Permit 41111114 _ ITY OF TIGARD ELECTRICAL PERMIT
P ERMIT #: ELC2004 -00642
I
D EVELOPMENT SERVICES D ATE ISSUED: 10/6/2004
A I
'13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 - 4171
PARCEL: 1S135AB-01003
SITE ADDRESS: 10300 SW GREENBURG RD 460
SUBDIVISION: LINCOLN ONE /RED LOBSTER/CASA L ZONING. C -P
BLOCK: LOT : JURISDICTION: TIG
Project Description: Tenant improvement.
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
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 10/6/2004 $53.50
[TAX] 8% State Surcharge 10/6/2004 $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: �� f Permit Signature: / 47 T/p
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 7:00pm for an inspection the next business day
OCT 05 2004 7:3SFIM HP LRSERJET 3200 P.2 cli
Electrical Permit Ap,plic FOR OFFICE USE ONLY
City of Tigard V Received io s Q -•, Permit No.: lea�/ dO6 Y�
13125 SW Hall Blvd„ Tigard, OR 97223 1-*4 Plan Review
Phone: 503.639.4171 Fax: 503.598.19 \ P � O "' " t p i �' DDate/B• : . Other Permit:
Inspection Line: 503.639.4175 1 h �. 1 Date Ready/By: ® See Page 2 for
Internet: www ci ri and or us ` �, � Notitied/Method Supplemental Information
pu > ; V t al l t it .`ipp: a�N=+ - •..«. 1C . ,'Pr I"' ; q .R . z JI - tt :p r. . rZ ,fl .i k :!..: ?. i" .� FPr. it .. t' . , -
A,l'. ,g rJ . � i , •, t"1 4VI i i1f,`! lS w• Pi t S'� > " 1 « i 1!) S} „d. • .. t �l' M
°'�" �., 1, ` , t ` c s= . ;` �.�s.�� "a +aril • � 3 , �"tt`d�� 'iw''��I %3�c��� t m.. :3r't• h �,r�� �'.'sc.•c � �' .u - .' ' :.
❑ New construction Addition/alteration/replacement Please check all that apply:
❑ Demolition El Other: ❑Service over 225 amps, comml ['Hazardous location
3 9 v cruaz i s h ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
ili i3 - W,I "t,r' +' ii`i i f {R 1�c' 1 F' ` f k I' tttx t fi m .15 of 1- and 2- family dwellings 4 or more new residential
0il1 1 i l �'.' �„ c..t.�}'IFfitin �p t" ly ..1 � . t this( n..::A'iime AL,7 - 4,3diiti 11 ( +a i an , : : '. #' :t "� it 3
0 1- and 2 family dwelling ] Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
['Building over three stories E3 Feeders, 400 amps or more
❑ Multi family 1 `fi Master builder El Other , Occupant load over 99 persons ['Manufactured structures or
Itf ' iF't��fR � SIilifi le lje -� l{¢f `i 3i16 11 ,t'7 "K i d �6` � t f4 ' V ,�.C `t ii i t 3t ?l li l '*�
d b t 1 4. 1�1`_ s. ,L a 4 , h ' - • A 14.4.. , ❑EgressAightingplan RV park
s• .= _J L€lt, a�..rr w:,ic a;tksa ,,3L d u cu :.... ehw,•..,r._..xi • ❑Other -
Job no.: i z i Job site address: j L _ A
— Health - care facility O � � �' - � � G''t Submit t th care Z sets of f p lans with any of the above.
T j `
City /State/ZIP: { `I 0, f 22„ JJJ The above are not applicable to temporary construction service, J �, _ F`�tIH "4 ri!tl'f`F 4 j � ;�r�i �i'lY'J�nay...,:r, 's ..
Suite/bldg./apt. no.: I Project name: %' j Fsl;tu i o ` r: � � -- ..
