Permit CITY TI GARD ELECTRICAL RESTRICTED ENERGY PERMIT
7 iTt ' I '� DEVELOPMENT SERVICES PERMIT #: ELR2005 -00104
c 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 5/9/2005
PARCEL: 1 S135AB -01002
SITE ADDRESS: 10220 SW GREENBURG RD 415 ZONING: R -12
SUBDIVISION: THREE LINCOLN -TOWN OF METZGER LOT: 009 JURISDICTION: TIG
Project Description: Thermostat.
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 #: LTC 33135
ELE 26- 993CRE
FEES SUP 2640LEP
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 5/9/2005 $75.00
[TAX] 8% State Surchart 5/9/2005 $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 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 st'on / to 0 NC t 503-246-6699.
Issued By: � �1't Permittee Signature: j !c ,1 ° f N it l r'54e
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 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
:
. .
0 , .
Electrical Permit Application .
' ' FOR OFFICE USE ONLY
City of Tigard RECEIVED . ..
Received
Date/By: &1
Permit No.: 4, / 4 'd • i
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 /4 41Alif Date/B : Other Permit:
Inspection Line: 503.639.4175 MAY 0 9 200 AAA. - v.. Date Ready/By: •
181 El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
4 '" :M0 -..,,,:.,,,VP,. - W.x M :' e r ,-F . e •,;'.:•:7: .4,7 4, . ;"1'0. o Ve.:4 4 14 , Wqrt i atIREZ , VjEW444 4 V.V3:n!Pkt'''-'=' :q.:;:".f
itt :_,:,'',".*--• , •f.ig: ,'ai: .• ,:" :-.1p4 t e71 ' ..i,"':,: 4 ,,,,15; , ..3. , i'Vr4. . ',..& 7_,,;,..: „ ': . .--,4,, , ,e4,-, ,,,,,,-, , .
El New construction gfAd ition/alteration/replacement Please check all that apply:
OService over 225 amps, comm'l OHazardous location
0 Demolition El Other:
vi ,r EService over 320 amps - rating OBuildng over 10,000 sq. ft.,
- - i--''t..t4.1.. ,. .: , - ImproAttreovaatz..-4.., -:. , 4-‘1g : ..,-,-...-____,..,1,1a , --- ,,, ,..,, , :,__ „,,, _ , „ _
1 145' ,,,41%, of 1- and 2-family dwellings 4 or more new residential
0 I- and 2-family dwelling %Commercial/industrial 0 Accessory building DSystem over 600 volts nominal units in one structure
ElBuilding over three stories Li Feeders, 400 amps or more
0 Multi 0 Master builder 0 Other:
[I Occupant load over 99 persons DManufactured structures or
or: ...Z j7:,5* 7' 4:16B31§i i i6108M2:61%rni'i f ireetitOW " " :".'"''' 0 Egress/lighting plan RV park
a facility 00ther:
Job no.: 1 Job site address: "0220 6, ree „ ) ,g c.v . w ,P ol D
Sub llelth-care mit 2 sets of plans with any of the above.
,.,
City/State/ZIP: 77 ale The above are not applicable to temporary construction service.
-,1
Suite/bldg./apt. no.: 41/5' 1 Project name: 4,I , ? fit v c.
Dueription Qty. i Fee. 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: 1 Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 I
Limited energy, residential 75.00 2
Tax map/parcel no.:
, , ,,, ... „.„, Limited energy, non-residential 75.00 2
_ „_,_ „,„ „ ,,
154744 , :ii ;*CON :a4 a 7 54, ' *iff&; 7 §12.11*4 ;i Each manufactured or modular
dwelling, service and/or feeder 90.90 2
/ 7.3? Cer> Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
gu 7;7; 1. qr:v crw 201 amps to 400 amps 106.85 2 ,
amps to 600 amps 160.60 2
),,..,_,.-.
Name: 5 601 amps to 1,000 amps . 240.60 2
Address: L 4,.., S1 J94:„.2 Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: ,.,. .a..-/,., c''' _,., ...1 . ,,...,
Temporary services or feeders installation, alteration, and/or
Cd I . .,./ C'' 1 relocation
_
Phone: ( ) I 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
.h#44,1:..',1"4,10;;VORiVAt::-..''';Z.- '.Mr.Z.: 4'1 fir: '''' 7'`'WelP0942.6 A. Fee for branch circuits with
6.65 2
Business name: Ecl e ,,,,,,,„.,,? a4 ,.., . 4.- _L c.... branch circuit
Contact name: 721Vek- 174 e,74.:16-- ,/ B. Fee for branch circuits
without service or feeder fee,
46.85 2
each branch circuit
Address: - / 39 ,.5 67 ,..../ ,.,.h S",
Each add'l branch circuit
6.65 2
City/State/ZIP: " , age 220e-- Miscellaneous (service or feeder not included)
,,,, 1 Pump or irrigation circle 53.40 2
Phone: ($23) 23c,-4':t _x) I Fax: : (37,23 ) 23q
Sign or outline lighting .
53.40 2
.
E-mail: Signal circuit(s) or limited-
Temr-pr-1712-memmtraitorovant:-",z4pw-msvi energy panel, alteration, or
extension. Describe: .„ Page 2 2
Business name: /9, 79ery e am 4,4 ...zi
„- . .; c. ,
Address:
Each additional inspection over allowable in any of the above
/33 , S a .-7- ',/ 0 S? • Per inspection 62.50
City/State/ZIP: ,... c) 9720 Z. Investigation per hour (1 hr min) _ 62.50
-,1 Industrial plant per hour 73.75
Phone: ,(5b3) a39 ,_,L).,e490 Fax: (5i/3 ) ca.239 ■ itr;,0141,101COW1744:0701WAMARTA*;;;i41
• 2 -.a.-s .
CCB Lic.:23 2 Electrical LIc.. 2,6 94)3 ek , e . Suprv. Lic.: . . Subtotal
Suprv. Electrician signature, requirear7 (c 2 . -- .. ..„, t - Plan review (25% of permit fee)
Print name: 1 L ‘?"
1 0 to,-i? Date:z-Aia s' State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: .....,, „.1,,2......../ This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: z e.. 414,,,e 7174' Date: ,57470:5 * Fee methodology set by Tri-County Building Industry Service Board
** Number of inspections per permit allowed.
i: \BuildingkPermits \ELC-PerrnitApp.doc 12/03 440-4615T(10/02/COM/WEB
• CITY OF TIGARD
BUILDING DIVISION • PE MIT #:
13125 SW Hall Blvd., Tigard, OR 97223 ATE ISS ELR2005 -00104
Phone: (503) 639 - 4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: PAGE:
X11/2005 TIME: 7:12AM 73
SITE ADDRESS: CLASS OF WORK:
10220 SW GREENBURG RD 415
SUBDIVISION: THREE LINCOLN -TOWN OF METZGER LOT #: 009 TYPE OF USE:
PROJECT NAME: FORD MOTOR CREDIT
DESCRIPTION: Thermostat.
OWNER: PHONE #:
EQUITY OFFICE PROPERTIES TRUST,
CONTRACTOR: AMERICAN HEATING PHONE #: 239 -4600
Inspection Request Scheduled For: Date: 11 /2x05 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 006549 -01 503- 209 -6696 Y
Corrections /Comments /Instructions: V/
❑ PASS yIPARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
c
Inspector: 6.k),( /j Date: ! A. Phone #: (503) 718-