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Permit (73) !� u CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT " ° COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00255 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/29/2007 PARCEL: 1S136DD-04100 SITE ADDRESS: 11850 SW 67TH AVE 100 ZONING: MUE SUBDIVISION: TIGARD TRIANGLE COMMONS LOT: 007 JURISDICTION: TIG PROJECT: AMERICAN FAMILY INSURANCE Project Description: Low voltage for Fire Alarm. A. RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: DATA/TELE COMM: NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: X OUTDOOR LANDSC LITE: OTHER: HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: TOTAL # OF SYSTEMS: 1 Owner: Contractor: PACIFIC NW PROPERTIES CAPITOL ELECTRIC CO INC 6600 SW 105TH SUITE 175 11401 NE MARX ST BEAVERTON, OR 97005 PORTLAND, OR 97220 -1041 Phone: 503- 626 -3500 Contact #: PRI 503- 255 -9488 FAX 503- 257 -7121 FEES Reg #: ELE 26 -496C LIC 48748 Description Date Amount SUP 2865S [ELPRMT] ELR Permit 6/29/2007 $75.00 [TAX] 8% State Surcha 6/29/2007 $6.00 REQUIRED ITEMS AND REPORTS 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 or 1.800.332.2344. I ///A�� /^� sued B : '� i Permittee Signature �/ L1 /j Issued By: �. / � 6 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. ,i 06/27/2007 09:11 5032551966 CAPITOL ELECTRIC PAGE 02 4 ,' - I . lect>Eical Permit A licatiolt � : . h:t)1 : OF'I•i(F 1151 ONI t Receiv i permit No ' �- 5 / , Ci of T V� igard VE1 Date/ f3 0 . v "r "' ° 13125 SW Nall Blvd.. Tigard. OR 97223 plat Rcvi • Other Permit I s Phone: 503.639.4171 Fax: 503.598.J1 2 7 2007 Uatc/By: y ;j. � Gil S ee Pagcz for TBIt „�Ith Ina ctipn Line: 503.639.4175 Date Rcndy/6y dtnia: r 'RD Natifiett/Method: Supplemental Information ''..:::-.-.^A . Internet; www.tigard- or.gnv CITY OF 1 IaA _ TvPit O i�RK "G UVi l ®N PLAN REVIEW ® New construction ❑ Addition /alteration/replaeement Please check all that apply (submit 2 acts of plans w /itcrria checked below): ❑ Service or feeder 400 amps or more CI Building over three stories. a Demolition. Et Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or O Pleating buildings. lean to ground. or exceeds 14.000 ❑ Commercial - use agricultural 0 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Fire pump. El installation of 75 K V A or ❑ Multi- family 0 Master builder El Other: ❑ Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION ❑ Addielem of new molar load of rJ "A ". "E ", "1 - 2", "1 - 3 ". IMP or mane. occupancy, Job rte.: 270610 lob site address: 1 SW 67"' Ave © $ix or more residential units. ❑ Recreational vehicle parka. ❑ Health -care facilities. ❑ Supply voltage for more than City /Statcl7,iP: Tigard, OR 97223 ❑ Hazardous locations, 6110 volts nominal. Suite/bldg. /apt. no.: 100 Project name: American Family insurance ['Service or feeder 600 a mps or more, FEE SCHEDULE Cross street/directions to job site: ne,eriptton - L 1 Fee. 1 total 1 • New residential single- or multi - family dwelling unit. Include; attached garage. Lot no.: 1_000 sq. it. or less 145.15 4 Subdivision: Ea. add'l 500 sq. ft. or portion 33.40 , 1 Tax map /parcel no.; _ Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. R.) Limited energy, multi- family 75.00 2 Install Fire Alerts' Circuit residential (with above aft•) _ Services or feeders installation, alteration, and/or relocation 200 amps or less 80 , 2 2 01 a sto400am s 106.85 2 ❑ PROPERTY OWNER ® TENANT( mP p . 401 amps to 600 amps _ 160.60 2 Name: American Family Insurance 101 amps to 1,000 amps 240.60 2 Address: �+ Over 1.000 amps or. volts 454.65 2 Temporary services or feeders installation, alteration, and/or City/State/ZIP: r relocation Phone: ( ) J Fax: ( ) 200 amps ar less - 66.85 1 201 amps to 400 amps , 100.30 _ 2 Owner installation: This installation is being made on property that F own which is not 201 amps to 4 00 amps � 100.30 � 2 intended for sale. lease, rent, or exchange, according to ORS 447. 449. 670, and 701. - Branch c)rcuIts - new alteration, or extension.er panel Owner signature: _ _ Date: A. Fee for branch circuits with APPLICANT � . CONTACT PERSON above service or feeder fee, 0.65 2 ® each branch circuit Business name: Capitol Electric Cn., Inc. B. Fee for branch circuits wit /tout service or feeder fee. 4G.R5 2 Contact name: Dan Wilson first branch circuit _ _ Each add'I branch circuit 6.65 2 Address; 11401 NE Marx Street Miscellaneous (service or feeder not included) • City/State/Z_IP: Portland, OR 97220 Each manufactured or modular 90.90 2 dwellin •. service and /or fader Phone: (503) 255 -9488 1 Fax; ; (503) 255 -1966 Reconnect only 66.85 _ 2 - E -mail; dan(r�r7cepdx.cnm Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 Signal circuit(s) or limited - Business name: Capitol Electric Co., inc, energy panel, alteration, or 1 75.00 extension. Describe: Page 2 2 Address: 11401 NE Marx Street Fire Alarm City /State /ZIP: Portland, OR 97220 Each additional inspection over alloable In any w of the above - Per inspection 62.50 Fax: (503) 255 -1966 62.50 Phone; (503) 255 -9488 ( ) Investigation per h our ( I hr m+n) lant per p 73.75 CCB Lie,: 48748 Electrical Lie.: 26 5uprv. T.ic.: 3132-5 - Industrial hour ELECTRICAL PERMIT FEES Suprv, Electrician signature. required: Subtotal: 75.00 Plan review (25% of permit fee): Print name: Darrell McNeel Date: /0 State surcharge (8% of permit fee): 6.00 Authorized sigtaturc: TOTAL PERMIT FEE: 81.10 i 6/27/07 This permit application expires if s• permit is not obtained with! RD Print name: Darrell McNeel days after It him been Accepted as templet • Number of inspections allowed per permit. 1 EulldlnpSPomlilA \F,I;C.PcrmtIACP•dtx 05 R 3 /a 6 440-46151111 /63 /COM/ :F.n CITY OF TIGARD BUILDING DIVISION PERMIT #: E:LR2007 -00265 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/29/2007 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639 -4175 s_' fil .. INSPECTION WORKSHEET FOR DATE: 8/24/2007 TIME: 7:00AM PAGE: 64 SITE ADDRESS: 11850 SW 67TH AVE 100 CLASS OF WORK: SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE: PROJECT NAME: AMERICAN FAMILY INSURANCE DESCRIPTION: Low voltage for Fire Alarm. OWNER: PACIFIC NW PROPERTIES, PHONE #: 503-626-3500 CONTRACTOR: CAPITOL ELECTRIC CO INC PHONE #: 503-265-9488 Inspection Request Scheduled For: Date: 8/24 /2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 054586-01 971 - 506.3495 N Corrections /Comments /Instructions: Q /:4 • PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: . ( v� G Date: b ),11-4- p 4 Phone #: (503) 718- ),`1 • CITY OF TIGARD .1° BUILDING DIVISION PERMIT #: E.LR2007- 00255 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/29/2007 Phone: (503) 639 -4171 '∎ 4111 1, Inspection Requests (24 Hrs.): (503) 639 -4175 I ''LL. INSPECTION WORKSHEET FOR DATE: 7/11/2007 TIME: 7:01AM PAGE: 37 SITE ADDRESS: 11850 SW 67TH AVE 100 CLASS OF WORK: SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE: PROJECT NAME: AMERICAN FAMILY INSURANCE DESCRIPTION: Low voltage for Fire Alarm. OWNER: PACIFIC NW PROPERTIES, PHONE #: 503 -626 -3500 CONTRACTOR: CAPITOL ELECTRIC CO INC WAtL„LI CE ILI PHONE #: 503 - 255 -94813 Inspection Request Scheduled For: Date: 7/11/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 135 Low voltage 051804.02 971 - 222 -8040 Y Corrections /Comments/ Instructions: /mil PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Ni� L • Date: 1 ' ` " Y) 1 1'0 Phone #: (503) 718 -1