Permit :„.., ,
_-, ciTy OF TIG`4RD I ELECTRICAL PERMIT -
RESTRICTED ENERGY
liIiA DEVELOPMENT- SERVICES PERMIT #: ELR2004 -00152
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/9/2004
SITE ADDRESS: 12703 SW 67TH AVE PARCEL: 2S101AD -01000
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 033 JURISDICTION: TIG
Project Description: Low voltage: Audio and stereo systems, data telecommunication, protective signaling.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: X INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATAITELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER: .
TOTAL # OF SYSTEMS: 3
Owner: Contractor:
BEACON HOMES NORTHWEST, INC. AZIMUTH COMMUNICATIONS INC
25115 SW PARKWAY P.O. BOX 508
BLDG. A, STE. C WILSONVILLE, OR 97070
WILSONVILLE, OR 97070
Phone: 503 -570 -8828 Phone: 503- 639 -0110
Reg #: ELE 36 -94CLE
SUP 2312LEA
LIC 145828
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 6/9/2004 $225.00 Elect'I Final
[TAX] 8% State Surchar€ 6/9/2004 $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 forth in OAR 952 - 001 -0010
through OAR 952 - 001 -0100. You may obtain copies of these rules or direct question t OUNC at (503) 246 -6699.
Issued by . Signature ,, . 0 l
,,,,,,..L.i.„, 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:
CaII 639 -4175 by 7:00 P.M. for an inspection needed the next business day
i1ectrica1PermitApplication -
Date received: • / ji, Permit no. :F1,, MRS rp'2_
":1.`,1}'il'la City of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: KO Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
❑ 1 & 2 family dwelling or accessory 'Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
$ Atitt. «t F. 0,41.% 4 tg tJOENITONFORMXIION�t _ `r' r °• t '?`
Job address: pa, 03 5, 10. , DEL' Bldg. no.: Suite no.: Tax map /tax lot/account no.:
' Lot: Block: Subdivision:
Project name: Description and location of work on premises: ►up 0 bl la , `
Estimated date of completion/inspection: ��
i * � 'Ari CONTRACTOR"APPLI, CATION ` tert,0 ' ,"� FEE SCHEDULE `�±q i
Job no: Fee Max
Business name: I2 v.uTbt comf'►'\u.,t) CA- 1ZOVNS Description Qty. (ea.) Total no.insp
New residential - single or mold- family per
Address: or 0 SOB dwelling unit Includes attached garage.
City: 1 L.SO) U tt-LE State:0' ZIP: q 076 ' Service included:
Phone: b3 6' • D I t 0 Fax: 639 411 S- E -mail: 1000 sq. ft. or less 4
CCB no.: �}Sg2 Rh,- C Each additional 500 sq. ft. or portion thereof __
E lec. bus. lic. no:
Limited energy, residential ___ 2
City /metro lic. no.: 01* d6S/ ' Limited energy, non - residential IM__ 2
G y , /9/ 6 V Each manufactured home or modular dwelling
Signature of supervising electric 1 (required) Date Service and/or feeder ■■. 2
/
Sup. elect. name (print): E77 u($ tr�G License no .3 ,Z Le ' Services or feeders — installation
� alteration or relocation: II
. Arita- PROPE t O,�VNL ' . I p
,- �4Rf 200 amps or less 2
Name (print): : • • in ( ✓ 5 201 amps to 400 amps ___ 2
401 amps to 600 amps ___ 2
Mailing address: 601 amps to 1000 amps ___ 2
City: State: ZIP: Over 1000 amps or volts ___ 2
Phone: Fax: E -mail: Reconnect only 17� 1
Owner installation: The installation is being made on property I on Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration,orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps ___ 2
Owner's signature: Date: 401 to 600 amps IMIMIl _ 2
fl w Branch circuits - new, alteration,
rta`yt 3 ``` , '' � ,q, .. , GINEER $ * , , t A r 4 Tx ,• Ig
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: ■■ 2
Phone: Fax: E -mail: Each additional branch circuit: ___—
,, ; �pLANt REVIEW (Pleasel k' all &tltat 0i MtiMig Misc . (Service or feeder not included):
❑ Service over 225 amps- commercial ❑ Health -care facility Each pump or irrigation circle ■■ ■ 2
❑ Service over 320 amps -rating of 1&2 ❑ Hazardous location Each sign or outline lighting MEM 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, IIIIIII
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other: Per inspection __ --
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ o . • 00
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ .1 -
Credit card number: / / within 180 days after it has been State surcharge (8 %) $ / �S
Expires accepted as complete. TOTAL $ 0-'/' 3 . O
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (6/00 /COM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIrFE S:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
f� Restricted Energy Fee $75.00
' Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total y Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular El Service or Feeder $90.90 2 Garage Door Opener
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2
201 amps to 400 amps $106.85 2 ❑ Vacuum Systems
401 amps to 600 amps $160.60 2 ❑
601 amps to 1000 amps $240.60 2 Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85. 2 (SEE OAR 918- 260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts, ..
see "b" above. Audio and Stereo Systems
Branch Circuits
New, alteration or extension per panel ❑ Boiler Controls
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee. •
Each branch circuit $6.65 2 F■ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
•
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems
Signal circuit(s) or a limited energy •
panel, alteration or extension $75.00 n Landscape Irrigation Control*
Minor Labels (10) $125.00
Each additional inspection over El Medical
the allowable in any of the above
Per inspection $62.50 ❑ Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting
Fees: rzt Protective Signaling
Enter total of above fees $ ❑ Other
8% State Surcharge $ 3 Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ No licenses are required. Licenses are required for all other installations
front of application. .
Fees:
Total Balance Due $
Enter total of above fees $ A9.5,00
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
All New Commercial Buildings require 2 sets of plans.
i:\dsts \forms \elc- fees.doc 08/30/01
CITY OF TIGARD 24 -Hour
BUILDING Inspectio0_I-,.ineA (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested U I AM PM BUP
•
Location / a' ) C 3 ( 7 f' X1---u-e-- Suite MEC
Contact Person Ph ( ) '/o 7 – a S PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 'eff
Footing
Foundation ELC
Access:
Ftg Drain ELR .eoq ° O / 5Z
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors F -,,��,,,�,�,j- j -�--
Ext Sheath/Shear ®s, -_ , °' A AVM
Int Sheath /Shear TM'
Framing
Insulation
.Drywall Nailing
Firewall , �, "�:1 i�!;/ ',0 �i !i� / 1 /;4 './ % ail*
Fire Sprinkler
Fire Alarm grI
Susp'd Ceiling' l
Roof
Other: r� v CTy
Final r Fl / � er
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service /'
Sanitary Sewer / /
Rain Drains V
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
gr 111
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SI ❑ Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
DAoach /Sidewalk Date l� 1 L b Inspector /6M. /17013a Est
Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL -