Permit DEVELOPMENT A: Tl( O F T I G A R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
; E•141 SERVICES PERMIT #: ELR2004 - 00328
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/21/2004
SITE ADDRESS: 10220 SW GREENBURG RD 500 PARCEL: 1 S135AB 01004
SUBDIVISION: TWO LINCOLN - TOWN OF METZGER ZONING: C -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: 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 MCKINSTRY CO.
ONE SW COLUMBIA #300 5400 NE COLUMBIA
PORTLAND, OR 97258 PORTLAND, OR 97218
Phone: 503- 412 -4800 Phone: 503- 997 -0234 .
Reg #: LIC 40981
ELE 26- 1190CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 10/21 /2004 $75.00 Elect'I Final
[TAX] 8% State Surchar€ 10/21/2004 $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
throug R 95 -:11 -0100. You may obtain copies of these rules or direct questions to OUNC at_ -03) 246 -6699.
Issu b �' /� �/ / Perm ittee Si n ature _ � �'�� �
Y ; k 1 / /tom_ g �� 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
• _ ' OFFIC USE' ONLY' Electrical Permit A pplica t ion
Date received: Q � Permit no.: G ��� -2 ,!
t i � '� ° City of Tigard Project /appl. no.: Expire date:
Cir0,ofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: : M Re ceipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
7]'PE OF'PERMIT
❑ 1 & 2 family dwelling or accessory ACommercial /industrial Cl Multi- family Ajenant improvement
❑ New construction ❑ Addition /alteration /replacement O Other: ❑ Partial
. . • • • ' 'JOB SITE,INFORMATION '' •
Job address: 1 02. a _ 6,4 , w . I Bldg. no.: Suite no. Tax map /tax lot /account no.:
Lot: Block: Subdivision:
Project name: . . Description and location of work on premises: 0 ( b 37— STAYS 1 Alet..)
Estimated date of completion/inspection:
CONTRACTOR APPLICATION . - , ' :FEE SCHEDULE
Job no: Fee Max
Business name: 04 L, � Description Qty. (ea) Total no.insp
n New residential - single or multi - family per
Address: co C
, 1 lf5`VD dwellingunit .Includesattachedgarage.
1131Moant.......4_ State:pQ, ZIP: /'_ rl Serviceincluded:
Phone: S 3b31 0234 Fax: E -mail: 1000 s.. ft. or less 4
Each additional 500 sq. ft. or portion thereof _—
CCB no.: 409 eI Elec. bus. lic. no:
Limited energy, residential ___ 2
City!. e o lic. no.: I t Limited energy, non - residential ___ 2
f Each manufactured home or modular dwelling ■■
X
Signature of s pervising ele trician (required) Date j 0--W-Oct Service and/or feeder 2
Sup. elect. name (print): License no: 7 L� Services or feeders— installation,
alteration or relocation.
- ' -- ' =PROPERTY; OWNER, -- -t -�- 200 amps or less 2
Name (print): E0. V Q h 1 Ct P(R,o 0 6e.Ti & S 201 amps to 400 amps ___ 2
II � 401 am.s to 600 am.s ___ 2
Mailing address: G W Col,' w,1 0....- r 4 ' 1,00 601 amps to 1000 amps _ 2
IIMVESPMMIIIIIIII State: ol. ZIP: '7ZS- Over 1000 amps or volts ___ 2
Phone: Fax: E - mail: Reconnect onl 1. 1...1. 11
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration,orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2 .
201 am•s to 400 am.s ___ 2
Owner's signature: Date: 401 to 600 amps ___ 2
' ENGINEER; . Branch circuits- new alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
State: ZIP: B Fee for branch circuits without purchase
City: of service or feeder fee, first branch circuit: 2
Phone: Fax: E Each additional branch circuit: __
' PLAN REVIEW (Please check all that •apply)' Misc. (Service or feeder not included):
❑ Service over 225 amps -commercial ❑ Health -care facility Each pump or irrigation circle RE■ 2
❑ Service over 320 amps- rating of 1 &2 ❑ Hazardous location Each sign or outline lighting ___ 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited ene t. panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* v L 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Descri.tion:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lighting plan ❑ Other: Per inspection __
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application ' o ,
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) $ y i il' J
Expires accepted as complete. TOTAL $ AI
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6 /00 /COM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Busines Line; (503) 639 -4171 MST
s'
oar p
Received Date Requested /1 - -23 AM ' "M BUP
Location 2-7-6 s ILL i� _ � Suite D MEC
Contact Person �.GL�/ Ph / ) 3 (Li g PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access:
ELC /
Ftg Drain I v ` ELR OW Y �Vd
Crawl Drain �
Slab Inspection Notes: (e/L SIT
Post & Beam
e4-7
Shear Anchors
Ext Sheath /Shear
Int Sheath /Shear •
Framing -
Insulation -
Drywall Nailing
Firewall - -
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final • • •
. PASS PART FAIL
PLUMBING -
Post & Beam
Under Slab 4
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 1 1�
Rough -In � (1) �I. 1 *■ 0 1 C )���" I
w Voltage � L { d a — L 1 `I i 1 \ h11
Fire A arm
*10 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA d
Approach/Sidewalk Date Inspector 1 .tom � /L cam- -- -�- Z' Ext
Other:
Final DO NOT REMOVE this inspection record from the b site.
PASS PART FAIL
•