�p 0 3 1u�ry g ,4 P /�G+ Rd nesrrtpttoa Qty. Fee. T otal
Cross street/directions to job site: 1 L-1 N.' . , q / ( r ( ' N ew res single -or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 - 4
Subdivision: I 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
.E jirt ?f ilq t tA. 1 F e-� y� l4 r :1 13 1 p �F l�l. i t�IN t r '` �� ? Ik�II � I s ii , 1rt u, yu l lJ h' `j Each manufactured or modular
iil f.._.. tiler .e41 .$i�,� €t D Eidliai .Y Ma4Y kr ,,;r,i,.,..at u ...111tphi ia... ai.,,P As at_,'l l.1i :l.,.:i t� s #
/T � dwelling, service and/or feeder 90.90 2
(� - - �f.4 l4', Vt. i Services or feeders installation, alteration, and/or relocation
/ 200 amps or less 80.30 2
t ,'1 %ry �.r 4, `'•.. ¢ ,., : i i� ,�,`_. i:.i. sire r. i t 1 1' ' t .. t, ° Fr '¢ f. t �.�t iri'� £ t . ,t ;h`,V'xV 201 amps to 400 amps 106.85 2
dl� 1 ;. 1" i i ti }� Pll .t �, ,. ,„� ' " 401 amps o0 600 amps 160.60 2
Name: FO 0 601 amps to 1,000 amps 240.60 2
Address: 0 stc.J co - L . `°' S �U Over 1,000 amps or volts 454.65 2
u Reconnect only 66.85 2 _
City /State/ZIP: P. 1 4-- Li......... tK / )- 2 cif Temporary services or feeders Installation, alteration, and /or
relocation
Phone: ( ) 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
.F.Ri a i r� i - ;' l� (, r +td si` 4,t :MIR I t {�: b 1,` M uu t y r ; A " �i�t f.d A. Fee for branch circuits with
;
i+tr .. .lie t.,.41 ` it.7F. w.1, .)_ .'.• � service or feeder fee, each
6.65 2
Business name: name: branch circuit
B. Fee for branch circuits //�� kr
Contact name: without service or feeder foe, I 46.85 - 7,4 46 2
each branch circuit
Address: Each add'l branch circuit 1 6.65 6 -E- 2
City /State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) + Fax: : ( ) Sign or outline lighting 53.40 2
E -mail: �„ Signal circuit(s) or limited -
lifI M W r l 1 < z R aa�a MTV �; 157 iZA 1��n', t, i�; ill i � ? gg ii r . 1 energy panel, alteration, or
s4 ,_.r t.i . .. i,, �i_ :3 �i�a Lev° , extension. Describe: Page 2 2
Business name: to it 4 e ti.{ Pl,F., rA. G 1� t- -
Each additional inspection over allowable in any of the above
Address: P d 'du 2.? O cc/ Per inspection 62.50
City /State /ZIP: .� � � () 94_ z nu
/ Investigation per hour (1 hr n) 62.50
Cr Industrial plant per hour , 3.75
Phone: Fa ( ) L — fr 3' ti vFtu �' '.�3F a ,,.-. M ,KS r? , :.:
. t
' < �) 6 z q — 3 6 � � 3 b W (i� a ' �ea..'���ta.,�t�aw���" � ra�� �. , .: .,.:. , r . . � �
i t �x r.� -
CCB Lic.: G �', Electrical Lic.: '74 Z� 7t Suprv. Lic.: /y‘ s---c Subtotal 3 VO
Suprv. Electrician signature, required: f - Plan review (25% of permit fee)
• State surcharge (8% of permit fee) 1 4, j
Print name: A ,v,,,, Fe . c , Date: to _ 5 ...f (/ TOTAL PERMIT FEE 5 l�,�p-
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.
istBuilding \PemritclELC- PermitAwdoc 11./03 4404613 T(t0i02/COM/WPB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: 639 -4171 MST
BUP
Received Date Requested 4 — i 3 AM PM BUP
Location w 21. • _.___AZ:Z-441 / Suite (- /6, v MEC
Contact Person Ph / ) PLM
Contractor Ph ( ) 2 — ,3( 3/ SWR
BUILDING Tenant/Owner ELC ?e
Footing
Foundation ELC
Ftg Drain Access: ELR
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
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at, City Hall, 13125 SW Hall Blvd.
S PART FAIL
SITE Please call for reinspection RE: ri Unable to inspect - no access
Fire Supply Line r-
Approach /Sidewalk Date ( //...� Inspect. j . � Ext
Other:
Final DO NOT REMOVE this inspection record from the J9 site.
PASS PART FAIL