Permit lo /03 � . - 1 w) CdUO ci a d-- - . e f
CITYOFTIGARD ELECTRICA PERMIT -
RESTRICTED ENERGY
A ' DEVELOPMENT SERVICES PERMIT #: ELR2003 -00254
" „��� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/15/03
SITE ADDRESS: 12511 SW 68TH AVE PARCEL: 2S101AA -08700
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 029 JURISDICTION: TIG
Project Description: Access control and security.
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: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER: ACCESS CON X
TOTAL # OF SYSTEMS: 2
Owner: Contractor:
EDWARD HEINTZBERGER ESDS CORPORATION
1600 SW 4TH AVE., STE 960 10700 BEAVERTON - HILLSDALE
PORTLAND, OR 97201 BEAVERTON, OR 97005
Phone: 503- 228 -6390 Phone: 503- 641 -9170
Reg #: ELE 34- 593CLE
LIC 59793
SUP 913LEA
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 8/15/03 $150.00 Low Voltage Inspection
Elect'l Final
[TAX] 8% State Tax 8/15/03 $12.00
Total $162.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699.
Issued by Q A 4 -
Permittee Signature _2_4) a 1J 1J
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
/I
;w .
Electrical PermitApplication O F.,
Date received: MM Permit no. - A l aid♦ - 002-- T
_ City of Tigard R ECEIVE Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall B RECEIVED
OR 97223 Date issued: rim
Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 AUG 1 5 2003 Case file no.: Payment type:
Land use approval: ply OF TIGARD
D 1 & 2 family dwelling or accessory Commercial/industrial 0 Multi - family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other: 0 Partial
Job address: 1 DS/ / 3 W (9$ - r1 ' ►oAZ,t) Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot: Block: I Subdivision:
Project name: ''jj�� I Description and location of work on premises: sti t c_,.., Twos- 'e S f „ s aw M
Estimated date of completiMl/i 'on: p c. T'- Q3
( ' ( I N I It: \( I Oit .01'I.I(. \l ION I:I I. Si 111:01:1.1:
Job no: Fee Max
Business name: Gs 05 c oiepo>�p T'lvn) Description Qty. (ea.) rote! no.imtp
New residential- single cund- famfyper
Address: J p70 v.s to 6traV= Nl- LtisamLe $.14y Swt rt iS dwelllagunit .lnchrdesattatrhedgarage.
City: g a -g) I StateoiZ_ ZIP: COO OS Servicelncindeth
Phone: !o - D I Fax: I E- mailsps z.'oi 4 al' R or less 4 _ .
CCB no.: �5'�j� 1 }y'', I Elec. bus. lic. no: aH 3 Cr additional 500 sq. R or portion thereof
Li m i ted energy, residential 2
City/metro lic. no.: IS 8 i 0 -t -0 3 C Limited energy, non - residential 2
\r\ g -I S X23 Each manufactured home or modular dwelling
Signature of supervising electric red) Date 913 Lcrq Service and/or feeder 2
Sup. elect name (print): 1 &tr 1 144c License no: _ 1 -e Services or feeders - imAalladon,
alteration or relocation:
200 amps or less 2
Name (print): 201 amps to 400 amps 2
amps to 600 amps 2
Mailing address: , 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E-mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders - reloadiom
which is not intended for sale, lease, rent, or exchange according to OD
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's si time: Date: 401 to 600 2
Branch cheeks - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
Phone: Fax E -mail of service or feeder fee, fast branch circuit: 2
Each additional branch circuit:
I'L Itl :\ 11 :\\ (Please check all IIcit :Ippl ) Misc. (Serv1ce or feeder not incloded)
0 Service over 225 amps - commercial 0 Health-care facility Each pump or irrigation circle 2
0 Service over 320 amps -rating of 1612 0 Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* 2
0 Building over three stories 0 Feeders, 400 anger or more *Description:
❑ Occupant bad over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
0 Egress/lighting plan 0 Other. Per inspection I I I I
Submit — sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other 77,�
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ / ��. /7l/
0 Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $ / • t,
credit card number / / within 180 days after it has been State surcharge (8 %) $
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6/00/COM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
�
/ BUP
`"1'
Received Date Requested l 7 AM PM BUP
Location 7/ '11) %R►--� Suite MEC
Contact Person ( ) (1- 06 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ..�� _.:� �_� T �� ELC
Footing
Foundation ELC
Ftg Drain Access: ELR 7 7'0aZS 4 7
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam ` -z- e 2, -
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
411744
Service
Rough -In
UG/Slab
Low Voltage
F larm
ina Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
❑ Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date DS C' _ / 03 Inspector f Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL