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Permit C ITY OF TI CHAR® ELECTRICAL PERMIT - RESTRICTED ENERGY , I- DEVELOPMENT SW Hall Tigard, O ERV SERVICES (503) 639 -4171 DATE R E 2 0 004 00308 SITE ADDRESS: 11560 SW 67TH AVE 333 PARCEL: 1S136DD -00200 SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE BLOCK: LOT: 004 JURISDICTION: TIG Project Description: Installation of data telecommunications, fire alarm & HVAC. 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: X OUTDOOR LANDSC LITE: OTHER: : HVAC: X PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: TOTAL # OF SYSTEMS: 3 Owner: Contractor: GREEN, JOSEPH W SUPERIOR LOW VOLTAGE LLC PO BOX 1 10027 SE RAMONA ST DONALD, OR 97020 PORTLAND, OR 97266 Phone: Phone: 877 - 336 - 6213 Reg #: LIC 150766 ELE 26- 1126CLE SUP 3422LEA FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 10/5/2004 $225.00 Elect'I Final [TAX] 8% State Surchart 10/5/2004 $18.00 Total $243.00 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 fort in GAR 952 - 001 -0010 throu AR 95 -i51-0100 You may obtain copies of these rules or direct qu- - .. to - NC a (503) 246 -6699. i Iss d by . /� i�� ,� i _ Permittee Signature �'a k. 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 ElectrLcal Permit " F O R OFFICE_ USE ONLY, CI of Ti and Received �� permit No 13125 SW Hall Blvd., Tigard, OR 97223 g Plan Review �� 5 Phone: 503.639.4171 Fax: 503.598. 2004 DateB : �� °'? i)' I '`�, Other Permit: .ZOO ��o?.� .P Inspection Line: 503.639.4175 =' II I '',. Date Ready/By: lurk ® See Page 2 for Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: Supplemental Information ; ' � a ee-s ws '�t..• •r,� � r vta 1 s, ry,'� �= t z .t .c"t� ): - at y'M - .t e � t �PwN 1�.W ..... �iew 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., of 1- and 2- family dwellings 4 or more new residential ❑ 1- and 2- family dwelling "mmerciaL/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑Building over three stones ❑Feeders, 400 amps or more ❑ Multi - family ❑Master builder ❑Other: ❑Occupant load over 99 persons Manufactured structures or Mµ ❑Egress/lightingplan RV. park Job no.: Job site address: ' 1 � 5u . / `� ❑Health -care facility ❑Other: Submit 2 sets of plans with any of the above. City/State /ZIP: 2 The above are not applicable to temporary construction service. Suite/bldg. /apt. n .. ? Project name: � S % . Dacripuon Qt Fee. Total •� Cross street/directions to jo sb tte: New residential single- or multi - family dwelling unit. Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: Lot no.: Ea. add'1500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limitedenergyrvesideutial� 75.00 2 _ Limited energy, non- residentiy3 75.00 a�S.6� 2 � B�`" �� : - 'w�+ > w �"� >5+ �.h xe r t �, .w.w_. terra j t�'IS zs�-•.., . �.. r,.�.�s�'.�- ._a -s. b• ~�,��.��.CsRIF *UF.�.'�. `�t��s��.��r``��n:.�,�'�.�# � �"ch manufactured or modular dwelling, service and /or feeder 90.90 2 Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 401 201 amps to 400 amps 106.85 2 �`° ` " amps to 600 arrlps 160.60 2 Name:e 1 y� � �� 601 amps to 1,000 amps 240.60 2 Address: P S ( x 1 -i� v9-� � o Over 1,000 amps or volts 454.65 2 I � � Reconnect only 66.85 2 City/State /ZIP: t,Qy / � 97Qa () Temporary services or feeders installation, alteration, and/or relocation Phone: (tea 3) ,/ Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installatio 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 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, 46.85 2 each branch circuit Address: Each add '1 branch circuit 6.65 2 City/State /ZIP: Miscellaneous (service or feeder not included) Phone:( ) Fax::( ) Pump or irrigation circle 53.40 2 Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited- energy panel, alteration, or rt...,r.�.f:.'1� •.,4,.�. «"S:. -.�eT .,i.. v,...w9a:,taza�.,:...:P °53fa?cs... -" extension. Describe: Page 2 2 Business name: S (� 1 0r l o w v o . f ! 1' � Address: , OQ / R GW✓10 r� S �— Each additional inspection over allowable in any of the above Per inspection 62.50 City /State /ZIP: 12Q r *J '4- 1 y o/2 a 6 ( Investigation per hour (1 hr min) 62.50 Phone: (Z') 3 '7 Fax: ( ) J o /I/ o. Industrial giant per hour 73.75 CCB Lic.: /Q 6 2t/ ie Lic.: ab_// OLF Suprv. Lic.: 3tl L Subtotal Suprv. Electrician signature, required: Plan review (25% of permit fee) Date: State surcharge (8% of permit fee) / g, Print name: �'1Gt,� �Por.c�l �D / / f TOTAL PERMIT FEE 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 \Permiu'ELC- PennitApp4oc 17103 440- 46!5T(10 /O71COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: ' Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: 01: 71 n4 .r : % H'H Fee for each commercial system $75.00 (SEE OAR 918 - 260 - 260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clo k Systems Data Telecommunication Installation Fire Alarm Installation �HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ 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 is Building \Permits\ELC•PetmitApp.doe 04/03 CITY OF TIGd4RD r_ �( BUILDING DIVISION PERMIT #: a 60 y --DG 3,4 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 Aye r . p °; Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: / / S-67 O � p 7 CLASS OF WORK: SUBDIVISION: ` LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE. #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: 3 - _ O ( � Pour Time: Code # Inspection Description Confirm # Contact # Message 300 y ?Le-- Corrections/Comments/Instructions: KNit. 14E vJ cs)N`DV • ' . `C MY.3' c01" t k r z.. '1 (vv. vavio ;3 c.•o i • ot1, s -3.Ob -o. . •v, `41■i 5 w L - Pt,\IA moo i L) - TEN - 41 - 4 1 New • vol 41)4'00 EL'S Z • 00023 Ga ► S E L.K 200' - fl 0 3 01 Arks L6 \ „;1‘.k r 0 0 ® o& 3/ 3/0 & Maw E PASS ❑ PARTIAL APPROVAL 1 CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: CY N (43 Date: Si') ()Az. Phone #: (503) 718- 2-41416 CITY OF TIGARD 24 -Hour BUILDING Inspection Line; 593); -4175 MST INSPECTION DIVISION Business Line: (503) 639 - 4171 / BUP Received Date Requested / ` � AM PM BUP Location // c , & (p 7 - Suite 3 MEC Contact Person 1 / Ph ( ) YO (' 30 0 / PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC o.�3 J L3 6 53 Footing Foundation EL • Ftg Drain Access: Crawl Drain ---:' l ° 41 ELR o l')O 4 1 - d00 36• Slab Inspection Notes: SIT Post & Beam Shear Anchors ' / Ext Sheath/Shear / • % , / 4. Int Sheath/Shear / Framing r,� Insulation . r � � - oTh lifw � ? t ) . - * G\ (� V V Drywall Nailing ��''�� ^�� " Firewall n� J 4't c-\ \ J Fire Sprinkler pp `� V Fire Alarm — ' Re ► , ,1 114 /` Ail ;! t \ . ; - '�e, Susp'd Ceiling _ Roof Other: w l e'i` ,, �� Q I �� 1 - -. o Final PASS PART FAIL /� i� PLUMBING . FAIL o 9 — O > L-f G t`` w \J i i'c C ` Post & Beam Under Slab Rough -In �� Water Service t_______2 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 _ ELEc RICAL- E:AK,')4 17 Lt. _ © CJ 3 0 9 - , P 1 rA Service UG/Slab i�� ow Volta. v ire Alarm Final ,, 0 Reinspection fee of $ required before next inspection. Pay at. City Hall, 13125 SW Hall Blvd. PASS � � F ' 'IL SITE 0 Please call for reinspection RE: Q Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Da$e �J �O /,y Insp.ctor Other: Final DO NOT REMOVE this Inspection record from the ob site. PASS PART FAIL