Permit I'Y OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
t 11 DEVELOPMENT SERVICES PERMIT #: ELR2004 -00291
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/14/2004
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 HVAC
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: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
TIGARD TRIANGLE I LLC AMERICAN HEATING
4650 SW MACADAM AVE STE 220 1339 SW GIDEON ST
PORTLAND, OR 97201 PORTLAND, OR 97202
Phone: Phone: 239 - 4600
Reg #: LIC 33135
ELE 26- 993CRE
SUP 2640LEP
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 9/14/2004 $75.00 Elect'1 Final
[TAX] 8% State Surcharl 9/14/2004 $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 • -• -s adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010
thr• gh OAR 952 -c 11 -0100,u ma obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
1 1 4 - i Permittee Signature
Is ued by r.r �J P i t
�� g X/ ( 4.44316,1
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
• III
Electrical Permit Application FOR OFFICE USE ONLY
City of TigaFd Received 4.,,IDI ... f
Date/By: f el Permit No.: 4, ,, ,,
13125 SW Hall Blvd., Ti cl gard, OR 97223
Plan Review
Phone: 503.639.4171 Fax: 503 441 41 'i Date/B : Other Permit:
v.. 1 •
Inspection Line: 503.639.4175 ts' , Date Ready/By:
.. .>isi- --- El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: -//a • Supplemental Information
,% ; ' ;f"- ' 4. ':' - ::.;":.:e.;::' ' 1 ....v.c,:!.:;: .„ ..7 --,i. - 1 .: ,- -..7
12 New construction "firi Addition/alteration/replacement Please check all that apply:
0 ['Service over 225 amps, COITUTVI 0Hazardous location
Demolition 0 Other:
, .. ..,..... 0Service over 320 amps - rating 0Buildng over 10,000 sq. ft.,
' . .-
'...•:,i ':;'.i ' . of 1- and 2-family dwellings 4 or more new residential
. ....,..-...., :r.. .-...=..... -, .., --...: L0s:...:..-__- t
0 1 and 2 dwelling Igt Conunercial/industrial 0 Accessory building ['System over 600 volts nominal units in one structure
0Building over three stories ['Feeders, 400 amps or more
0 Multi 0 Master builder ' 0 Other:
_ Oc. cupant load over 99 persons 0Manufactured structures or
4.
'-':
.iikfisiWA:iiiii
T: • '' - :. ,:-.9,,
---*1-'-',--',7z.,'•;-'•-',;sz,.'-'?; 0 RV park
:. .,,,,, JAI) 1, 9 ,..„ :s.. .i ,4 0Egress/lighting plan
. ..if 0Health-care facility 00ther:
Job no.: 1 Job site address: i3) , god 6 8# Ar4 1 4145 7fr) Submit 2 sets of plans with any of the above.
City/State/ZIP: .7- are as The above are not applicable to temporary construction service.
Suite/bldg./apt. no.: i die Project name: /9 ft ,.' .... i .
I 7 ) ‘
‘.VICY) DesuiptIon I Qty. I Fee. I Total I .•
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'I 500 sq. ft. or portion 33.40 I
Limited energy, residential 75.00 2
Tax map/parcel no.:
_ Limited energy, non-residential 75.00 2
- kt--t,ft 'T.'-e.-:11%ts.',-.aiie-4.,,A'444;iV0V.'5.-."..-4--jd:''',W..g.,ri=ir•-,17.1.,
k: ,,..:''- Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Tcr7a.P7 7 .nr•apre iiwie- 7 la - 4 - Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
'z''''.. - ' "----' ''''`"..- ' ' ""` '-'-' •"' " '';' '' '' ' '` '--)"'''''''` 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/ZIP: 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 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 609 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
6.65 2
Business name: / 9, e/ ... y e a „, i_j ..D. branch circuit
B. Fee for branch circuits
Contact name without service or feeder fee,
46.85 2
each branch circuit
Address: /339 Si - 6:,dee2.1 SP4 Each addl branch circuit _ 6.65 2
City/State/ZIP: „..... -i (9,02 9,10 Z. Miscellaneous (service or feeder not included)
../ Pump or irrigation circle 53.40 2
Phone: ( )239_ 4 I Fax: : (4R3 ) 239_ 2
Sign or outline lighting 53.40 2
E-mail: Signal circuit(s) or limited-
' .- 7 .. -2: -"'"'-fe-i•-'' ",: '''-'i' 7 ': -.''.' energy panel, alteration, or /0
n. .,.f .,........ - -......., --..q.r.; -1 .*_....:-..-_ a., " -- •
extension. Describe: .-. Page 2 (0 2
Business name: /',.?..)/7/..-iran Alea_76,-/ -.7r,e,
Each additional inspection over allowable in any of the above
Address: /331 sg 4„. 3 , -,1
Per inspection 62.50
City/State/ZIP: 14, d o e 9202. Investigation per hour (t hr min) 62.50
Industrial plant per hour 73.75
Phone: (03) a39_veced [ Fax: kW ) 703 e
CCB Lic.: 33/25 Electrical Lic.: Suprv. Lic.:069e
Subtotal
(70
Suprv. Electrician signature, requircric:- V Plan review (25% of permit fee) q...., -
State surcharge (8% of permit fee) & .0
Print name: (... I
i \i/c9t..4.47.9 Date: p_ _0
TOTAL PERMIT FEE Q i .0°
Authorized signature: AA 2/4....,..., This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: ... ,4,,,,,.„, Date: 9-}3 .-6 V • Fee methodology set by Tri-County Building Industry Service Board
•• Number of inspections per pemit allowed.
i:\Buikling\Permits\ELC-PennitApp.doc 12/03 440-4615T(10/02/COWWEB
. ..
CITY OF TIGARD 24 -Hour
BUILDING InspectiontLt'ihe:: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received l b Date R nested AM PM BUP
Location / 3 �1( �4 7 J l( jj Suite MEC
Contact Person /1/Lv R I ¥O v PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR ( - a029/
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall ti' ,
Fire Sprinkler �1
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
PAS T FAIL
ECTRICA /
Rough -In Lp� E— l—r2 a -a G , j P / , /i 1 Alt
owVoage )y /fr1Al
- �:�ART FAIL
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
ADA Date /l/AX Inspect Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this Inspection record from the jo s te.
PASS PART FAIL