Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00564
DEVELOPMENT SERVICES DATE ISSUED: 9/3/2004
Ai' 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 1S135AB-03400
SITE ADDRESS: 10260 SW GREENBURG RD 190
SUBDIVISION: LINCOLN TOWER -TOWN OF METZGER ZONING. C -P
BLOCK: LOT : 014 JURISDICTION: TIG
Project Description: (1) 200amp serv. with (10) branch circuits.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: 10 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
EQUITY OFFICE PROPERTIES TRUST WILLAMETTE ELECTRIC INC
ONE SW COLUMBIA ST #300 PO BOX 230547
PORTLAND, OR 97258 TIGARD, OR 97281
Phone: Phone: 503 - 624 - 3631
Reg #: LIC 75059
SUP 1965S
FEES ELE 34 -283C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 9/3/2004 $146.80
[TAX] 8% State Surcharge 9/3/2004 $11.74 Rough -in
Elect'I Service
Total $158.54 Elect'I Final
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 or 1 -800 -33 44.
Issued By: Permit Signature:
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: (9
Call 639 -4175 by 7:00pm for an inspection the next business day
SEP, 03 2004 8:06AM HP LASERJET 3200 p,2
1
Electrical Permit A,U ",i - t�`on - FOR OFFICE USE ONLY ,
City of Tigard SEp 0 3 of o e se `s �..� 1 -ease, ` -�U /
13125 SW Hall Blvd., Tigard, OR 9722 Plan Re ' w
y,, Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 �® . ,41178 .1 1 ' ll Date/l3 :
Inspection Line: 503.639.4175 'g'( OF T , -a 4 '•' I ". Date Ready/By: 121 See Page 2 for
Inmmet: ww`w c1 tigard onus VIM pIV1S
�� 'Or Notified/Method: Supplemental Information
T r 4= xtr�sa •:��,'saS4:tk- �.: IIF7' Y;(1F`IISdtk� ?, LT`. U�{ `. r ?.,� - 7. ' "�,5{,.� � .., ): _.. �;�,, t �i ;� .v �, F' ,
lua `� ql _�,,; i ,t i :( t,._t l'•k,.,rivlit ra!: '�. , ,l itt � a°�„Q ° ls;�s,. " 5n . 1 Ni. ; .�1
r itatiJ ,11111 d, s s a. �. h :iu,w �.. n,,a a''!cwY,'
�!: a 'u. ... ,,.. � �, Y h°':{i:l 4t�i Ts{,� ry`.: urtl•.-
❑ New construction iki Addition/alteration/replacement Please check all that apply:
❑Service over 225 amps, comrri l ['Hazardous location
ID Demolition ❑Other 10,000
rpro r ' r (i t „i rt - Y i ��` a r" 9 i3��( � ta 4 ' , r j in OS
and 2 over dwelling 4or ne identtial '
i r � `&J , 1.: 4.l ls s a.i s .0.,..4-„,1 1 ,1-! ..,,e„v .. ? ». .._.Flfi ii '? L r- , ,u .
❑ 1 - and 2- family dwelling ® Commercial /industrial ❑ Accessory bu ❑s 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
<v 6� ,r I ' L}'�' °'i a� LK ilE.7., A�asas� i�i`i [i 'x - ; • -. K , * d + qp � , " g�' ' v n {'
p . N:g � iD E s t: i} 4 ,i , r t t l �. t i fit' xint i "' i 't` , jl :,h t ia13r y � i a , a � .a 4 i I E i { , .i ❑E�es s, 7ighting plan RV park
4� .,. ['Other:
Job no.: Job si te address: ❑ Healthcare facility
�'Q { f o'Z f, (/ `a w �p�'t,ty'i+� - � S� f �/ (J Submit 2 sets of plans with any of the above.
City/State/ZIP: T' 44 , n ] The above are not applicable to temporary construction service
l * ,i';W�Y. N" L' ts. ,i,:t.t, .,-) ' k ,....e.:1:-...
_ „' .
Suite/bldg. /apt, no.: 19 v ! Project name: ¶ e Ali, c Y' ii'to. li Description Qty. Pee. Toni - ""
Cross street/directions to job site: -ti. _ ' - S i qt.) New residential single- or multi- family dwelling unit.
�^t "' cc 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 tnap /parcel no.: I , ' , „ Limited energy, non - residential 75.00 2
,Ji itl . a a HI 11' �l F i m i � pu�� 1 �, a xa „ h et , il r t s i kl A t 0 11` . 1,4, Each manufactured or modular
. r l dwelling, service and/or f ee d er 90.90 2
k_ , e ,, t , ' „,„,..,..X t y l' t (Nx.A
t. L' .p 4 . a Services or feeders installation, alteration, and/or relocation -
(( 200 amps or less 1 80.30 $G, w 2
r u ii# } c u ,u a t�;yz� {� F 4 gs' i (4j try v as ,' ,p.: ' 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: C O 0 601 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: (S ) 41 2-1 kZ 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
fi`''x } �; : � ,�'�7191 o j ari l" a' H'7 - 1 , i t s�,sl!l it 7 . Ai ` i4 r 1 n i . A. Fee for branch circuits with
`("1. �a j � .'� a , ali e � : 'i a ua � ` Ill i t iA 1i v id ,f ti.f a i : 7t` C -
�? , ' ; r �f ' 5 service or f eeder fee each 0 6.65 G 6 i' 2
Business name: _ branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
_ each branch circuit ,
Address: Each add'I branch circuit 6.65 2
City /State/Z1P: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) I Fax: ( ) Sign or outline lighting 53.40 2
E - mail: � Signal circuit(s) or'limited-
d l„ ii . '� l a 81 tl )..s rh., lf u; ' a' t1s� t -nt d i i lt- 1 i "4" ever panel, alteration, or
:>:w i"aL..E, ``. 1.: I� �d -- ;•. - " e xte on. Describe Page 2 2
Business name: W IA( 4 wt . h t gi C C T .or s c (K' c_
Each additional inspection over allowable in any of the above
Address:
0 Ox Z • d s.-Li }
Per inspection 62.50
/
City /State /ZIP: 7, J a rt n‘ .... 9 � - Z t . Investigation per hour (t hr mm) 62.50
Phone: (
Industrial plant per hour 73 75
° Z 1 kl<a1 r~ t ci 9' ,0 "�a a t .
�) 6 �k - 3G �( � Fax: (S (e Z 3 � " ji �"��'- .- ��,,,,�. �Mx�1,�.�+�1�?:;#�' , ,a,.
CCB Lie.: 75 Z/s -- / Electrical Lie.: 3 L' 2i.-7c Suprv. Lic.: /4' j - f Subtotal r y L .g.....1
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) H t 7 t(
Print name: .g vt .., r c Date: q 3 -- G/
TOTAL PERMIT FEE r s h .. try
Authorized signature: This permit application expires if a permit is not obtained within 580
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.
is tliuiidingtPermits \EL -C- PereitApp.doc 12/03 440 4615`r(10 /02 /CObt/VJB8
CITY OF TIGARD 24 -Hour
BUILDING • Inspection. .Linea (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Li Date R-que AM PM BUP
Location - o' • Ii % —L /,1_'/ i ‘. uite / 9(3 MEC
Contact Person P ) 3/ PLM
Contractor _ _ .%' . !� - Ph ( ) SWR
BUILDING Tenant/Owner ELC °57a
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam ND=
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation p$4-4‘-s1 - F - / Drywall Nailing 1U , 1 v
Fi rewal l 1
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
L
ervice
Rough -In
UG /Slab
Low Voltage
Fire Alarm
111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
qiiip PART FAIL
Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line / ADA rpm s
Approach/Sidewalk D l v V I Inspector , ��`�"�
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL