Permit • - CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00051
DEVELOPMENT SERVICES DATE ISSUED: 2/6/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S135AB-01003
SITE ADDRESS: 10330 SW GREENBURG RD RED LOBSTER ZONING: C -P
SUBDIVISION: LINCOLN CENTER/ONE LINCOLN LOT : JURISDICTION: TIG
Project Description: Replace roof - top gas pack control wiring.
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: 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 AMERICAN HEALING
ONE SW COLUMBIA ST #300 1339 SW GIDEON ST
PORTLAND, OR 97258 PORTLAND, OR 97202
Phone: Contact #: PRI 503 - 239 - 4600
FAX 503 - 239 -7038
FEES
Description Date Amount Reg #: LIC 33135
[ELPRMT] ELC Permit 2/6/2006 $46.85 ELE 26-993CRE
[TAX] 8% State Surcharge 2/6/2006 $3.75
Total $50.60 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these a or direct q e tions t OUN at
503 - 246 -6699 or 1 -8 32 -2 4. ��
P ermittee Si nature� GcCJ ° K�n� ��
Issued By: � g r� r
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit App E "WEDA . F OR OFFICE USE ONLY
C1 of TI and Received perrz tNo. / �. ,/� /'
4J g JAN / 7 4 - t e�,2,0d I, iUi5 A
2 13125 SW Hal
Tigard, OR 97223 M Pl R ev i ew
Phone: 503.639.4171 Fax: 503.598.1960 Uy/ th. ,I , Other Permit:
�� DateB
CfTY OF TIGA
Inspection Line: 503.639.4175 r. 4 1 � Date ReaReady/By: Jurist 0 See Page 2 for
Internet: www.ci.tigard.or.uS Notified/Method: �) Supplemental Information
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❑ New construction vt Addition/alteration/replacement Please check all that apply:
['Service over 225 amps, comm'l Hazardous location
❑ Demolition El Other:
['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
raw ia �$ iftus� - 00 Ir ;: *h z
� � �, ]�T fit; t , . �t of 1 and 2- family dwellings 4 or more new residential
�.r�:�.r>. p
« " ,• ,'� , xrfa ;.�'�.` Y x a, <,r: v,�.:a.°s: r� ,z z .: a:�xxa:a�.. �>.. ,.. � �.... , -., .
❑ 1 and 2 family dwelling p Commercial /industrial ❑ Accessory building ESystem over 600 volts nominal units in one structure
❑ Multi - family El Master builder ❑'Other: ['Building over three stories ['Feeders, 400 amps or more
['Occupant load over 99 persons ❑Manufactured structures or
? _'r . , ..,x: n= as, a - -4e44: t u ° = A, v,. }, +w f z.- , :•',V. .: s RV park
= J1J _���3'Ei, A IOP, 91 A e.r VW-AN, _ ` ess/li htin P
� °at..' 6 .r= '��r..�w�v >;u+7v�w - a a< s ,_.; u.ae:. • ..x r," , t rr' r ❑E , �-. : gr g g plan
Job no.: . Job site address: t 0'13 7 S � C-2 t ° ',ti r ��. Y�c ❑ He it 2-car facility ❑abovee.
� Submit 2 sets of plans with any of the above.
City /State /ZIP: l A.r Q X912. The above are not applicable to temporary construction service.
l lir `ie s iW =rW 2;;:, ° {:J °< ,'';`,. `3
Suite/bldg. /apt. no.: Project name: C d i b SI� Description o 1 QG7 e Description a; Qt y . I : ' Fee. I Total ' _
I Qty. I tal `•
Cross street/directions to job site: 'E• t5 t d G��� Q%r7r New residential single - or multi - family dwelling unit.
[[�� - o Includes attached garage.
Rio C--CA 0.0 Y S S ?YA�v►.. w (/1 %b1 Aq4 4 r 9Q,. 1,000 sq. ft. or leis 145.15 4
Subdivision: �c.J1 (� Lot no.: Ea. add'l 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
:*`' , ._ '- .tair ,W i . , Each manufactured or modular
`QC.. Y' s d � f �G.( ct eek J t tt
dwelling, service rs installation, allation, alteration, and/or relocation
90.90 2
rep � Services or feeders insta 200 amps or less 80.30 2
° + , ,�, • - 201 amps to 400 amps. 106.85 2
'I ° r' ' re. ' . 4` ' ,,,,,' 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
Phone: ( ) I Fax: ( ) relocation
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
4 • _ °� a ' e -- iyVi y> . a 't 'n •bti [� '" A. Fee for branch circuits with
: tl l i .. o . � 1: va .':!Tins v ' -' spa. " ' X3 it.' f, `� + � et }'�k'I4;
^�_�_� �' � , service or feeder fee, each 6.65 2
.Business name: tlrY Can'` � \ branch circuit
Contact name: F 1 oy d S PAS V B. without o ur service circuits es
without service or feeder fee, I 46.85 2
Address:
E add'I branch circuit
City/State/ZIP: Miscellaneous (service or feeder not included) .
Pump or irrigation circle 6.65
53.40 2
2
Phone: ( ) I Fax:: ( ) each branch circuit
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
sx,,;:++,.. �n4:' - :.:a;�a-•','°,,`- , x :, 4; ii ' c -` = .. �c� ..,,µ. §,.:. «.,. " _ _ y *;:,. 't.'r,R;' °;'.eaa .:a:ara,« energy panel, alteration, or
1 emi. 1 e. t extension. Describe: Page 2 2
Business name:
Address: I Se'l CS Gt ; i'• t Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: pw^K A OZ. q 1 '2® 2 Investigation per hour (1 hr min) 62.50
Phone: (5,y 2. sq - ®fi \ I Fax: 6 J 3) va q /OM Industrial plant per hour 73.75
CCB Lic.: 3 al as I Electrical Lic. 26 - eR Suprv. Lic. 0 tig 8 Subtotal ( ' $
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: - te: I State surcharge (8% of permit fee) J 75. 75. � 1 i 1 �J 1
' t �'T" l V�(fv you Ili �l D TOTAL PERMIT FEE �d 60
Authorized signature: 101 , e - This permit application expires if a permit is not obtained within 180
d y"" days after it has been accepted as complete
Print name: r s s,�n,� Date: t a41 9 0911 • Fee methodology set by Tri- County Building Industry Service Board
�� °°'"�� " Number of inspections per permit allowed.
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