Permit t., ELECTRICAL PERMIT -
CITY TI CARD RESTRICTED ENERGY
�'I DEVELOPMENT SERVICES PERMIT #: ELR2004 -00316
•
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/13/2004
SITE ADDRESS: 10260 SW GREENBURG RD 190 PARCEL: 1S135AB -03400
SUBDIVISION: LINCOLN TOWER -TOWN OF METZGER ZONING: C -P
BLOCK: LOT: 014 JURISDICTION: TIG
Project Description: Installation of limited energy for data cabling.
Job no. 13506
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 COMMWORLD OF PORTLAND
ONE SW COLUMBIA ST #300 5711 SW ARCTIC DRIVE
PORTLAND, OR 97258 PO BOX 3675
BEAVERTON, OR 97005
Phone: Phone: 503 - 520 - 1220
Reg #: Li6gi'6- 023503916
ELE 26- 890CLE
SUP 3541LEP
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 10/13/2004 $75.00 Elect'I Final
[TAX] 8% State Surchart 10/13/2004 $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 O -952 001 -0010
through OAR 952 -0 1 -0100. You may obtain copies of these rules or direct questions to OUNC :t (503) 2 6 -6699.
Issued by / �� a Permittee Signature �l�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
Electrical Permit Application. 'FOR:OFFICEUSE .
City of Tigard Date/By: /2) PermitNo.:eL / ' a)ef�
Y i
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: .503.639.4171 Fax: 503.598.1960 � � �� d dp { I Date/B Other Permit:
Inspection Line: 503.639.4175 c'" e1I.- Date Ready/By: 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Ivfethod: i Supplemental Information
6 Z ;Y: 4 ,t , r i. , TYPE.OF W ORK' t . ° = ° -'P iAN .
El New construction , ddition/alteration /replacement Please check all that apply:
❑ Demolition ❑ Other: vl e over amps, mm' Hazardous
: �x,,-.,,_ , >.�J „ _. >,,�..,ua . :._, :s : :� : : - : :, ,, k._ : >. « -h. > : :, :,.... :;.. , s amps — rating ❑B ng over sq. f ,
Ser is r 225 a co aza location
❑Service over 320 a rati uild ver 10 000 t.
P ' ''` , '4 W 'C A TE G ORY OF hCO - -s of 1 -and 2-family dwellings 4 or more new residential
vat as .ye ev, .' ,,,,.' Pn&w. _. � ..,. ,,,, a : ....... —, , ,,. .R .._.,z ,. s . ., y g
❑ 1- and 2- family dwelling ,'Commercial/industrial ❑ Accessory building ESystem over 600 volts nominal units in one structure
111 Multi family ❑Master builder ❑Other: ❑Building over three stories ❑Feeders, 400 amps or more
: ily <;.: K :. , : ;,,; . ter builder
= A _: r . =g „ > <, , :,. : -_ .; s,., n . r c _ , ,, ❑Occupant load over 99 persons ❑Manufactured structures or
a. A .' � r. JOB SITE,IIe A1VD ,,, ,, O C r r0 , ; . t t ' : s w . ❑ Egress /lighting plan RV park
Job no.: 13506 Job site addressl 0260 SW Greenburg Rd #1c, 0 ❑Health -care facility ['Other:
Sub 2 sets of plans w any of the above.
City /State /ZIP: Tigard, OR 97223 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: S 19 C Project name: Kelly Sevices - ;. �' • " .,. : TEE..'SCIIEDi31E;;,.. **
Description Qty. 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: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
T map /parcel no.: •
a x ax <;. P ,; f �.. :; - ,. <., r ..r; „�_: u ,., ;,. Limited energy, non- residential 75.00 2
, , w , ' 1 1..m
c r 1 DE S CR IiPTION OO Fr�WOORK ° '` P
: z a_... Ni : -�,.. � . . �. . .ham .. .... - K-. �, � . +;. u� .r..� -�t - :� r , »...W Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Data Cabling Services or feeders installation, alteration, and /or relocation.
200 amps or less 80.30 2
- s,., ._:,v_�. : i .r a� a�r , r . ..:4 tw„ r :; 7:i'V «: :. °,. ».. ,, ? 201 am s to 400 aro s 106.85 2
A -0.,� = .,,, P ROEE ItT Y OWN ,, e °, �. 3 , .: „ ® T EN y A1V T . : t : _ y 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 1
Owner installation: This installation is being made 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
c , , - :°' - - ` -.0 "s+' ?isa . 3;� ; = .- Ycv:..: .;•- ; 7 =�:Stt
.41 ,W ON ,„A . ., ICAN T u ;� m i yd CO TACFSP RS ' �, A. Fee for branch circuits with
serv or feeder fee, each 6.65 2
Business name: Commworld of Portland branch circuit
B. Fee for branch circuits
Contact name: Bob Olsen without service or feeder fee,
each branch circuit 46.85 2
Address: 5711 SW Arctic Drive
Each add'I branch circuit 6.65 2
City /State /ZIP: B eave r ton, OR 97005 Miscellaneous (service or feeder not included)
( (5 0 3) 646-0235
Pump or imgation circle 53.40 2
Phone: 5 0 3) 5 2 0 -1 2 2 0 Fax:
Sign or outline lighting 53.40 2 .
E - mail: Signal circuit(s) or limited -
, F ' ' fi i A a { , .t i ` CON RACTOR "-_ - . ” a :i;: k- energy panel, alteration, or
extension. Describe: / Page 2 75: 2
Business name: Commworld of Portland
Address: Each additional inspection over allowable in any of the above
5711 SW Arctic Drive
Per inspection 62.50
City /State /ZIP: Beaverton, OR 97005 Metro #5276 Investigation per hour (1 hr nun) 62.50
Industrial plant per hour 73.75
Phone: (503 ) 520-1220 Fax: (503 )6 4 6 - 0 2 3 5 ' a te5':= .t^<EL EG I'tl[CAL1;P.7RN[IT-'FEPS *' -''-;
CCB Lie.: 103916 Electrical Lie.: 26_8 ;� prv. Lie.: Subtotal
• Suprv. Electrician signature, requ t / (� � Plan review (25% of permit fee)
t
Print name: Date:
Alvaro __ � State surcharge (8% of permit fee) co
B -
//�/ ,�,, TOTAL PERMIT FEE E /►
Authorized signature: /� �1�-� /�tA.'✓ J This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete
Print name: Robert Olsen Date: /0//2 / L/ * Fee methodology set by Trt- County Building Industry Service Board
r l ** Number of inspections per permit allowed.
i 3Buildieg'.Pemtits'ELC- PennitApp doc 12/03 440- 461 ST(10 /02 /COM/VEB
Electrical Permit Application - City of Tigard " ,
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESI ELT y.,RW�ORKOl�IIY.. �.:,
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
S eo ,g m rRWi WDV on r Ita ._: f
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
•
Data Telecommunication Installation
n Fire Alarm Installation
HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
Landscape Irrigation Control*
- Medical
Nurse Calls
- Outdoor Landscape Lighting*
n Protective Signaling
_ I t
Other
Total number of commercial systems: /
*No licenses are required. Licenses are required
for all other installations
is \BuildingPermits\ELC- PeimitApp doc 04/03
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CITY OF TIGARD " 24 -Hour
BUILDING Inspection Line: f503) 639 -4175 MST
INSPECTION DIVISION ; Business Line: (503) 639 -4171
1 BUP
Received Date Requested / d —°/ AM PM BUP
Location /0 ( 6 ��P� Qr-LCJI �°i Suite 19 MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) ` v r SWR
BUILDING Tenant/Owner ELC
Footing I
ELC
Foundation �/
Ftg Drain Access: ELR , 71/ 36 / — a 63
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 At 0,-f
Fire larm •
RT FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE_' ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA ' `
Approach/Sidewalk Date /6 �6 / � Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record fr m the job • ite.
PASS PART FAIL