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Permit ELECTRICAL PERMIT - CITY O TIGARD RESTRICTED ENERGY lA DEVELOPMENT SERVICES PERMIT #: ELR2004 -00359 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/19/2004 SITE ADDRESS: 13221 SW 68TH PKWY 460 PARCEL: 2S101 DA -00102 SUBDIVISION: TRIANGLE CORPORATE PARK ZONING: MUE BLOCK: LOT: 002 JURISDICTION: TIG Project Description: Limited energy for installation of projector. 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: OUTDOOR LANDSC LITE: OTHER: HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: PROJECTOR X TOTAL # OF SYSTEMS: 1 Owner: Contractor: ROBINSON, ROY HANSEN TECHNOLOGY GROUP 2655 SEELY AVE. PO BOX 83783 SAN JOSE, CA 95134 PORTLAND, OR 97283 Phone: 408 - 943 -1234 Phone: 408 - 943 -1234 Reg #: L$433- 351111 2 ELE 3090LEA FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 11/19/2004 $75.00 Elect'I Final [TAX] 8% State Surchart 11/19/2004 $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 folio - adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 thro OAR 952 -0I .-0111. You may obtain copies of these rules or direct questions to U at (5 3) 246 -6699. Iss ed by i � . 4 1 s 4. 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 Elet' Ica! Permit Application l OR OF Hsi:ONi • Received � ��/'' City o T igard Da � Permit No.: et 900 ,le y r 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review /i / Phone: 503.639.4171 Fax: 503.598.1960 "ir �°• I Date/B . Other Permit: Inspection Line: 503.639.4175 __ _ _ t Date Ready/By: 65 See Page 2 for Internet: www.ci.tigard.or.us Noti fied/Method Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction Addition/alteration/replacement Please check all that apply: ❑ Demolition ❑Other: ['Service over 225 amps, comm'I ['Hazardous location ['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft., CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential ❑ 1 and 2 family dwelling 16,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 ['Occupant load over 99 persons ['Manufactured structures or JOB SITE INFORMATION AND LOCATION 0Egress/lightingp1an RV park ' /'' / Job no.: Job site address: 322/ SK/ 6 Z 7- ' 1 , 0 44 y ❑Health -care facility ['Other: Submit 2 sets of plans with any of the above. City/State/ZIP: The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: 960 1 Project name: /91J ti 1 Qom} K FEE* SCHEDULE / Description I Qty. I Fee. 1 Total I •• Cross street/directions to job site: 7Z '`O of 2i 7 7- g 7P New residential single- or multi- family dwelling unit. n - � Includes attached garage. piz - z• TN a 7 6 Ct/9-/Cc /3 L/ 1,000 sq. ft. or less 145.15 4 Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 Limited energy, non - residential • 75.00 2 DESCRIPTION OF WORK Each manufactured or modular /N / 37 L / (- 't./ O ` O Ifr - [ L- / ' ' 7 Services dwelling, 90.90 2 es service and/or feeder _ ,, v / ,f C ,� NVP / or feeders installation, alteration, and/or relocation / / C �(. / � - f e. "( Ct c_./ AJC V.4 -.17 200 amps or less 80.30 2 ROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: 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/Z)P: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that 1 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 ex tension, per panel ❑ APPLICANT 1 ❑ CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each 6.65 2 Business name: / branch circuit Contact name: B. Fee for branch circuits without service or feeder fee, 46.85 2 Address: each branch circuit Each add'I 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 - CONTRACTOR energy panel, alteration, or - ap Business name: �— extension. Describe / Page 2 75' 2 /�*i SciJ /CCHA/a/ .c:) �( 6/000(9 plc ECR2 z Q Each additional inspection over allowable in any of the above Address: L� > �(� 30>< 3 Per inspection 62.50 City/ State/ZIP: 47( �� 0/4 Q 7 -$' 5 Investigation per hour (1 hr min) 62.50 II Phone: ()' )- 3 S� _ � z 9U Fax: ( ) Industrial plant per hour 73.75 - ELECTRICAL PERMIT FEES • .CCB Lic.:/ clip / Electrical Lic.: 30 L uprv. Lic.: Subtotal 00 70 Suprv. Elecl'ar7 ata�ure, required: /O / 4 , j Plan review (25% of permit fee) Print name: J /9 / f NSC� Date: //— / 9 -o(� State surcharge (8% of permit fee) 'etc) TOTAL PERMIT FEE 8 i . Authorized signature: p 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 i:\ Building \ennits\F1.C- PenmitApp.doc 12/03 440- 46I5T(10/02/COM/WEB Electrical Permit Application - City of Tigard , Page 2 - Supplemental Information • LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: 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: COMMERCIAL WORK ONLY: 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* ❑ Protective Signaling • ❑ Other Total number of commercial.systems: *No licenses are required. Licenses are required for all other installations is\Building\Pennit ELC- PennitApp.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 1D — / , S — AM PM BUP Location B a a l Suite 7..6 MEC Contact Person � 0 41 Ph ( ) gO T —00 / 3 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing 6U d 6 Foundation ELC °� � — Access: Ftg Drain ELR c ( 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 P 77- 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 Reinspecction fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. cab PART FAIL SITE 0 Please call for reinspection RE: 0 Unable to inspect — no access Fire Supply Line ADA Date / //5 ® Imps �� / Ext Approach/Sidewalk �'�� Other: Final DO NOT REMOVE this Inspection record from t Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503639 -4171 MST Received Date Requested / /— / ° � AM PM BUP Location / Suite "H MEC Contact Person b Ph ( ) PLM Contractor Ph ( ) SWR • BUILDING Tenant/Owner ELC Footing Foundation — ELC Ftg Drain Access: c � �,p ELR o■ - 00- Crawl Drain Slab Inspection Notes: SIT Post & Beam rr n I Ext Shear Sheath/Shear h /SSh ear � e -1//4 `dam Ext eah/h Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm ' f 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 L v '7 / _ a , ? — " ma c;aDs CC- Slab - L4�Voltage� r“ r L . F. tJi - Fi e Ala I PART FAIL E Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE Please call for reinspection RE: Unable to inspect - no access Fire Supply Line l/ AApp Approach/Sidewalk Y! Y 7 Inspeetor ��.� "'�- G Ext pp dewalk Date Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL r