Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
iil DEVELOPMENT H BMEN 1639 -4171 DATE ISSUED: 001 -00159
13125 ED: 6% ELR2001-00159
SITE ADDRESS: 13221 SW 68TH PKWY 200 PARCEL: 2S101 DA -00102
SUBDIVISION: TRIANGLE CORPORATE PARK ZONING: MUE
BLOCK: LOT: 002 JURISDICTION: TIG
Proiect Description: Limited energy for NC installation. Job #81171
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:
PACIFIC REAL ESTATE MGMT AMERICAN HEATING
6650 SW MACADAM AVE. 200 1339 SW GIDEON ST
PORTLAND„ OR 97201 PORTLAND, OR 97202
Phone: 503 - 224 -1460 Phone: 239 -4600
Reg #: LIC 00033135
ELE 26- 683CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 6/7/01 $75.00 2720010000 Elect'I Final
5PCT CTR 6/7/01 $6.00 2720010000
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 i /.AR
952 - 001 -0010 thro gh OAR 952 - 001 -0080. You may obtain copies of these rules or dire q tion • p UNC at (503)
246 -1987.
Issued by -%, • , �/ 1 Permittee Signature < /10
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
P " - Electrical Permit Application
Date receiv - . (,ii0 Permit no.: / —Zo0 / i < .,' :• ! `69
6f::
t ..�7 l ih
�>�' '•{ I City of Tigard • Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 . Date issued: Mill Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERiIIT
❑ 1 & 2 family dwelling or accessory GI ❑ Multi - family ❑ Tenant improvement
❑ New construction WI /alteration/replacement ❑ Other: ❑ Partial
JO11 SITL INFO1ti1IATlON
Job address: )3 it ( S( 6g '1H _A Bldg. no.: Suite no.: A0o Tax map /tax lot/account no.:
Lot: Block: e Subdivision:
Project name: f 0 1. i J jr I Description and location of work on premises: .4 c ...Aeltai T 0 CO*t)Oolrreft. RM
Estimated date of completion/inspection:
Job no: S 117 / Fee Max
Business name:, IWs r r 144r 4,7iwlq , .L�/ G on Qty. (ea.) Total no. iasp
J New rasidem1ai - single or multi - family per
Address: 1339 sm. Gi1er(!@n ST dwelling unit. Includes attached garage. •
City: M.rt..bvc) I State: 0121 ZIP: 97 20 2 Servioebtcluded:
Phone: ASq .46 04 1 Fax:g 70381 E-mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft or portion thereof
CCB no.: 3 3 i 3.6 Elec. bus. lic. no: 2,(,— (R3 oar energy, residential 2
City /metro lic. no.: / 7 7 Limited energy,
Q / rgy,nnn- residential 2
41 7/v / Each manufactured home or modular dwelling
Signature of supervisin electric' (required) Date {{ Service and/or feeder 2
Services
Sup. elect. name (print): License no: or feeders — installation,
'
alteration or relocation:
Act Qn 200 amps or less 2
Name (print): Inc i F! c Rttir i.a rm /14.11.47- 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: tics- 0 SG►/ Vt 601 amps to 1000 amps 2
City: D (R T/J. State: OR I ZIP: 9 7 .ZO ( Over 1000 amps or volts 2
Phone: 224- 11 O I Fax: Z) 4_4'70 1 E -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 don, alterallon, orrelocatlon:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am ,s 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
Phone: Fax: E-mail: of service or feeder fee, first branch circuit: 2
Each additional branch circuit:
P REVIEW check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps - commercial 0 Health - care 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 over600 volts nominal more residential units in one structure alteration, or extension* 'r .Ttx. / 2
0 Building over three stories O Feeders, 400 amps or more *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional Inspection over the allowable in any of the above:
O Egress/Iightingplan O Other
Per inspection
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit 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 %) .... $
Ex,uCs accepted as complete. TOTAL $
Name of cardholder as shown on credit card
Cardholder signature Amount
440-4615 (6A0/COM)
Electrical Permit Fees: Limited Energy Fees: '•- ti t
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: . Items Cost Total 4
Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or Tess $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1
Limited Energy $75.00 ❑ Burglar Alarm
Each Manufd Home or Modular ❑
Dwelling Service or Feeder $90.90 2 Garage Door Opener
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2
201 amps to 400 amps $106.85 2 ❑ Vacuum Systems
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 ❑ Other
Over 1000 amps or volts $454.65 2
•
Reconnect only $66.85 2 • •
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918-260 -260) '
201 amps to 400 amps $100.30 2 .
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see "b" above. ❑ Audio and Stereo Systems '
Branch Circuits • •
New, alteration or extension per panel ❑ Boiler Controls
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee. • ,
Each branch circuit $6.65 2 ' ❑ Data Telecommunication Installation
b) The fee for branch circuits
•
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous ❑ Instrumentatiori •
(Service or feeder not included)
Each pump or irrigation circle $53.40 •
Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems , • •
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over ❑ Medical
the allowable In any of the above
Per inspection $62.50 ❑ Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting
Fees: ❑ Protective Signaling
Enter total of above fees $ I I Other
8% State Surcharge $ •
Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ * No licenses are required. Licenses are required for all other installations
front of application. •
Fees:
Total Balance Due $
. Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
•
i:\dsts\forms\elc- fees.doc 10/09/00
CITY OF TIGARD BUILDING INSPECTION DIVISION -- •
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
/! BUP
P Date Requested 6/t AM PM BUD
Location ) 2 2� ( Q 44- 74 , 6 Suite MEC
Contact Person Ph 7 ? ---Q' PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR d0! r �� !j
Footing Access:
Foundation FPS
Ftg Drain SGN -
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd.Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final 11/
PASS PART FAIL
MECHANICAL
Post & Beam
Roug Ie
Line
Gas Line
Smoke Dampers
Final
PASS FAIL
ELEC ICA
Rough In ir ..
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill/Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA Q�
Approach /Sidewalk
Other Date [/ ( Inspector Ext
Final
PASS . PART FAIL DO NOT REMOVE this inspection record from the job site.