Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
�i� DEVELOPMENT SERVICES PERMIT #: ELR2006 - 00092
�1I DATE ISSUED: 4/25/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S135AB -04500
SITE ADDRESS: 10250 SW GREENBURG RD 112 ZONING: C - P
SUBDIVISION: LINCOLN CENTER /LINCOLN BLDG LOT: 001 JURISDICTION: TIG
Project Description: Data /Telecommunication
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 A -REBS COMMUNICATIONS INC
ONE SW COLUMBIA ST #300 5855 SW TARALYNN AVE
PORTLAND, OR 97258 BEAVERTON, OR 97005
Phone: 503 -412 -4800 Contact #: PRI 520 -0625
FEES Reg #: ELE 34- 558CLE
LIC 86096
Description Date Amount SUP 2340RET
[ELPRMT] ELR Permit 4/25/2006 $75.00
[TAX] 8% State Surcha 4/25/2006 $6.00 REQUIRED ITEMS AND REPORTS
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 questions to OUNC at 503 - 246 -6699.
Issued By: - 1 - 21 4:0 44 . 42 Permittee Signature: / • � I%
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.
•
L
letrical Permit ApplicatiolV . . FOR OFFICE USE ONLY
III City of Tigard 4 / 6 Date/By. (":"1.5—a"...)64— Permit No.: j .„ GU[J72-
' 13125 SW Hall Blvd., Tigard, OR 97223 2, 5 20�
B .: . APR Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By. Other Permit:
T I G A tt D Inspection Line: 503.639 g i � p ') e Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov Q ~ �� ‘....1: ed/Method: � Supplemental Information
TYPE OF ._D11\ }. PLAN 'REVIEW
❑ New construction kr Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑ Other: ❑Service over 225 amps, comm'l ['Hazardous location
❑Service over 320 amps – rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION . _ 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 structure
['Building over three stories ❑Feeders, 400 amps or more
❑ Multi- family ❑ Master builder ❑ Other:
['Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ` ❑Egress /lighting RV park
Job no.: Job site address: 102Zi cSC.c, i 1ljuE.C3 ❑Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City / State/ZIP: T61Z Z'C-A,'Q , 97 ZZ 3 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: 1 j C__, Project name: K A 0 . FEE* SCHEDULE; ""
Description I Qty. I Fee. I Total I "*
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: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non - residential 75.00 2
. . DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ 'PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
• ' - 401 amps 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 services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( )
200 amps or less 66.85 I
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 7011. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits – new, alteration, or extension, per panel
. - ❑ APPLICANT ❑ .CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
first branch circuit 46.85 2
Address: -
Each add'l branch circuit 6.65 2 .
City /State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting . 53.40 2
E -mail: • Signal circuit(s) or limited-
CONTRACTOR energy panel, alteration, or
Business name: A _ {� S co,ffol -3.,N1 extension. Describe: �" Page 2 2
Address: S 855 3L,3 - - KA RAT ym0 .AVE Each additional inspection over allowable in any of the above
Per inspection 62.50
City / State/ZIP: EAv Z'v.V.3 CA 97 S Investigation per hour (1 hr min) 62.50
Fax: Industrial plant per hour 73.75
Phone: (Sa'j) 5 ZC� 0C-.22-.5 F
(So'>) ( p -C [ sat t ELECT RICAL PERMIT FEES *' '
CCB Lic.: 860 %6 Electrical Lic.: C L. 5S/ Suprv. Lic.: 2'& Lc3 Subtotal:
Suprv. Electrician signature, required: G %'w 4 f�,e. Plan review (25% of permit fee):
Print name: (��� S' - UN G Date: IWZS /OCj State surcharge (8% of permit fee):
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
1:\ BuildingWermits \ELC- PermitApp.doc 03/23/06 440- 4615T(11/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
[ .RESIDENTLAL WORK ONLY: ___ v _... _�
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
-COMMERC°IA.L WORK ONLY: -
•
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
0...Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
UBuilding\Permits\.LC- PermitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2006.00092
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4126/2006
Phone: (503) 639-4171 /A
Inspection Requests (24 Hrs.): (503) 639-4175 IL
INSPECTION WORKSHEET FOR DATE: 4/28/2006 TIME: 7: 02Alvl PAGE: 95
SITE ADDRESS: 10260 SW GREENBURG, RD 112 CLASS OF WORK:
SUBDIVISION: LINCOLN CENTER/LINCOLN BLDG LOT #: 001 TYPE OF USE:
PROJECT NAME: KK FINANCIAL
DESCRIPTION: Data/Telecommunication
•
OWNER: EQUITY OFFICE PROPERTIES TRUST, PHONE #: 503
CONTRACTOR: A-REBS COMMUNICATIONS INC PHONE #: 520-0625
Inspection Request Scheduled For: Date: 4/28/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
136 Low voltage 028900-01 603-520.0625
PqL,
C ctions/Co ments/Instructions:
•
_ —
I PASS El PARTIAL APPROVAL LI CANCEL NO ACCESS
I FAIL n CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: C-- Date: M ( Z.% O4 :) Phone #: (503) 718- 244
CITY OF TIGARD . ,...
BUILDING DIVISION PERMIT #: ELR2006-00092
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 412512006
Phone: (503) 639-4171 1644
Inspection Requests (24 Hrs.): (503) 639-4175 ‘.4.-4 chl,
INSPECTION WORKSHEET FOR DATE: 4126/2006 TIME: 7:03Alvi PAGE: i7
SITE ADDRESS: 10250 SW GREENE3URG RD 112 CLASS OF WORK:
SUBDIVISION: LINCOLN CENTER/LINCOLN BLDG LOT #: 001 TYPE OF USE:
PROJECT NAME: KK FINANCIAL
DESCRIPTION: DatarreisCommunicatiOn •
OWNER: EQUITY OFFICE PROPERTIES TRUST, PHONE #: 503
CONTRACTOR: A COMMUNICATIONS INC PHONE #: 520.0625
Inspection Request Scheduled For: Date: 4/26/2006 Pour Time:
Code # Inspection Description • Confirm # Contact # Message
135 Low voltage 028728-01 503-520-0625 N
C.rrections/Comments/Instructions:
..
It 1 ki-- I 7 — 11 • t__.:. . ■
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A . . — .....— .
6V 6 6 4 3 ‘ gte F e„, ! too.15 IA..
t. ■.
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n PASS PARTIAL APPROVAL n CANCEL fl NO ACCESS
rAl FAIL CALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED
1 L. ,
Inspector: Gia ft NO3 1--)6) Date: 4 1 t o 1 0 Phone #: (503) 718- 244 •
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