Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
, �� DEVELOPMENT SERVICES - PERMIT #: ELR2003 -00018
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/27/03
SITE ADDRESS: 12750 SW 68TH AVE PARCEL: 2S101AD -01300 •
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 033 JURISDICTION: TIG
Proiect Description: Install voice and data cabling.
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:
HAMPTON BUILDING, THE LLC RIEKS COMMUNICATIONS
PO BOX 94 1704 N MERIDIAN
CAMP SHERMAN, OR 97730 NEWBERG, OR 97132
Phone: 5541 -595 -2495 Phone: 538 -8852
Reg #: LIC 74386
ELE 36 -49CEP
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 1/27/03 $75.00 Elect! Final
[TAX] 8% State Tax 1/27/03 $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
I Issued by 'J _ L , _ � � 1 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
• FOR OFIICE USE ONLY
►le(�rlcal Permit Application FOR
op Electrical
Date/By: , — .3 7 -- 2) Permit No.: Ir,A0D3 -Q 'D / 8-
Planning Approval Sign
City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date /By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
�,irdl�ka I 'i\ Date/By: Case No.:
Internet: www.ci.tigard.or.us a 6 7 i Contact Juris.: g See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 '- Name/Method: Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
® Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
❑ I & 2- Family dwelling sa Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: /2750 SeJ 6F IA "' FEE* SCHEDULE
Suite #: 1 Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: r- Spvu.t,sat,+ Description Qty Fee (ea.) Total i
New residential - single or multi - family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or Tess 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Lot # Limited energy, residential 75.00 2
:
Subdivision: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
Services or feeders - installation,
V U Q tQ S !1c. (`r.t- ti4," alteration or relocation:
/ 200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY OWNER ' ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
❑ APPLICANT ❑ CONTACT PERSON Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: 1 Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name: `K CoL BLt.Q Description:
Address: Ogg $) Si .p.4..4aro
,/� Each additional inspection over the allowable in any of the above:
City /State /Zip: Ad tJ t 0,2 Per inspection per hour (min. 1 hour) 62.50
Phone: 9 3 53 'X8 Fax: 538 - Investigation fee:
-
CCB Lic. #: 7 1 .r (2.3- Lic. #:- Other: Electrical Permit Fees*
Supervising electrician i c_E1-' - Subtotal $ 7 .(2d
signature re uired: � // 63 Plan Review (25% of Permit Fee) $ •
Print Name: Va ■ Lic. #: ap,, Lao State Surcharge (8% of Permit Fee) $ 6 -co
TOTAL PERMIT FEE $ %/ , 00
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
• i:\Dsts\Pertnit Forms\ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information 4
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
O Audio and Stereo Systems
❑ Burglar Alarm
❑ Garage Door Opener
El Heating, Ventilation and Air Conditioning System
❑ Vacuum Systems
D Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
Audio and Stereo Systems
0 Boiler Controls
O Clock Systems
O Data Telecommunication Installation
0 Fire Alarm Installation
HVAC
0 Instrumentation
•
0 Intercom and Paging Systems
L Landscape Irrigation Control
0 Medical
n Nurse Calls
❑ Outdoor Landscape Lighting
El Protective Signaling •
17 Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
•
•
i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
171— BUP
Received Date Requested q AM PM BUP
Location SZ D o � " — 40-t- Suite MEC
Contact Person Q Ph ( ) 146E PLM
Contractor Ph ( ) ' 7 (2 `j- 6 /3.2- SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC 3
Ftg Drain Access: ELR 3 - Od O /
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation t,\ I G
Drywall Nailing \(
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final G r •
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
Fire Alarm
- fl Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• SS PART FAIL
SITE 0 Please call for r inspection RE: 0 Unable to inspect - no access
Fire Supply Line
ADA Date c= Inspe Ext
Other:
Final DO NOT REMOVE this inspection reco from th = Job site.
PASS PART FAIL