Permit t
'' ELECTRICAL PERMIT -
TY T 1 RESTRICTED ENERGY
i �� DEVELOPMENT SERVICES PERMIT #: ELR2004 -00104
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/16/04
SITE ADDRESS: 12703 SW 67TH AVE PARCEL: 2S101AD -01000
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 033 JURISDICTION: TIG
Project Description: New building HVAC.
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: OUTDOOR LANDSC LITE:
OTHER: : HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: .
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
BEACON HOMES NORTHWEST ARROW MECHANICAL
25115 SW PARKWAY AVE STE C 10330 SW TUALATIN RD
WILSONVILLE, OR 97070 TUALATIN, OR 97062
Phone: 503 -570 -8828 Phone: 503- 692 -1565
Reg #: MET 00002476
LIC 5193
ELE 34 -47CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 4/16/04 $75.00 Elect'I Final
[TAX] 8% State Surcharl 4/16/04 $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 throuc
Issued by l� �,�jt P erm itt e e Signature /i /.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:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
i
R.CE'VED
Flictrical Permit Applicauon FOR OFFICE USE ONLY
City of Tigard APR J.. 6 20044,10 Received
Date/By: /(, , , .61, ,. A ... i Pennit No.-Elk .... ./ey
0 ,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revi
Phone: 503.639.4171 Fax: 503.598.1960 CITY OF I:GAF Date/B : Other PennitauAzoog....i i i lp .•
Inspection Line: 503.639.4175 I.50 OM i
BUILDING DIVI --- Date Ready/By: - 10 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: atr Supplemental Information
„ ,_ , ,,,,.,,,,.,,,,, , :,, , ,:;, , j,4',.: , :' , ; : ,:',, '',; '• ,' ''',...., -, --",-,: ''''''',:•'-`;:', .' i
•1•Y'.' :...., ,,.::::,,,,:,: -:.- ;
TYPE WORK :,i. ,--,,,--,,,,, : -,,:,:- :,, .: ., -,,:,,,,,,;! PLAN ,, :
NI New construction D Addition/alteration/replacement Please check all that apply:
EjService over 225 amps, comm'l ['Hazardous location
0 Demolition 0 Other:
['Service over 320 amps - rating 1:1Buildng over 10,000 sq. ft.,
:,::. - T:'", - ... , CATEGORY - OF CONSTRUCTION :,, -:,,;.,.;,,.,,„,,,,-..:,,, ,,, of I - and 2-family dwellings 4 or more new residential
ci 1- and 2 dwelling IN Commercial/industrial 0 Accessory building ['System over 600 volts nominal units in one structure
DBuilding over three stories pFeeders, 400 amps or more
10 Multi 0 Master builder p Other:
I=1Occupant load over 99 persons ['Manufactured structures or
ii3O* A'■ili00001: : , , i ' C'' : ',;":1;,_:- DEgress/lighting plan - RV park
EHealth-care facility ['Other:
Job no.: Job site address: / Z 7 DX 5 et) C, 7 E- 4 vc Submit 2 sets of plans with any of the above.
City/State/ZIP: `27 6, 1). a b () a The above are not applicable to temporary construction service.
'SCIEiEDULEI. 7.
Suite/bldg./apt. no.: f Project name:
Description I Qty. Fee. Total
Cross street/directions to job site: 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'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map/parcel no.:
Limited energy, non-residential 75.00 2
pEK,• , i ,-, ;:,-; ,--, . : • -,,, Each manufactured or modular
dwelling, service and/or feeder 90.90 2
/_9(.1i I) 0 L'1 6-r "f ki 6am (), frn I Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
, ::. , [3;,PROPErifY.C'AVIN' Ei . ,:':,;-;;'- ""-.1:.''''''' ' , - ,.:: - 201 amps to 400 amps 106.85 2
160.60 2
Name: 3P6c - riz UM D6 u6 7- 601 amps to 1,000 amps 240.60 2
Address: 1 2, 7 o , tj 6 - 71,_ 4 taf. Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: cl
f ) ) b(t 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 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
N ; Aisiii.leA14.TT .=11-cONTActryErt§oN; . ' '.:,,::: - A. Fee for branch circuits with
service or feeder fee, each
6.65 2
Business name: Ilge it,4 ,q 4 _, _ branch circuit
B. Fee for branch circuits
Contact name: A r a 5 8 6.-iz._ without service or feeder fee,
46.85 2
each branch circuit
Address: / 6 3 _ n ___ b 7 --- 4 g 4 477 it go iflo Each add'I branch circuit 6.65 2
City/State/ZIP: 7 i At ) n 9_ c f 7 6 (d Z....- Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: (523) 6 1 2 .... _ /se ,1--- Fax: : (563 (09/ - / X 7 9 Sign or outline lighting 53.40 2
E Signal circuit(s) or limited-
' coNtiikeroR ,, :::--:;•!:,,,,,:',,,, ,,,',,,,.,,,,'„. 'k:,:-,,,,,,i. c energy panel, alteration, or
extension. Describe: i Page 2 2
Business name: A aftr 1,46: I cA e
Each additional inspection over allowable in any of the above
Address: / 3 3 6 s t j ,-T- ;9 e _ 4 , g tin li
Per inspection 62.50
City/State/ZIP: 1: L 6. 7// (, 2 7 7 0 6 7,
/I i Investigation per hour (1 hr min) 62.50
Industrial plant per hour 73.75
Phone: L5 ) 6 q p ... _.../ 5 s- Fax: 6.6 ) (0 9 / -/ F 79 Etteritico.ktolit- VEtS:* '::•::'. '.' ' ":'
CCB Lic.: 67 3 Electrical Lic.: 3q-47Cte Suprv. Lic.:Z45/ ta Subtotal -75 , 0 -0
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) 6 . o
Print name: Date:
TOTAL PERMIT FEE .Ff . ay)
Authorized signature , This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: AMe3 110 vcedupo(2. 7 Date: / - _A 4
/ .0 ei . Fee methodology set by Tri-County Building Industry Service Board
** Number of inspections per permit allowed.
i: \Building \Permits \ELC-PennitApp.doc 12/03 440-4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard -_
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
`::RESIDENTIAL W. ORK�ONLY,� `�` , .
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
eating, Ventilation and Air Conditioning
Syste
❑ Vacuum Systems*
❑ Other:
7 101 lV IERCTAL WORK1 "ONLY, qMS '
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
❑ Fir • . •. • .• allation
HVAC
s entation
❑ 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 \Petmits\BLC- PemutApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection4Jne: *503) 639 -4175 •
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Re uested 7 V 2-0 AM PM BUP
Location 1 2 703 S 6.7a- Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR 2-00q— t?O SOY
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam /11111M---
Shear Anchors
' Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation A-- L Ate ) RO Vet) L1 �!
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm _ ! M`7 yo frt
Susp'd Ceiling '� F
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 /S
ow Volta
Fire Alarm
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
f ig El Please call for reinspection RE: Unable to inspect – no access
Fire Supply Line // ADA Date 7- ZO - 0 y Inspector/ 16/1 , Al A 6 e !2 y Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL