Permit CIT'TIGARD ur ELECTRICAL PERMIT -
RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT #: ELR2003 -00178
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/23/03
SITE ADDRESS: 11308 SW 68TH PKWY 2ND FL PARCEL: 1S136DA -00100
SUBDIVISION: ZONING: MUE
BLOCK: LOT: JURISDICTION: TIG
Proiect Description: Install low voltage Data /Com.
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:
BENENSON 68TH PARKWAY OREGON ELECTRIC CONST /GROUP
KEY LLC, THE 1010 SE 11TH AVE
BY FIRST AMERICAN TAX VALUATIO PORTLAND, OR 97214
WORCESTER, MA 01615
Phone: Phone: 503 234 - 1001
Reg #: L503-23429E00
SUP 4460S
ELE 26 -95C
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 6/23/03 $75.00 Elect'I Final
[TAX] 8% State Tax 6/23/03 $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 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
r .
IE1ect>i ica ermit Application
OFFICE USE ONLY
A ' City of Tigard Date received: Permit no.It./60 o v0/7
,t 13125 SW Hall Blvd Project/appl. no.: Expire date:
,.,,1,l„ I Phone: (503) 639 -4171, FAX: (503) 598 -1960 Date issued: By: (Receipt no.:
Internet address: www.cl.tigard.or.fis.1. • +,•- -) Case file no.: Payment type:
24 - Hour Inspection Request 503694i75,,J
U 1 &2 family dwelling or accessory U CommerciaVindustrial U Multi- family ❑ Tenant improvement
❑ New construction ❑ addition/alteration/re • lacement ❑ Other: . ❑ Partial
JOB SITE INFORMATION
Job Address: 11308 SW 68th Parkway Bldg. No.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision
Protect Name: Tigard Data Center _Description and location of work on premises: LE for teledata
Estimated Date of completion /inspection:
Will ou call for ins • ection within 24 hours? Yes ❑ No ❑ Pro Contact Shawna Pabst (503) 5194868 Phone
CONTRACTOR APPLICATION FEE SCHEDULE
, axno .
Job No.: 63595 -103 Description Qty Fee (ea.) Total Insp
New residentlal•stngle or -
multi - family per dwelling unit.
Business name: Oregon Electric Group Includes attached garage.
Service Included:
Address: 1010 SE 11th Ave. 1000 sq. ft. or less $ 145.00 $ - 4
City: Portland)State: OR Zip: 97214 Ea Addl 500 SF or Portion $ 33.40 $ -
Phone: (503) 234 -9900 Fax: (503) 234 -1001 1E-mail: Limited Energy, 1 8 2 Family $ 75.00 $ - 2
CCB no.: 203 Elec. bus. lic. no.: 26 -95C Limited Energy, Multi- Family $ 75.00 $ - 2
City /me • li o.•
Each manufactured home or
modular dwelling. Service
ia ° • 1 _ : 6/20/2003 and/or feeder. $ 90.90 $ - 2
, r Service or Feeders -
Su • . lect. Name int : ark Ken ,�" License no: 4460S Installation, Alteration or
Relocation:
PROPER rY OWNER 200am.sorless $ 80.30 $ - 2
Name (print): 201amps - 400amps $ 106.85 $ - 2
Mailing Address: 4olamps- 600amps $ 160.60 $ - 2
City State: (Zip: 60 tamps • 1000amps $ 240.60 $ - 2
Phone: Fax: 1E-mail Over 1000A or Volts $ 454.65 $ - 2
Owner Installation: The installation is being made on property I own which is Reconnect Only $ 66.85 $ - 1
or
not intended for sale, lease, rent, or exchange according to ORS 447, 455, Temporary Feeders s - I Services nstallation, ,
479, 670, 701. Alteration or Relocation:
Owners si nature: Date: 200 am s or less $ 66.85 $ - 2
201amps - 400amps $ 100.30 $ - 2
Name: Over 401amps- 600amps $ 133.75 $ - 2
Branch Circuits - New,
Address: Alteration or Extension Per
Panel: A. Fee for branch
City: _State: Zip: circuits with purchase of service
or feeder fee, each branch
Phone: Fax: E -mail: circuit $ 6.65 $ - 2
B. Fee for branch circuits W /Out
Purchase of Service or Feeder.
PLAN REVIEW 1st Branch Ckt $ 46.85 $ - 2
❑ Service over 225 amps -coma ❑ Health -care facility Each additional branch circuit $ 6.65 $ -
❑ Service over 320 amps - rating of ❑ Hazardous location Miscellaneous • (service or
feeder not included)
1 &2 family dwellings ❑ Building over 10,000 square feet four or Each pump or irrigation circle $ 53.40 $ - 2
❑ System over 600 volts nominal more residential units in one structure Each Sign or Outline Lighting $ 53.40 $ - 2
❑ Building over three stories ❑ Feeders, 400 amps or more Signal Circuit(s) or Limited Energy
nag geteratign� Ext
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park vJ/¢1 A 6` O� 1 $ 75.00 _ $ 75.00 2
❑ Egress/lighting plan ❑ Other: 'Description: .
Each Additional Inspection over
the Allowable In any of the
Above. Per inspection
_ $ 62.50 $
Submit 2 sets of plans with any of the above. Investigation fee:
The above are not applicable to temporary construction service. Other
Permit Fee $75.00
Notice: This permit application Plan review 25% $0.00 ,G
expires if a permit Is not State Surcharge 8% $6.00 N 9
obtained within 180 days after it
has been accepted as complete. Total $81.00
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: X03).839 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
� B UP
Received 1 vv► Date Re 1 1 /zh' � quested /- ` � M PM BUP
Location l (as i� --LA) G]i Suite MEC
Contact Pers4 > LPT7 t 0 Ph ( 'SU �) cl In 9 — 3 10 ! �p PLM
Contractor 12 �.' - !'� J Ph ( ,� SWR
BUILDING Tenant/Owner - /3et t �r ELC
Footing ELC
Foundation Access:
Ftg Drain • 4206__
Crawl Drain •
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall C •
Fire Sprinkler
Fire Alarm •
Susp'd Ceiling
Roof iff/
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/Slab
Low Voltage
PART FAIL 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SI Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA Approach/Sidewalk Date ✓ / � Inspector tivti Ext
Other:
Final DO NOT REMOVE this Inspection record from the j site.
PASS PART FAIL
•