Permit if CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00379
Vic, l& DEVELOPMENT SERVICES DATE ISSUED: 6/24/2004
` 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
, PARCEL: 1S135AB-03400
SITE ADDRESS: 10260 SW GREENBURG RD 1 3 0�
SUBDIVISION: LINCOLN TOWER -TOWN OF METZGER ZONING. C -P
BLOCK: LOT : 014 JURISDICTION: TIG
Project Description: 2 branch circuits: Clean up space.
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: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 1 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
10260 SW GREEN BURG RD #100 PO BOX 230547
TIGARD, OR 97223 TIGARD, OR 97281
Phone: 892 -2500 Phone: 503 - 624 -3631
Reg #: LIC 75059
SUP 1965S
FEES ELE 34 -283C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/24/2004 $53.50
[TAX] 8% State Surcharge 6/24/2004 $4.28 Rough -in
Elect'I Final
Total $57.78
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- 332 -2344.
Issued By: G,__, — Permit Signature: ( N „
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: 'd b 5 S
Call 639 -4175 by 7:00pm for an inspection the next business day
• Electrical Application ® � 4 • - , ' FOR O FFICE . USE O .
City o'Tigard GE U l Received `� Pemmit No.:
13125 SW Hall Blvd., Tigard, Plan ard, OR'9722. Plan Re •
i t
Rev: (/ � �
=
Phon 503.639.4171 Fax: 503.598.1960�� t g 200 -voi i i i ,i. DateB : Other Permit:
., Inspection Line: 503.639.4175 , 4. J aJ; el I ' Date Ready/By: Juris: 0 See Page 2 for
Internet: www.ci.tigard.or.us RD Notified/Method: T I 4 Supplemental Information
. T.� �G TIGA
it alt, m�,b�' '�.Ss' - `k. '� ^,..:;fie .,'� `:s+ ga s . s � l+ .?,s.a °e?'an ,r , y- ;,t. z�.aw-- F - „v�- r
�s;- '-S.`, "5.�''� - •.. >.; '?;'r'" ,. ,±ads' rte: �^: '
� s1PI' W c .. • ,!) :a . t i r ; ,P L?r g4,9EF Z .
��,,. -��= r>. � ` "u�°3'�.a» •�ni2taq'p t�. - a-��'i�`3r �rl"°"° v�. 3�3�4 ?4k'::'.r..`,�ta,..'::xx��.:.. .;�'a Y- t,.'�,. .:- „��.F, ........,- _
❑ New construction 1 p Please c heck all that apply:
�] �A1hon/alteration/re lacement � ,
❑ Demolition ❑ Other: ❑Service over 225 amps, comm'l ❑Hazardous location
.,;; ; mid ,/, x.. .. aC, EG
z ... _ 5. a; " "1F =r �` - : :: - °s i ❑ Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
r F t - y. AORY F CO NSTRUC TIO N' ` - 4 te r 4 i s
attAth -., eg+ �� , ,,-4....,,,,,,,,,;,,,,,,,,,,,;,,a,,,,, , -. .., ,.,,,.,_,,„ ,, t of 1 and 2 family dwellings 4 or more new residential
i
❑ 1- and 2- family dwelling Z Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑ Master builder ❑ Other: ❑Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
1 r JOE SLTEII�FORMA TION�IVDLO(rATLON' l ❑E gress /lig plan RV park
.t�- �- �r>�`��=�.a„ ruar- r.a=-".sa��. :4�- �,,....s�co. sw: , `��� s.,,. ,wru' 'at.0
Job no.: w 11 7- Job site address: /6 7 4, U sC.j ❑ Health -care facility ['Other:
�p Rite µ, ►7�., Submit 2 sets of plans with any of the above.
City/State /ZIP: Tt f i k A. v i OA_ °P- ZZ y The above are not applicable to temporary construction service.
Suite/bldg./apt. ^ no.: / 7 Q Project name: �l N�'�N! l �t ?,c) i � X ! p ` ;- `t:r': EE* SCHEDTIIE ==f ._
2 ' r dt 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
Tax map /parcel no.: Limited energy, residential 75.00 2
T
.� „ ���. �F � t� ap_ �,�m� ax ma / ;` wYi;: s b ,, , , ; ;. ' ,,, ,, , w.. ,- Limited energy, non - residential 75.00 2
l i 1. y ES PTxIAN O E t�W®RK a ",e ""
� � . � _ -� � r.�, �,�� � - ; f Each manufactured or modular
dwelling, service and /or feeder 90.90 2
�-ww. U t' � � � a A a Services or feeders installation, alteration, and /or relocation
1 Y 200 amps or less 80.30 2
,, .v o: varvtor r --v N .e--., ,. 106.85 2
1 ,.
C _ * BROEERTY OWNER 4s '
;l®TENANT "
4,`. .v 2 1 amps too amps
,.. , .,; t i. ? i ;< ; . 4 . mi l,. . ' -4 .. ;nay 401 amps to 600 amps 160.60 2
Name: O 601 amps to 1,000 amps 240.60 2
Address: 0 oC 60 A.,0 ✓ . 4 _af., N. _ 1 0l/ Over 1,000 amps or volts 454.65 2
i 9 � r\ Reconnect 66.85 2
ZY� (�
City /StatO / ,T + Tempomporary y services or feeders installation, alteration, and /or
relocation
Phone: ( )get F ax.
'� ( ) a- A 5 200 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
A. Fee for branch circuits with
'`' " ` "'' i ik`""°-`"' h- a
�' °y��"' ; `APPLICANT � �� " � " �2, � �rC01�7TAC�'F PERS6
service or feeder fee, each 6.65 2
Business name: branch circuit
. B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 tit �� 2
Address: �;
Each add'1 branch circuit l 6.65 6 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 -
la g -l f� T * 'CO RACTOR'„ ;, a 12 6:1 ,°l';, a'i energy panel, alteration, or
` extension. Describe: Page 2 2
Business name: /I A, 6 .e. ( e ,tic /iesj (..._
Address: <j x Each additional inspection over allowable in any of the above
Y Per inspection 62.50
City /State /ZIP: 7, 1 N a 0 C� 9 ZZ t t f Investigation per hour (1 hr nun) 62.50
Phone: (S273 ) b 2 La • - g ( Fax: (66'3) 2,4 - Zci.- Industralplantperhour 73.75
tIMAMIVOR!IC_AL +��PtRMIT�EES�.a:> �:, „ ,.:, i"r
CCB Lie.: - 9S ' 0 , Electrical Lic.: '79, A5-3 c JJJ Suprv. Lie.: fyG 1 "S Subtotal S ^ s
3
Suprv. Electrician signature, required: • Plan review (25% of permit fee) J
,n.
Print name: ((,,�� D ( � State surcharge (8% of permit fee) L .2-
yJ '22 -0 `
�' 'v r TOTAL PERMIT FEE s C 3, 7 .e
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
55 Number of inspections per permit allowed. •
i \ Building \Pernuts\ELC- PermitApp.doc 12/03 440- 4615T(10 /02 /COM/WEB
Electrical Permit Application - City of Tigard •
.Page 2 - Supplemental Information . •
LIMITED ENERGY PERMIT FEES:
KRESID� k � "� , e a a l i
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:
x GOMM arat ar4Ol LI' RWR s xR = r
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
❑ 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
i \Building\Permits \ELC- PermitApp doe 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection-Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested F—/ 9 AM PM BUP
Location / d , (p Zi uite <-3ed MEC
Contact Person Ph (el / ) 1 q— 6 PLM
Contractor Ph ( ) 2 - 3/ SWR 4/-061377
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam NM MP
Shear Anchors
Ext Sheath /Shear MIM
Int Sheath /Shear
Framing
Drywall Nailing ' „ �
Drywall Nailing ' 1 u I`'"
Fi rewal I
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof Cl 1 2C n .C3 A /14 /Sf /X!r
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 CA!'alk) 5V 1/I► v No, 3 g
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
Fire Alarm
4'" PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
l�L�� Please call for reinspection RE: Unable to inspect — no access
Fire
ADASupply Line J fc M . Approach /Sidewalk Dat .. Inspector hipLe5604 Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL