Permit CITY O T I G A R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT #: ELR2005 -00008
'--' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/6/2005
SITE ADDRESS: 10220 SW GREENBURG RD 410 PARCEL: 1 S135AB 01004
SUBDIVISION: TWO LINCOLN - TOWN OF METZGER ZONING: C -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of limited energy for data telecommunications. Job No. 7684
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 ACCOLADE TECHNOLOGIES
ONE SW COLUMBIA #300 10200 SW ALLEN BLVD STE B
PORTLAND, OR 97258 BEAVERTON, OR 97005
Phone: 503 - 4152 -4800 Phone: 503- 617 -9800
Reg #: L933-617190%
ELE 3- 390CLE
SUP 128LEP
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 1/6/2005 $75.00 Elect'I Final
[TAX] 8% State Surchar€ 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 to • • " • o adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through OAR 952 -0c 1 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
by r---
Is ued b ���� i � Permittee Signatu,- *!fyter' / '
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
lei ►ideal Permit FOR OFFICE USE ONLY
City of'i igard Received Dates :, / d » Le, Fennitlfo.: C'4'�C 1
13125 SW Hall Blvd, Tigard, OR 97223 Pion Review
Phone: 503.639.4},7] Pax 503.598.1963
JAM �' 2005 a" " i' r t *I {'� 1�atdB Ord erFermit:
Inspection Line: 503.639.4175 II ,,JJ I \ '1 U L „ r 1 f _. Date Rcady/By: �' F5 See Rage S ter
J>iteatet: www.oi.tigard -onus = . Notified/Metbod: 9 1 Cp. Supplemental Information
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yfi• k; ex. A a;it 4 a. i fi u i A A; 3, ::k u_ ,.. .a::• 9 �S: s�ba+ A A�
�7.C. d, a £ <'�i a . vee A : � ti A�e�t. ' �:p �u,n �'.. O40N� SRs
e t f r Please check all that apply:
El N constraotion �i .i4ti .'j:, t1 ttmifi ' , �,:1•r ant
❑Service over 225 amps, catnm'. ['Hazardous location
❑ Demolition ■ Other: _ ['Service over 320 amps - rating ['Bulking over 10.000 sq. IL,
tN,' - rl &"g u zn r 3. A ', R .4 a . : i 4 R 'sirs 'rFfi: t. r< °" ': • .. ': 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 stru re
❑Building over three stories ['Feeders, 400 amps or more
El Multi - family ❑ Master builder ❑ Other: ❑Occupant load over 99 persons ❑ Manufactured stntotures or
= :;;:x r3£ 8tE A g . _ „�,... '� �:::' 'E£ £1:8 . '4 1 R V park
.a .ky:' : - s $' s a . t sse: A.77 :, x .i:;;;Ea x 6:, ;R ` ['E . -.k ... •s *.:.��^ ., .' ". .,�, )� � • : ,• s. c�x? . f' s.. emu: ^,
Job rio.: t
Job site address: ' - ti ❑Health -care facility ['Other: :
lei Job f / . Submit 2 sets of plans with any of the above,
City /State/ZIP: 'l r' OR, The above are not applicable to temporary construction service.
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Suite/bldg,/apt.
Description no.: Project trams: 14( (� �� [�Q RR UM { "' 0 - . '''''.,,'.� J.. rah -"--
Cross street/directions to job site: U New residential single- or multi - family dwellbtg wait.
Includes attached. gauge.
1,000 sq. IL or less i 145.15 4
Subdivision: Lot no.: Ea. add'i 500 sq. fl. or portion 33.40 1
Tax map/pared no.:
Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
6:.y;
'�e9 r=`, rat v sw, y- ' . .. , ,�^ �R#�lQka' < oiLk u�nip' R u'u:3e:?e ti fL'u�
g.. ..;✓.r.,3 44.',. . ' � � '. 0 :s: 4: s
fi ' �' >• .: >¢•.� N 9R e f"e.�e�a 7anufa.Ciured or modular
� 8f- #a�,4r fu?:� .f:a ^: `��°'.:�`. .. .. Each n
J /� �� y / / I dwelling., service and/or feeder 90.90 2
V o i Ce l f C d ( / ft✓t 1yy .1 l -U 1 1 F CO - i g. J 1 0 91 Servlcce or feeders installaU alteration, and/or roioeatio
200 amps or less - 80.30 2
: ' a oA . • ,,. , " q sae, u° < . y ? ' sin? ii . ..gt o �R 201 amps to 400 amps 106.85 , 2
P raA 3 p , < �, ? i. ..�A
- ''' • 4%..t .•' • • , s.Y ', :.. ..a xdIAx9;R�,;9.: i' '•":.k • .xe,es art
401 an,pa 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 aersices or feeders %donation, alteration, and/or
relocation
Phone: ( ) P ( ) 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 I 2
Owner signature: Date: _ Branch circuits - new, alteration, or extension, per panel
.
A R / e.7 �` e•:m�'SAle x 'kg = 't ;. ?; -- i - S Ma ofo < .f:
g, i> ... ": .: e ' " :t *r . , « %<s �e :s ;A`'''.;': b :.::. • S f " . : '4 ', °.: •. • . x•3 .+ »x •: a
' 4 ::tt s A. Fee for branch circuits with
• 4.. Aow.r x axua 3 : `u.,:•a .e•:. :. t?4 . :'i9ue: �a�:en
-.. . ._ ... : : � • -:- ..:.:. . .. .:. �.....,... • �
service or feeder fee, each
Business name: branch circuit 6.65 2
Coarser rlatne: B. Fee for branch circuits
without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'. branch circuit 6.65 2
City /State/ZIP: . Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax :: ( )
Sign or outline lighting 53,40 2
E-mail: Signal circuits) or ener limited -
�r . qx: R . A A::Q� gem tl •; °tt - «� 0 :� %x`�ig�raA,us °�>s ik? �Q�:s:ia¢�,sifs`,iA<x��tssk�<A' p' panel, alteration. or
'fi+:A,A r. Aa�:YjsA:A.s;A ssA '�A.:A -: i`:a` a. ..., >
extensi Describe: Paget �� 2
Business name: mg + . ' ,, i • ' it e$ -.- - - - --
Address: D /. .!r Go G 0 F3 Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: k t - - () / • 0 Investigation per hour (1 hr min) 62.50
Phone: { j) / n (1! G Q(3 Fax: (006) 1, t'-i. d Industrial plant per hour 73.75
R:3 /fi3�f.,:Xi' <AiL` �1! ,i. ;.eei'� .. f <tk ?9.9i ..ix'2-"t¢x qi.
:A ?e ie400A :o[:':3# , , .;. 35A„�:4s:<'s,R:�`�gi
CCB Lic,: 1" l (. I Electrical Lic. :�3C1(K. (,A Suprv. Lie:. 4s ' L t. Subtotal ~V ` - p -
Suprv. Electrician signature, required: Plan review (25% or pennit fee) --e-'
•
State surcharge (8% of permit fee)
Print name: an ♦ . Date: i k e 0
TOTAL PERMIT FEE
Authorized signature: + / l This permit application expires if q permit h not obtained within 150
,► days after it has been accepted as complete
Print Mine: Date: * Fee methodology set by 7}i- County Building industry Service need
•• Number of inspections per permit allowed,
i:mutid6aWotatimime- rutnkNm.doo 12/03 44 - 4el5T(Ia02/CO /WEB
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received I Date Requested / AM PM BUP
Location / a ?1d s4)-1,42,6„.? Suite g/0 MEC
)
Contact Person PFi ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain
ELR 606Q
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
n
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rater Service
Water Service
Sanitary Sewer
Rain Drains , �J
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL _
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
dRI FAIL
rr
Service
Rough -In
UG /Slab
ow
Fire Alarm
P S PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Ei Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Date \ �� Inspecto l V\ S Ext
Approach/Sidewalk pact
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL