Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT #: ELR2003 - 00343
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/7/03
SITE ADDRESS: 10220 SW GREENBURG RD 540 PARCEL: 1S135AB-01004
SUBDIVISION: TWO LINCOLN - TOWN OF METZGER ZONING: C - P
BLOCK: LOT: JURISDICTION: TIG
Project Description: Tenant Improvement
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 COMMWORLD OF PORTLAND
10260 SW GREENBURG RD 5711 SW ARCTIC DRIVE
SUITE 100 PO BOX 3675
PORTLAND, OR 97223 BEAVERTON, OR 97005
Phone: Phone: 503 -520 -1220
Reg #: L646-023103916
ELE 26- 890CLE
SUP 3541LEP
FEES Required Inspections
Description Date Amount Ceiling Cover
[ELPRMT] ELR Permit 11/7/03 $75.00 Wall Cover
Elect'I Final
[TAX] 8% State Surchart 11/7/03 $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 follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throuc
Issued by Permittee Signature c %
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
r
Electrical Permit A lication FOR OFFICE USE ONLY , •
�� Received J / Electrical
Date /By: 1 1 1 / / 0 :5 � Permit No /) ZGlj G'-- ' 3 V3
CIt of Tigard Planning Approv ' Sign
y g Test Form Date /By: PetmitNo.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 e Post - Review Land Use
Date /By: Case No.:
Internet: www.ci.tigard.or.us e I) Contact Juris.: ❑ See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 ""`"" Name /Method: Supplemental Information.
< - .,,;� _ n�. :; � - ��,;�,�:- ,, Fyn, .4
., . „-��.- �:T�Y >PEOF.WORK ,_ �.,,.'` :
;e�, �� =��'- =PLAN,REVIEW Please.ch 'e''ck�all;ttiata ° "'1� - �,��F..., -
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial El 11) Addition/alteration/replacement ❑ Other: Hazardous
El Service over 320 amps- rating of ❑ Building Building over er 10 10,000 square feet,
.:41-4.WANiZt'!4§ I &2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
S sets of plans with any of the above.
. K ;,::IOBSITE:'INFORMATION`ianN LOCAT�IONy��?����;; p y
The above are not o
Job site address:1 0220 SW Greenburq Rd. � � s P:fiZ. n service.
< ..;- applicable to temporary constructi • � ' : : : :g� �
rv�,,, . � t .„mac . - ;;iFEE,� SC�HEDfJLE' .. :���° : :..' ��:� : ; �.x;,
Suite #: 540 Bldg. /Apt. #: Number of inspections per permit allowed
ProjectName:Paxton & Miller Description Qty Fee (ea.) Total 1
New residential - single or multi - family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Two Lincoln Center 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
' ` •1/2'4, ` 2I 'DES'CRIPTIONrOF WORK `•i ' r, Tom; service and/or feeder 90.90 2
Services or feeders - installation,
Data Cabling & Jacks 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
;, I PROPERTY OWNER ;'"; ' I `' _ ; •s; 601 amps to 1000 amps 240.60 2
_ � �.� ' ®,`TENANT °_'. �' �; ,,�
Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
Clt /State /ZI alteration, or relocation:
y p 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
,r x,,, . ® ,m 401 to 600 amps 133.75 2
®4APP
=liICANT. ,,, ',a. =..,, CONTACT E RSON:F;=;,i,}-'s1 Branch circuits - new, alteration, or
Name: CommWorld of Portland extension per panel:
A. Fee for branch circuits with purchase of
Address: 5711 S . W . Arctic Drive service or feeder fee, each branch circuit 6.65 2
City /State /Zip: Beaverton, OR. 97005 B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: 503-520-1220 Fax: 5 0 3- 6 4 6 - 0 2 3 5 Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
.,. ;/ *- # ZIA' t l%r „�C ,r.:� :..:s� ,y Each pump or irrigation circle 53.40 2
- :� - -:, , -. nom?. °`sue s. _ .. �.ON�T CTOI2� � � P � _ ��g P P g
Job No: 12160 Each sign or outline lighting ' X53.40 2
Signal circuit(s) or a limited energy panel,
Business Name:CommWorld of Portland alteration, or extension* / 75.00 2
*Description:
Address: 5711 S.W. Arctic Drive Data Cabling & Jacks
City /State /Zip: Beaverton, OR , 97005 Each additional inspection over the allowable in any of the above:
Per inspection (per hour - min. 1 hour) 62.50
Phone: 5 0 3 - 5 2 0 -1 2 2 0 Fax: 503-646-0235 Investigation fee: _
L ic #: Other: CCB Lic. #:103916 2 6 - 8 9 0 CLE Oth ' ; ' „Electrical l'1,d'mfii. ees*. , _, �, ' S k;.,. ";
Supervising electrician _ METRO #5276 5 2 7 6
Subtotal $ $/ 00
signature required: \ _ L--&/ Plan Review (25% of Permit Fee) $ 6,66
Print Name: Bert Alvaro - tic. #: 3541 I l is'?e State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $ i57. eO
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: / -' A QA � c Date:1 1 / 7 / 0 3 180 days after it has been accepted as complete.
Robert 1 sen *Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
r CITY OF TIGARD 24- Hour ,, •
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received ____ll Requested l //2- AM PM BUP
Location . r6 2 20 Suite 5 MEC
Contact Person P h _� J — 1 22. 0 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner athC 4(3Y\ 'al 11 1 ELC
Footing
ELC
Foundation Access: �/
Ftg Drain CO (J /� () (. 143
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
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
UG /Slab
Low Voltage
COP
FART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• SI E Please call or reinspection RE: A Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date O _ Inspect r A ... t
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL