Permit ELECTRICAL
CITY OF TIGARD NERD
RESTRICTED ENERGY
1i DEVELOPMENT SERVICES PERMIT #: ELR2002 -00291
13125 SW Hall Blvd., Tigard, OR 97223 (5031639 -4171 DATE ISSUED: 12/11/02
SITE ADDRESS: 12750 SW 68TH AVE PARCEL: 2S101AD -01300
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 033 JURISDICTION: TIG
Proiect Description: Limited energy for fire alarm system. Job No. 2119
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: X OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: .
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
HAMPTON BUILDING, THE LLC FIRE PROTECTION SERVICES
PO BOX 94 15100 SW 139TH AVE
CAMP SHERMAN, OR 97730 TIGARD, OR 97224
Phone: 5541 -595 -2495 Phone: 503 -590 -3732
Reg #: ELE 34- 488CEP
LIC 121039
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 12/11/02 $75.00 Elect! Final
[TAX] 8% State Tax 12/11/02 $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.t6 follow rules-Oopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 throuc
Is ed by • �i ;+ , . CQ (, ,/ Permittee Signature ,/ A , A ;L.,_A, /A., A ' �/ bNIWAr;
\-'*------ t VI p 1 .,-
OWNER INSTALLATION ONLY
The installation is being made on property 1 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
Electrical Permit Application OFFICE USE ONLY
Date received: /- // 6 Permit no.: i,,,,2— Qr9,'F(
�,�, r ..�'(i" City of Tigar ECEIV ED Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall S ivva , Tigard, OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171 1 1 2002
Fax: (503) 598 -1960 pEC Case file no.: Payment type:
Land use approval: CITY OF TIGARD
- ., ISION
1'1'll? OF PERMIT
0 1 & 2 family dwelling or accessory A Commercial /industrial ❑ Multi - family ❑ Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other: 0 Partial
.106 SITE INFORNIA1'ION
Job address: 0-15 W fp-Wea . ( Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: I Subdivision: f 40+ D
Project name: A2 , 50/.644 eV - Description and location of work on premises: )/JS17 t/ rig 6 /(6[R/l7 9
Estimated date of completion/inspection: , , ■
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: / ( Fee Max
Business name: Fi R 6 p o (C-cn o S L-{L cl i G 6s Description Qty. (ea.) Total no. insp
New residential - single ormulti- family per
Address: /s ScA) 139 AV G" C dwellingunit .Includesattachedgarage.
City: 17 C dpi I StateDR I ZIP: et ; g V Serwiceincluded:
Phone:61)05/0 -373?" 1 Fax:(0900-0E-mail: frce,ts; coo, 1000 sq. ft. or less 4
CCB no.: 103% 'Elec. bus. lic. no S 7 L/ y a Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
City/metro 1' no.: S Limited energy, non - residential 2
0 — 9_ Each manufactured home or modular dwelling
Signature of supervising c e rcquir d) Date Service and/or feeder 2
Sup. elect. name (print): 0 '11 p ` _ I li( (7 r; License no: / 7 ' (,e Services or feeders - installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): 146 Pre") gc(I 1. W (n LLO 201 amps to 400 amps 2
401 amps to 600 amps
Mailing address: 62-0. go* 9 601 amps to 1000 amps 2
City: CAS e S I{{64r1 A-1.1 I State /L I ZIP: 7.7-3 0 Over 1000 amps or volts 2
Phone; 5 VYtiifax:(r((, / jy4E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation:
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
INC I N F E R Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
Cit I State: 'ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E - mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) misc. (Service or feeder not included):
O Service over 225 amps-commercial 0 Healthcare 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 a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension' 45" 2
O Building over three stories 0 Feeders, 400 amps or more *Description:
0 Occupant Toad 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 1 1 1 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 CX)
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Plan review (at _ %) $
O Visa O MasterCard expires if a permit is not obtained
Credit card number: / / within 180 days after it has been State surcharge (8 %) $ C - ab
Expires accepted as complete. TOTAL $ 0 I
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
3.---6-03 BUP
Received Date Requested AM PM BUP
Location / 0:9 ( / � 6E Suite MEC
Contact Person Ph ( 3) /5" o 3 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR — C AA n
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
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE i Please call for reinspection RE: El Unable to inspect – no access
Fire Supply Line
ADA
Approach/Sidewalk Date '� 2 Inspector / (7 v ei , <�� Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL