Permit Ti
CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
� ���;� DEVELOPMENT SERVICES PERMIT #: ELR2003 -00315
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/10/03
SITE ADDRESS: 11410 SW 68TH PKWY PARCEL: 1S136DA-00101
SUBDIVISION: PERS SITE ZONING: MUE
BLOCK: LOT: JURISDICTION: TIG
Project Description: JOB NO. 03 -100
Voice & Data
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:
OREGON, STATE OF PUBLIC NETWORK CONNECTORS INC
EMPLOYEES' RETIREMENT FUND 14865 SW 74TH #130
11410 SW 68TH PKWY TIGARD, OR 97224
TIGARD, OR 97223
Phone: Phone: 503 - 595 - 1851
Reg #: LR03- 59561
ELE 3- 313CLE
FEES Required Inspections
Description Date Amount Ceiling Cover
[ELPRMT] ELR Permit 10/10/03 $75.00 Wall Cover
Elect'I Final
[TAX] 8% State Tax 10/10/03 $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 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699.
Issued by Permittee Signature ajj
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
Oct 09 03 10:59a Steve Baptiste 5035951850 p.3
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,
;;�t:iy City of Tigard �'. /
Electrical Permit . 1 lication
} ,� Daureceivadi
D Project/appl.no.: Permit noate .: x403 -0.315
T
Expired
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CityofTigard Address: 13125 SW Hall Blvd, Tigartl;9 t 973,,,,,, Date issued: By: I Receipt no.:
Phone: (503) 639 -4171 '' let',
Fax: (503) 598 -1960 Cll-Y Case file no.: Payment type:
BUILD! r . /G F
Land use approval: r D w; N
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/mdustrial 0 Multi- family 0 Tenant improvement
O New construction g Addition/alteration/replacement 0 Other: 0 Partial
JOB SITE INFORi11ATION
Job address: Ff L/ /0 3 /A ) 1, Y -- 6. - J(aJ) Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot: I Block: • I Subdivision: 1
Project name: 4' £ e S •I Description and location of work on premises: JD (- a - d LA - L - ( L.101 t ..
Estimated date of completion/inspection: J
'; '. < ...CONTR.ACTOR AI3PLI CAT' ON .. .. .,. FEE SCHEDULE
Job no: 03_ 0 v Fee Max
Business name: �fl.2-)0,G CIA t'1 eG� t' 1 ,1 n c,
New (ea.) Total no. Insp
New residential - single or mu1tf- fattdly per
Address: 1 4i ' S 6LJ 74 e- 1 3 0 dwelling unit Includes attached garage.
City:1 c I Stat ' I ZIP: Ct 7a a q Ser iexineluded:
Phone: 1000 s . ft. or less 4
t
St3 f r S - a s-1 I Fax• sv3 - SSS-� l: 1000 g
v q q y r . 3 -.�/ 3 GL Ea additional 500 sq ft. or portion thereof
CCB n0.: Elec. bus. tic. no: L energy, res ' ± 2
Limited energy, Dort - residential 2
City /metro lic. no.: 3 ) C7
4. r 4.. � r Each manufactured home or modular dwelling
Signature of supervising elec 'clan (required) Date /Q- ei_c, Service and/or feeder 2
Services or feeders— insta
Sup. elect. name (print):,ar _ ., r ' . •} License no: r ').t_Ep alterat ion orocatlon Radon,
PROPERTY OWNER 200 amps or less 2
201 amps to 400 amps 2
Name (print): 401 amps to 600 amps ' 2
Mailing address: 601 amps to 1000 amps 2
City: I state: IZIP: Over 1000 amps or volts 2
Phone: I Fax: 1E-mail: Reconnect only 1
Owner installation: The installation is being made on property I own Tempo 'servicesorfeeeders- .._
which is not intended for sale, lease, rent, or exchange according to Installation, alteration, °CceIOO°
200 amps or less 2
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
or extension per pane!:
• Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee. each branch circuit 2
I S 'ZIP: B. Fee for branch circuits without purchase
Crty: of service or feeder fee, rust branch circuit: 2
Phone: Fax: E-mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Mc. (Service or feeder not included):
0 Service over 225 amps - commercial • 0 Health -care facility Each pump or irrigation circle 2
O Service over 320 amps- rating of 1&2 0 Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or limited energy panel,
O System over600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over three stories 0 Feeders, 400 amps or more *Description:
O Occupant load over99 persons 0 Manufactured structures or RV park Each additional Inspection over the allowable ht any of the above:
O Egress/lightingplan 0 Other. - Per inspection 1 1 l 1
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other _
Permit fee $ -- 7 5
. Not all iudsdictiom aedit cards. call 'arisdctioo for more iafonnae ln1 Notice: This permit application Plan Permit f review (at %) $
II expires if a permit is not obtained
within 180 days after it has been State surcharge (8%) .... $ -
accepted as complete. TOTAL $ V/ -
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440.4615 (6100/COW
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Une: (503) 639 -4171 MST
-
BUP
Received Date Requested // /7 AM PM BUP
Location HIM D (o ff" PK Suite / 9- Pocfmc • MEC
Contact Person M0.9 Ph ( ) 344g- o f `F (o PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain 3 - O 0 3 / s ---
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
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
RT FAIL
ELECTRICAL
ice
Rough -In
UG /Slab
ow Voltage
Fire A arm
❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
V; PART FAIL
SI ❑Please call r reinspection RE: ❑Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date / 7 Inspecto l ."3 Ext
Other:
Final DO NOT REMOVE this inspection recor rom the Job site.
PASS PART FAIL