Permit '`..
C I TY OF T I G A R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
1 1 � - DEVELOPMENT SERVICES PERMIT #: ELR2003 -00292
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/26/03
SITE ADDRESS: 10220 SW GREENBURG RD 350 PARCEL: 1S135AB-01004
SUBDIVISION: TWO LINCOLN - TOWN OF METZGER ZONING: C -P
BLOCK: LOT: JURISDICTION: TIG
Proiect Description: Installation of limited energy for data telecommunications system.
'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:
EOP LINCOLN, LLC AZIMUTH COMMUNICATIONS INC
10260 SW GREENBURG RD P.O. BOX 508
SUITE 100 WILSONVILLE, OR 97070
PORTLAND, OR 97223
Phone: Phone: 503 639 - 0110
Reg #: ELE 36 -94CLE
SUP 2312LEA
LIC 145828
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 9/26/03 $75.00 Elect I Final
[TAX] 8% State Tax 9/26/03 $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 ow rules - ad\ed by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throuc
I sued by p •��',;l j .( i4 ; � !_�_ A
Permittee Signature A � i -
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
4,1ectrical Permit Application F.oROFFICE USE ONLY -.
Received Electrical
Date/B / : i PermitNo.: C G / j, .0
City f Tigard Planning Approval Sign
Y g an Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 ar Post - Review Land Use
yr�rmi �,
Internet: www.ci.ti g d.or.us� I� Date/By: : Case No.:
� � i �� > W Contact Juris.: [8] See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method:
7a Supplemental Information.
•
?.y ixa; ..~OF .-g y`,",'° .»;., . '+ta„ - ""'........ ... .,_cpr. ' ;xT.t3,ffi.t.° r :i^ 'aEfR�
u�
[=1 construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
Addition/alteration /replacement ❑ Other: El Service over 320 amps-rating of 0 Building over 10,000 square feet,
,b,,.? 10 :,. ,I A A VIO:42'St ® t, $TrI C k l'C1 - � r 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ErCommercial/Industrial ❑ System over 600 volts nominal one structure
❑ Accessory Building I=1 Multi- Family ❑ Building over three stories ID Feeders, 400 amps or more
❑ Occupant load over 99 persons ['Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress /lighting plan ❑ Other:
P Y
t s ° " ���n Qe?� i - QN� �. S sets of plans with of the above.
. x , ���,., �.: ���TQ�t . . �i
The above are not applicable to temporary construction service.
Job site address: 022 O S W 6 �E� R c.,Qd7 � F, E* SGH Dt tiea ` Ain aT:� , . _ =
Suite #: r7 Bld /A t. #: s r m ,e .
c o g• P Number of inspections per permit allowed
Project Name: �7p � Vic. Description Qty Fee (ea.) Total
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 1
Subdivision: Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
;; a ' .; ..,. ag 1? °WO . k " " ' av service and/or feeder 90.90 2
/ �.,�y� ` Services or feeders - installation, •
Ui Ce ! t)' d r alteration or relocation: •
200 amps or less 80.30 2
• 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
t `Q wing g f i f 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
City/State/Zip: alteration, or relocation:
p 200 amps or less 66.85 1
Phi. e: Fax: 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
I3524-01400-01 ,._ [ 61131 T PEI S
4 O i '' Branch circuits - new alteration, or
Name: &- P)>2 ■extension per panel:
r 6-11-/ A. Fee for branch circuits with purchase of
Address: 2,531,5 sW ( service or feeder fee, each branch circuit 6.65 2
B. Fee f or branch circuits without purchase of
City/State/Zip: WI l��"� �11.1�G (9 9 '�ap _ p
service or feeder fee, first branch circuit 46.85 2
Phone: 9,3 9 - Ot 1 D (j' /'I Fax: 5173 -6 3 q— o i 1c Each additional branch circuit 6.65 2
E- mail: f'bur nctC aZrwtu/J M+vtvish CR C70VN$ : CC i r( Misc.(Service or feeder not included):
g � ; r � wR .:a u;r .. Each pump or irrigation circle 53.40 2
,. _ yr . GON I2AT,
Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel, .
Business Name: kZ{M v (z0 41 A M.U)S- . cAt- 11014. alteration, or extension Page 2 2
Address: Z. 315 50..) l,�i 6 1249 Description _^ -
City /State /Zip: �U11,5 pi1vi� C2 p Each additional inspection over the allowable in any of the above:
Per inspectioo per our (m
n per hour (min. 1 hour) 62.50 .50
Phone: S03 &31' 01/0 Fax: 03 (, 0/
Investigation fee:
CCB Lic. #: 145 (, Lic. #: ;3� —9 L{ Lt-E Other
(,t -�, - Liz, - - . "°"'�;m,�,`�"`c�, °, k "'4s §k� .' *air � � �.
Supervising electrician
, 7 - ' Ater lect a r ..„
Subtotal $ J,
signature required: Plan Review (25% of Permit Fee) $
Print Name: Rur2 -A - tr Lie. #: 2 5 o0 1..E State Surcharge (8% of Permit Fee) $ r 6 c )
TOTAL PERMIT FEE $ ' vD
Authorized OD s Notice: This permit application expires if a permit is not obtained within
Signature: -all`j q Date: 1/' & (0 3 180 days after it has been accepted as complete.
,51 e r-
*Fee methodology set by Tri -County Building Industry Service Board.
(Please print name)
•
i:\Dsts\Permit Forms\ElcPetmitApp.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
❑ Burglar Alarm
n Garage Door Opener
n Heating, Ventilation and Air Conditioning System
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
7( Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
E Instrumentation
El Intercom and Paging Systems
n Landscape Irrigation Control
n Medical
• Nurse Calls
n Outdoor Landscape Lighting
n Protective Signaling
n Other
I Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Lint: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 • MST
BUP
Received Date Requested - a AM PM BUP
Location / /) c 3
7 1,6 E IEIY t • Suite 350 MEC
Contact Person re (3 M./V n Ph ( _ 7 ) '7 93 -29 0 PLM
Contractor A--5 /1rt ea"( lCYV rn . Ph ( ) SWR
BUILDING Tenant/Owner al)7 e ELC
•
Footing J— y' cL fr 2
Foundation ELC Access:
Ftg Drain ELR� — 00212-,
Crawl Drain
Slab Inspection Notes: // I_ SIT
Post & Beam w [ [ l U Y�Ct_p pi `�P� ri4 e
Shear Anchors OH Si - W i't� Q ( acicL e-'` / t- heecPecd .
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
0
Firewall
Fire Sprinkler
Fire Alarm
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
ow Voltage
Fire Alarm
` PART FAIL ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE jJ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date / Inspector Ext
Other:
Final DO NOT REMOVE this inspection record om the site.
PASS PART FAIL