Permit •
•
CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00237
DEVELOPMENT SERVICES DATE ISSUED: 5/6/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1 S135AB -01002
SITE ADDRESS: 10220 SW GREENBURG RD 245
SUBDIVISION: THREE LINCOLN -TOWN OF METZGER ZONING: R-12
BLOCK: LOT : 009 JURISDICTION: TIG
Project Description: Job #4733 (1) branch circuit.
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: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 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:
SPIEKER PROPERTIES L.P. WILLAMETTE ELECTRIC INC
10260 SW GREENBURG RD PO BOX 230547
SUITE 100 TIGARD, OR 97281
PORTLAND, OR 97223
Phone: Phone: 503 - 624 - 3631
Reg #: LIC 75059
SUP 1965S
FEES ELE 34 -283C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/6/2004 $46.85
[TAX] 8% State Surcharge 5/6/2004 $3.75 Rough -in
Elect'I Final
Total $50.60
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 OUNC at (503)
246 -6699 or 1 -800- 33 ."44.
Issued By: • - / / Permit Signature: 0?- as -- pr (a
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 7:00pm for an inspection the next business day
'tr Permit , -. t� t.' 4 ,1 (tdOon FOR OFFICE USE ONLY
- _ _ Received Electrical a
I ,, r , Date/By:, tf�'1 M Permit No � QV X10 ;
City a1 Tigard f ; �LUU Planning �a((pp val Sign
V L Date/By: No.:
13125 SW Hall Blvd. I FM Plan Review Other
Tigard, Oregon 97223 GARp Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 5 ;f9 1�- Post- Review Land Use
G VIS i /yn ^Nl�� Date/By: Case No.:
w
Internet: ww.ci.tigard.or.us 1 001N .��I�
W Contact ®See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: 17 Supplemental Information.
� .. 2'1 romoRK '= - i,na, ,lovasi ei ° t.t mmw .(Please checks l li gp lY) , -, _ s °; 7 ,2U
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
0 Addition/alteration /replacement El Other: commercial ❑ Building over location
10,000
�_, � _{_ �„ � _ _,_,�, _�,,,,�,�, -„ ,� ❑Service over 320 amps-rating of ❑Building over 10,000 square feet,
i x TE 01 O a ,_„sal * % I 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling Q ,Commercial/Industrial ❑ System over 600 volts nominal one structure
Accesso Buildin Multi -Famil ❑ Building over three stories
0 load over 99 persons ❑Feeders, 400 amps or more
❑ ry g ❑ Y ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
Ma "14 '° sets of plans with any of the above. Submit
t.' � .�f� SST °®' _ ' pan The above are not applicable to tern orar�y construction service.
Job site address: /0 L 2- 541 CA.[�,.-- lia.- r y l ; E�E SGHi ULE : ,, . :1-24
Suite #: 2 ti Bld /A t. #: �� � �
g• P 2 i.w tr /vv Number of inspections per permit allowed
Project Name: A y rA,r e-,gWe,p30ets,L Description Qty ' Fee (ea.) Total i
New residential - single or multi- family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
1000 sq. ft or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 I
Subdivision: Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
x _, F .,: t :>'r service and/or feeder 90.90 2
° Services or feeders - installation,
•
`i ), 4.. ,T Jl A4 ,./ . .
-T l alteration or relocation:
t 200 amps or less 80.30 . 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
15 WAVVitatt S R L jig tl t11 T,1 'MIL* ." 601 amps to 1000 amps 240.60 2
1 � / � , i O ve r 1000 a mps or volts 454.65 2
Name:
fit 0 e oM .5 Gs S •-e Reconnect only 66.85 2
Address: 3 L ,,, Sv z 4 b Temporary services or feeders - installation,
City/State/Zip: T alteration, or relocation:
Y p i 5 '14- /cJ 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 _ 2
_. „ Branch n h circuits 133.75 2
`� `� * �A'PPIC �', . � t"� �` ���O TGTF ; � ', "�'� Branch crcuits -new, alteration, or
Name: extension per panel:
Address: A Fee for branch circuits with purchase of 6.65 2
service or feeder fee, each branch circuit
City /State /Zip: B. Fee for branch circuits without purchase of ��
service or feeder fee, first branch circuit / 46.85 y‘ 2
Phone: Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
a = = r _� 7".I:' ° Each pump or irrigation circle 53.40 2
' ° • 67 ` : "° • "' ` ` M " 4 "" `�' ° Each sign or outline lighting 53.40 2
Job No: • y .7 3 Signal circuit(s) or a limited energy panel,
n F t . r i or extension Page 2 2
Business Name: ta a �t , G /- , C T � / L `L C Description:
Address: Po i l z36 4 "7-
City/State/Zip: additional inspection over the allowable in any of the above:
Y /State /Zi T Q,� �� Z $ l
p l s 19 2 n Per inspection per hour (min. 1 hour) 62.50
Phone: a te) 41 q - 3 6? ( Fax: 62A - 2_5 3 Investigation fee:
CCB Lic. #: 7- 6s Lic. #: 3q- z & 3 t other .,. • �z lit , : --� : .
�� . _ _.. �.e� . ��� ` E7�c£ ricalerm7�Fees��� � ,... �'�� . r�
Supervising electrician . Subtotal S 7 t
signature required: / ,� Plan Review (25% of Permit Fee) $
Print Name:, r *t i'L1c #: %q6 F.-- S State Surcharge (8% of Permit Fee) $ f
TOTAL PERMIT FEE $ S (}', 66
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: _ Date: 180 days after it has been accepted as complete.
*Fee methodology set. by Tri -County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
Audio and Stereo Systems
n Burglar Alarm
n Garage Door Opener
Heating, Ventilation and Air Conditioning System
n Vacuum Systems
0 Other
COMMERCIAL WORK ONLY:
Fee for each system ... $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
0 Intercom and Paging Systems
Landscape Irrigation Control
0 Medical
0 Nurse Calls
Outdoor Landscape Lighting
n Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03