Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
_Zeri I� D EV W H Hall M E N Tigard, SERVICES S -00149
) 639 -4171 DATE ISSUED: 6/8/2004
SITE ADDRESS: 09020 SW WASHINGTON SQUARE RD 500 PARCEL: 1S126BC-01506
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Proiect Description: JOB NO 60060A -47310 Tenant Improvement
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:
PORTLAND OFFICE ASSOCIATES COCHRAN ELECTRIC
BY TC PORTLAND, INC BROADWAY ELECTRIC
8930 SW GEMINI DR 626 SE MAIN
BEAVERTON, OR 97008 PORTLAND, OR 97214
Phone: Phone: 234 - 6564
Reg #: LIC 77942
SUP 3184S
ELE 37 -546C
FEES Required Inspections
Description Date Amount Wall Cover
[ELPRMT] ELR Permit 6/8/2004 $75.00 Elea! Final
[TAX] 8% State Surchari 6/8/2004 $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 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.
Issued by Permittee Signature = iii !� ! jai
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 OFFICE USE ONLY
City 6i I and +. Deceived Permit No ,, /+/ .4.0 0 "
13125 ; i'J Hall Blvd., Tigard, OR 9 ' '4 p
Plan Review
Phone. 503.639.4171 Fax: 503.598.' ".a -? -e t '' A Date/B : OtherPernur�u� 01,---MA �'
Inspection Line: 503 639 4175 _ Jj r Date Ready/By. 0 See Page 2 for
Internet: www.ci.tigard.or.us JUN � le, -� Notified/Method BM Supplemental Information
f n k e +.r WV :Y ,_ _ ��,'' ° r _ : i 1 . -i r �,.e, c.c_ -
} v, € + ;. _ LZ ; j rt e 'ti ,, 1' ,�). ;O T `I• S 1.7'.'':-.'";r4",-;;,13,1:=,=,-:.;-, ,._ -- i r • . ^, .. q - ~ • ` ...7.• . . ' ,. -
".. .�'' � r a =ti ? �i ^' •1:3i , r'w, e":"=' �: [' i..: r, r`' r ?�,.v >�� 4 ;:,.; ��= _ - P.L�1
❑ New construction .; i X .€' . gn/alteration/replacement Please check all that apply.
.•,
❑ Demolition \ /i
G,y &® ❑Service over 225 amps, comm'l ❑Hazardous location
14 ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
f :
'' ; ,t`��° �ar ,`. .i•F � _ � �t -�C TE/-. Y- �OB� _.. °-, �. ,••u:.._° .� ...pw U�'IUIY ` .', .
... ::: •• �i
� of 1 -and 2-family dwellings 4 or more new residential
�„ iArri_' x,. .... .. .. . a. a•.. -_,
❑ 1- and 2- family dwelling Commercial/industrial ❑ Accessory building OSystem over 600 volts nominal units in one structure
❑ Multi ❑ Master builder ❑Building over three stones :Weeders, 400 amps or more
❑ Other: ant load over 99 ❑Occup persons ❑
°� "•��.�+,�,``� �r,�� :r
.t "�" , � , - ��'�� r *�� �.,, . w -� •• r Manufactured structures or
' %,i' Y; `f c _ii., , ,�SIT,E i T� e D dCA;IO - jl^°' a'' `. ❑Egress/lighting plan RV park
r 1• .! JI` A.
too0(o0.{ - ❑Health -care facility ❑Other:
Job no.: Job site address:
473/0 9v,2 D SW L✓RS %/f �j win SO W) ,Subnut 2 sets of plans with any of the above
City / State/ZIP' �/ T he above are not appli_ab1e to temporary construction service
_ Ti yam q � a 3 .
Suite/bldg. /apt. no.: 500 / Project name: 774—c_.—/.1 X '`"i�` - .'}x ?REF* ;SCHEDULE; • ;,_'_'
Description I Qty. I Fee. I Total I •.
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
r I_ '1-e Includes attached garage.
Aie k- '4 G � b 5 / S/✓ S 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
j tp� _ Limited energy, non - residential 75.00 2
g✓f,: •�1,-Ct }'.� ?�t.tte1 1 7� ;j�u E4 c r - `O,'7t �0� a ::' : `�,yrk,'1 i, '�''� if;ti
r..,,, -. � , �u._ a;i .?fr ;r , ;'� +s.�l+. Each manufactured or modular
/ L �' . dwelling, service and/or feeder 90.90 2
1/
Y O' C -e once et u-'L � [ ��1( '1 Services or feeders installation, alteration, and/or relocation
200 201 a amps s or to less 400 amps 80.30 2
:." ,, y r , • „•:.., , , :� 3 , _, , - ..._..i,.;,....,.7.,.: , , m 106.85 2
_° _ -. QP R T,YLbVV E - : v h _ .
, ;,` i - . EN S . , - -_,.. ' - • 401 amps to 600 amps 160 60 2
Name: 7 c X 601 amps to 1,000 amps 240 60 2
Address: 973 5 5W d (id its ki il 3.1-e. Over 1,000 amps or volts 454 65 2
Reconnect only 66 85 2
City/State /ZIP: 13'e4 ve,rd 072._ _ 970 p Temporary services or feeders installation, alteration, and/or
relocation
Phone: ($ 3) 5 , 7 r 9-( 9-et Fax: ( ) 200 amps or less I I 66.85 I 1
Own:: 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
'11, ` p �' `` �` aA" O ` °W ' ;: 0" uq "` `' n
•s +w a'.,a� ;. PI.Ia..t1L� �•r,?�;'�r�Jys+•L airs;' ifi'; �; ���ir dt= Cr 'UG�- .��s'liJOPf',��,�- ;:}w•; ^ A. Fee for branch circuits with
'`' " service or feeder fee, each
Business name: C L u �� � ` branch circuit 6 65 2
Contact name: /tom, �� - C,14 �� B. Fee for branch circuits
CA without service or feeder fee, 46.85 2
Address: (9.2 to SE a r� �` p p `7 each branch branch n
"" Each add'1 bch circuit 6 65 2
City/State/ZIP: / by Lo / OR- Miscellaneous (service or feeder not included)
Pump or irrigation circle 53 40 2
Phone: (5,?) a 3o 8 a 0 „ 7 Fax: 50 3 - o2 3 5-- 3570
Sign or outline lighting 53 40 2
E - mail: Signal circuit(s) or limited -
ti`= .:i,. ;' e,_ Y`i-i_w ; •.' .AD RACCUIF:•1r°R,�.s _a:.P.V: 7tt 1. y w..- . _,yr-- energy panel, alteration, or
r.is•_ 3:'L.i.d-zi, a,-'” "�. +::; ..:.... ti _ _ '. - - - ._ -' ` extension Describe I Page 2 Ic 2
Business name: �,t--o e+.1 c..'.l •*?--c.-X- f
Address: ( C �[,�, Each additional inspection over allowable in any of the above
�
Per inspection 62.50
-c...)„, City/ State/ZIP: -c...)„, ,s-.\ ads- 09, ` t1 2.(4 Investigation per hour (1 hr min) 62.50
Phone: (503) 234 --(9 ( Fax: (s03) 2 - 2. ek S Industrial plant per hour 73.75
:c.' :At:r ° =;, a: +,EiiEtillit:W .itE. _'kE $H -
CCB Lie.: ,2CO2 Electrical Lic.: -`5' „C.. Suprv. Lic :' Subtotal x
p
Suprv. Electrician signature, required: �( � _ �� Plan review (25% of permit fee)
Print name: �Gv\hLT� \\e---0 Date:
State surcharge (8% of permit fee) (p - 7
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained with 0
days after it has been accepted as complete r/ OF�
Print name: Date: • Fee methodology set by Tn -County Building Industry Service Board
•• Number of inspections per permit allowed.
r \BuildingiPemuts\E nu / /
LC •PertAppdoc 12/03 � e_ 440- 4615T M/WEB �
/� (/' I // ' OCV
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information /14,;,
t
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
6
❑ Burglar Alarm .
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning .
System*
•
❑ Vacuum Systems* -
❑ Other:
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*
11" 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 \Buddmg\Pem=\ELC- PemutApp doc 04/03
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 7 - / AM PM BUP
Location 9 Z S(/ Suite �vv MEC
Contact Person Ph ( 1 ) 0.19 - 9 a 7 8 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC ���jj
Ftg Drain Access: ELR (7� 7 — DD / t.(7
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 r �. ��v [ � L , �i✓a' ` A ✓e/)
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
OM, Reinspection fee of $ required before next inspection. Pay at. City Hall, 13125 SW Hall Blvd.
PART FAIL
❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line / / ,
ADA Approach/Sidewalk Date / Inspector v �--�`� � _Est
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL