Permit A ..
!� CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
.- L 'A-� DEVELOPMENT SERVICES PERMIT #: ELR2002 -00204
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 9/23/02
SITE ADDRESS: 12909 SW 68TH PKWY 400 PARCEL: 2S101AD -03200
SUBDIVISION: TIGARD OFFICE BUILDING ZONING: MUE
BLOCK: LOT: JURISDICTION: TIG
Project Description: Low voltage for 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:
PACIFIC REALTY ASSOCIATES C3 // COMMUNICATION CNNCT CNTR
15350 SW SEQUOIA PKWY #300 -WMI 10950 SW 5TH
PORTLAND, OR 97224 SUITE 110
BEAVERTON, OR 97005
Phone: Phone: 503 - 643 -1922
Reg #: LIC 0117658
ELE 24- 373CLE
SUP 994JLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 9/23/02 $75.00 2720020000 Elect'I Final
5PCT CTR 9/23/02 $6.00 2720020000
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 -0080. You may obtain copies of these rules or direct questions to UNC at (503)
246 -1987.
Issued by Permittee Signature - 0
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: C I9 ,77-g
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
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ElectiicalPeemitApplication.
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1i . City of Tigard Project/appl.no.: iiiiiiieda te:
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City of7igard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: :),,o. I
By: ari) 1 Rece iptno.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Payment type:
N 6
Land use approval: -
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory - 4 • mmercialfindustrial 0 Multi-family 0 Tenant improvement
O New construction 0 Addition/alteration/replacement CI Other: 0 Partial
JOB SITE INFORMATION
Job address: ti g e) 5 ,x4-10. , Bldg. no.: Stiiie 6.: 40) Tax map/tax lot/account no.:
Lot: I Block: 'Subdivision:
Project name: NWeA . I Description and location of work on premises: 7)4-rAl
Estimated date of completionTmspection: 0 / .02/
CONTRACTOR Al'I'LICATION FEE SCHEDULE
Job no: IF& Max
Description Qty. (ea.) Total no. insp
Business name: C, ' COhtntuts. • (40 Pe f =si L.
New residential -singk or amid-family per
Address: 101 5 SA4 cf-k 51- . r 4-, 1 1 0
dwelling mit. Includes attached garage-
City: get/4" I- v' I State: Ott] ZIP: q10 0 s Service included:
Phone: (9 1 '-1L I Fax:Oil I E-mail: 1000 sq. ft. or less 4
CCB no.: IP (.S it I Elec. bus. lic. no: Zig . 3 73 (,Le Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
City/metro lic. no.: Limited energy, non-residential 2
Each manufactured home or modular dwelling
• f0 ■ 0 6peatisin required) Date Service and/or feeder 2
Sup. elect. name (print): Sere 0 CA - License no: " ale Seniors or feeders- Instalbtion,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 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 senices or feeders -
Installation, alteration, or relocation:
which is not intended for sale, lease, rent, or exchange according to
200 amps or less 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 , . 2
ENGINEER 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
City: I State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, rust branch circuit: 2
Phone: Fax E-mail:
Each additional branch circuit ,
PLAN REVIEW' (Please check all that apply) Misc. (Service or feeder not Included):
0 Service over 225 amps-commercial 0 ilealth-carefacility Each pump or irrigation circle 2
0 Service over 320 amps-rating of l&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,
0 System over 600 volts nominal more residential units in one structure alteration, or extension* / 75 1 -2
O Building over three stories 0 Feeders, 400 amps or more •Desaiption:
0 Occupant load 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 7s°
Not all jurisdictions azcept audit cards. please call jurisdiction for more information. Notice: This permit application Permit fee $
0 Visa 0 MasterCard expires if a permit is not obtained Plan review (at ____ %) $
- ,,,--
Credit card number / / within 180 days after it has been State surcharge (8%) $ •
Expires TOTAL $ 0
accepted as complete.
Name of cardholder as shown on credit card A
$ eY sb3 7s
Cardholder signature Amam /1 i 440-4615 (6OO/COM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 _ -
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / D ' Ly AM PM BUP
Location / Zy 9 sw 6, /w„ l( cuc y Suite 4 U MEC
Contact Person Ph ( ) 75 24 PLM
Contractor C / / ( Q i1 ✓v)4.).1 7cafi Ph ( p ) SWR
BUILDING Tenant/Owner 4/Gr0 F(J f I O)'ts ELC
Footing ELC
Foundation Access:
Ftg Drain ELR _ — U2 O .
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 aCtcS �
Susp'd Ceiling Cc x -
Roof
Other:
Final s ( / - i
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
r"*\
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL •
MECHANICAL r - s I Ir
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ArCEC1111CAL
Service
Rough -In
UG/Slab
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
- g 2r PART FAIL
E Q Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date t; n Q1 Inspector — • - Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL