Permit •
ELECTRICAL PERMIT -
CITYOFTIGARD
RESTRICTED ENERGY
Aeo DEVELOPMENT SERVICES PERMIT #: ELR2004 -00311
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 10/6/2004
SITE ADDRESS: 13221 SW 68TH PKWY 400 PARCEL: 2S101 DA -00102
W
SUBDIVISION: TRIANGLE CORPORATE PARK ZONING: MUE
BLOCK: LOT: 002 JURISDICTION: TIG
Project Description: Limited energy for (4) systems. (3) data panels & (1) voice panel.
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: 4
Owner: Contractor:
TIGARD TRIANGLE I LLC ACS DATATLINE
4650 SW MACADAM AVE STE 220 ATTN: ALEX ELLIS
PORTLAND, OR 97201 2111 NE 25TH AVE
HILLSBORO, OR 97124
Phone: Phone: 503 264 - 9726
Reg #: LIC 110173
ELE 37- 533CLE
SUP 3125LEA
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 10/6/2004 $300.00 Elect'I Final
[TAX] 8% State Surchart 10/6/2004 $24.00
Total $324.00
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 lowTOtes- adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010
th gh OAR 952 -00 1100. Y. a • btain copies of these rules or direct questions to OUNC at (503) 246 -6699.
I ued by . W' ' _ ' ' li/j �/ ` Permittee Signature ,( C� i�
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
Electrical� mi pp
Pert Alication FOR OFFICE USE ONLY
City of Tigard Received ���� Permit No.: &2 .a
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 i' +� 'F'r: ; ; � -- Date/8 : Other Permit:
Inspection Line: 503.639.4175 r '' ' Date Ready/By: J 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: / Supplemental lnformation
; c t ,e �t - 1� vn .. /��y i r 'y 1 y3 x+: x "°4, .V. ' r h i L' a t'.
!:.4',;4: 'a k , ., : r d e a .r`I,e �* Wl� : ..Li�A y�`F" 4 g r J �,1- t `1 ritp % 4 . _ li '5 y£ 2 T •, y l .- '� r .t'_
=r G. i - . / . !' u s �??_ -,,`' i. ax'�.T'� • +rw .,,. - �''r . „_ .:a..dF.�'� t C � 1`) �, ..., rt+�.. .::t„ ,at.. w... _ 0 _ r .. . �.. � r , _ � ,
❑ New construction $ .Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑ Other: ['Service over 225 amps, comm'l ['Hazardous location
z �r of ti es : , ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
_ ':" Y, t s l 't A T QR ..' . G'O *R' TI r � E y i, of 1- and 2- family dwellings 4 or more new residential •
❑ 1- and 2- family dwelling 10 Commercial/industrial ❑ Accessory building ❑System over - 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑ Other: ['Building over three stories ❑Feeders, 400 amps or more
i Occupant load over 99 perso
❑ 1 o persons Manufactu red structures or
=.? R ;` „_'Y C /C. T N,Ai�I# YA0A3Fb$l „ ate s > , . __ . ❑Egress/lightingplan RV . park
r . �. �._ 1 $j
.,.:...'�. � ❑Other:
Job no.: Job site address: 13 2 2. 1 5.0. b g PK W y ❑Health care facility
Submit 2 sets of plans with any of the above.
City/State/ZIP: - 661‘..e_3) oe_ G !' 7 z z 3 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: 40 p Project name: ' t ha ' ` i ''
Description I Qty. 1 Fee. I Total
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 I
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential if 75.00 3 D O, 2
'` kk 4:- ';; zC: rirC {IP';( t) f. 1 ` 4' ^ '5•„ r Y �' Each manufactured or modular
dwelling, service and/or feeder 90.90 2
2.e LA-b .i fr y S u..iT e 1.") ■ /-i. K., � Lots Services or feeders installation, alteration, and/or relocation
1)60-41.,..e_ •e_44 r - 3 T / 1 �0 L e e � !}- / J L 200 amps or less 80.30 2
,. j . • • � s 201 amps to 400 amps 106.85 2
s K '4.
'• , : p tO RTi';f)WNER': .r _ • . TLl� r } '•. ° ..n ;
-- - -- - '. - - -' 401 amps to 600 amps 160.60 2
Name: 4 . /71-6-21- c A .r 1N (..,r p. 1 lr 5 - 7 as- 5 60 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( )
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 _ 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
4 .z =A i' '7 k ' # a y `� A. Fee for branch circuiu with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address: Each add'l branch circuit 6.65 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
' :f :'t+.1.4.:, " _ 16D C7 ryjipt r ...r kr G } .4 energy panel, alteration, or
extension. Describe: Page 2 2
Business name: a c.S A T A L i N e A. / 4/ex Eli/5
Address: 2z. � 1 0- t ,25 i.Vz% Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: ii. ; I 5100 r0 t ' 2 9 7 / 1-if Investigation per hour (1 hr min) 62.50
Phone: C5-03 ) 72-4. Fax: ( - Z _ 1 2 l Industrial plant per hour 73.75
CCB Lic.: / / G 173 Electrical Lic.: 37- 53361 - � E Suprv. Lic.: 31 2f L E G � " '
, - Subtotal In . o O
Suprv. Electrician signature, required: ,/1/0,
•
Pla re view (25% of permit fee) n State surcharge (8% of permit fee) -00
T
Print name: J /rl ,5 a . LI i'1 I'S Date: /0 _ 4 0 y
TOTAL PERMIT FEE 3 g.ii .ad
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
is Building \Pcrmits\ELC- PermitApp.doc 12/03 440.4615T(10 /02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
■
❑ Outdoor Landscape Lighting*
0 Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
is \ Building \Permits \ELC- PemutApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / - a9 AM PM BUP
Location / 3 2a, ( (o R fkWeSuite 4 /06 MEC
Contact Person Ph ( ) c f 3 9 - 1”33 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Ftg Drain Access: EL�— D0 31t/
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
-In
Water Service
Sanitary Sewer
Rain Drains °Ill
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
FAIL
CTRICAL
Service`
Rough -In FY/to _ 0 0 �- I 'p
UG/Slab
Voltage Lc-4.X 0l 1 — °° .3
Fire Alarm
417 ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
- PART FAIL
SITE ❑ Please call for reinspection RE: D Unable to inspect - no access
Fire Supply Line
ADA Approach/Sidewalk Date ` � d Inspector I( __ Oct
Other:
Final DO NOT REMOVE this inspection record from the • b site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection L .: 3) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 - 4171
BUP
Received Date Requested / - IC AM PM BUP
Location / 3 ;,2, ( Suite MEC 4
Contact Person 99/YY) Ph ( ) - 333 PLM
Contractor (Q � Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR gdU
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 E L, cJ LJ - a u ;Lq/ 14 r,
Service
Rough -In k yt, -0Q 6 / a
w o
arm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
=•ART FAIL
Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA / �/l
Approach/Sidewalk Date ! �� �"�` Insp r L�% ` Ext
Other:
Final DO NOT REMOVE this Inspection recur from t he ob site.
PASS PART FAIL