Permit ELECTRICAL PERMIT -
CITYOFTIGARD
RESTRICTED ENERGY
lij DEVELOPMENT SERVICES PERMIT #: ELR2004 -00148
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/7/2004
SITE ADDRESS: 11685 SW 66TH AVE PARCEL: 1S136DD -03800
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 007 JURISDICTION: TIG
Project Description: Installation of data /telecommunications.
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:
CASEY, EDWARD L JR + RICHARDSON COMMUNICATIONS
CASEY, PATRICK D 15875 SE 114TH
BY COMMERCIAL REALTY MGMT GRP CLACKAMAS, OR 97015
CLACKAMAS, OR 97015
Phone: Phone: 503 617 - 9800
Reg #: LIC 137396
ELE 3- 390CLE
SUP 2956LEA
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 6/7/2004 $75.00 Elect'I Final
[TAX] 8% State Surchart 6/7/2004 $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 j t - Permittee Signature £�
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 ApREarigIVED FOR OFFICE. USE ONLY
Received Q �O
City of Tigard Date /By: ;. y Pemtit No, [,2oj0 "f
13125 SW Hall Blvd., Tigard, OR 97223 JUN 7 2004
Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 • V• ili r Date /By:
Inspection Line: 503.639.4175 CITY OF TI a Date Ready /By: tuns: 8 See Page 2 for
Internet: www.ci.tigard.or.us
GAR ►. - -�
BUILDING DIVISION Notified/Method: / Supplemental le Page Information
YPE OF WORK PLAN REVIEW
❑ New construction Addition /alteration /replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ['Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
❑ 1 - and 2 family dwelling 13 /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
0 Building over three stories ❑Feeders, 400 amps or more
❑ Multi family 0 Master builder 0 Other:
['Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑ Egress /lighting plan RV park
Job no.: r Job site address: j' 1 1 l �� ❑Health -care of any ❑Othe
J 7 4,-, Submit 2 sets of lans with an of the above.
City /State /ZIP: y� ile7 e/ 0, 7 20 The above are not applicable to temporary construction service.
/. 1 /� FEE* SCHEDULE
Suite /bldg. /apt. no.: Project name: /1J kf 4 (�c 1;a "lc Description 1 Qty. Fee. 1 Total **
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or Tess 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 I
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or /i. modular
I/0 r .Y dwelling, service and/or feeder 90.90 2
'
V d /L [ L 44 c 4_ ti Gy Services or feeders installation, alteration, and /or relocation
0 200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
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
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 I
Owner installation: This installation is being made on property that 1 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
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
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 2
Address: Each add'l branch circuit 6.65 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 -
CONTRACTOR energy panel, alteration, or
extension. Describe: / Page 2 75, trr) 2
Business name: Rtc 4a, 1 (0 ,17 /7-. Lt,G sq b,.'tJ
/� Each additional inspection over allowable in any of the above
Address: G
7 c /Y ii rrjx di U 3 /-"C . Per inspection 62.50
City /State /ZIP: .fy i '7-vv Investigation per hour (I hr min) 62.50
Phone: (5 0 3) . � 1 '?- 41 80 I Fax: () 03) ,4 1'1 c1 F y Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: / 37 3c // Electrical Lic.: 3- 3 LL i Suprv. Lic.: 7%s Subtotal X 7 5
Suprv. Electrician signature, required: % ( Plan review (25 %ofpermit fee)
.
State surcharge (8% of permit fee) ,
Print name: ' j �/' v f D (`,
lliYl L/ j G�'^� l C' t TOTAL PERMIT FEE 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
** Number of inspections per permit allowed.
i ? Building \ Penults \ELC- PennitApp.doc 12/03 440- 4615T(10 /02 /COM /WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Li `. (S23) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
• BUP
Received Date Requested � 1 ( AM PM BUP
Location / /1,R5 cL) 10 6 Suite MEC
Contact Person (/,,t_/ Ph ( ) PLM
Contractor —� %��( ) SWR
BUILDING Tenant/Owner - ELC
Footing
Foundation Access:
ELC
Ftg Drain ELR Y'—�'bl [��f
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
EL
Rough -In
UG/Slab
ow o ag
Fire arm
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 1 •
ADA Approach/Sidewalk Date D Inspector l ""y `"
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL