date/B Other Permit:
Inspection Line: 503.639.4175 ,......• ell Date Ready/By: El See Page 2 for
Internet: www.ci.tigard.or.us x l t_ 00ga Notified/Method:
DM Supplemental Information
p PE � } z �.•<;: '=
€ . . ,,,J,,,,e — — r,:'� -:xr:- - , ta-r: `` 4 .. v._4 i a � �3_ `PL yI � a - . - < ,v ..
III New construction Addit Please check all that apply:
11) Demolition 111 Other: ['Service over 225 amps, comm'l ['Hazardous location
Ma �� ['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
• G ,• C k T ) GO t O ' Q 3, TSR . ' - ,: : ' - 174#4:1 of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2 family dwelling 'Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ M ult1 fam11 ❑ Ot hei ❑Building over three stories ['Feeders, 400 amps or more
y ❑ Master bu ❑Occupant load over 99 persons ['Manufactured structures or
xaa,... t 040210 7 ;'r '�411 0 Egress lighting plan RV park
❑Health -care facility ['Other: e.
Job no.: Job site address: /0z2.0 ,50..i Gr'e ! h L , above.
d
J Submit 2 sets of plans with any of the above.
City /State /ZIP: / /'G ot.,,-- f The above are not applicable to temporary construction service.
uite Idg. /apt. no.: 7Zs Project name / mt�CC7u /^ r. °t' ' ffrtI �;A Wit ;,= g : I
name: �r Description I Qty. I Fee. I Total I
Cross street/directions to job site: New residential single - or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or legs 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited 'energy, non - residential 75.00 2
#` II CSC > 1 - " ® ` : ,.. Each manufactured or modular
�
L dwelling, service and /or feeder 90.90 2
1109e- 7 ,Cr^,r L7S
)aS7' Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
47 201 amps to 400 amps 106.85 2
'•" �' _ ';'/'=" � 401 amps to 600 amps 160.60 2
' Nattte: /t /� /
"'IA �--, 61 - s Cr, l o?e#- 4te.S 601 amps to 1,000 amps 240.60 . 2
Address: 0,. c., s(Ai wit t..n 6/ GL Si di e Over 1,000 amps or volts 454.65 2
d Ova Reconnect only 66.85 2
City /State/ZIP: ?e C �9 7e ..C" Temporary services or feeders installation, alteration, and /or
Phone: ( ) J Fax: ( ) relocation
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
A. Fee for ice or branch feeder circuits feee with h
: �, �LL� ._, � - ' ti °�G�O1�A� °_ R O sery ac
Business name: A �/��/�,�7, �J-7;,c, branch circuit 6.65 2
� ��
/ B. Fee for branch circuits
Contact nam ef f 'f �� 1"a-aM g � . without service or feeder fee, 46.85 2
Address: ��p ` each branch circuit
133 S 6 C� G O!? 19.. Each add'l branch circuit 6.65 2
City /State/ZIP: `Oe. # 10./ 0/0 9.792 Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: (5 ) o?cS 9 - -Mai 00 Fax: : (j3)
239- 7€43B Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
,, ' Q TR gTeR m s,-s. "" .,74 energy panel, alteration, or C1C
extension. Describe: Page 2 7 2
Business name: / .Ms -r,'c.Lh ea.�i,: al)
9 Each additional inspection over allowable in any of the above
Address:
/ , 33 9 j e- ,, - .,01,04 Si
Per inspection 62.50
City/State /ZIP: /-
B,,-.714")d.„ 0 e 9 l 5 Q 4 Investigation per hour (1 hr min) 62.50
Phone: �e3) 239_ vied Fax: �a3 ) 23 9 )03 Industrial plant per hour 73.75
CCB Lic.: # / 7 7 .e. I:C1 W:W: # E 1140EES* , �.. .
33/3s Electrical Lie.: Z6 — �g 3 c. () Suprv. Lic.: V 0 _mac.'" Subtotal 7t °'D
26 9 c�
Suprv. Electrician signature, required: t � Plan review (25% of permit fee)
Print name: SrG ve J D !! 7.7 / State surcharge (8% of permit fee) , O v
O� TOTAL PERMIT FEE 21. aV
Authorized signature: AR /2� C(/ .,/J This permit application expires if a p ermit is not obtained within 180
�/ jjll v e o d ays a it h as b ee n ac cepted as complete
Print name: --- ,,,,„/. 6 Q ,-)e T� - Date: / /6 � S • Fee methodology set by Tri- County Building Industry Service Board
f
.... Number of inspections per permit allowed.
i.\ Building \ Permits \ELC- PermitApp.doc 12/03 440- 4615T(10 /02/COM/WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
C CTION DIVISION
Business Line: (503) 639 -4171 MST
BUP
ed �� Dat Requested AM PM BUP
Location 0 37 � � Suite ` MEC
V Contact Person Ph ( ) S 7 Z 5q 7g PLM
Contractor , Ph (__A__ P ) 6 SWR
BUILDING Tenant/Owner v`� Uj � ' C- ' ELC
Footing ELC
Foundation Access:
Ftg Drain EL f�'�'� G1��0
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors •
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: f
Final
PASS PART FAIL
PLUMBING ._ -
°I •
Post & Beam a
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
P PART FAIL
EL CAL
Service
Rough -In
UG ab
ow Vo
Fire ' larm
Fin El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE . ❑ Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA Approach /Sidewalk Date 1 l Inspector LA. S VO El_ O ri �� Ext
PP
Other:
Final DO NOT REMOVE this inspection record fro the Job site.
PASS PART FAIL