Permit / / /6-c., ;(9 3 _ cv�
• �+ ELECTRICAL PERMIT -
CITY OF TIGARD RESTRICTED ENERGY
*� DEVELOPMENT SERVICES PERMIT #: ELR2003 -00134
` 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/14/03
SITE ADDRESS: 13221 SW 68TH PKWY s PARCEL: 2S101 DA -00102 296
SUBDIVISION: TRIANGLE CORPORATE PARK ZONING: MUE
BLOCK: LOT: 002 JURISDICTION: TIG
Proiect Description: HVAC thermostats.
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 #: MET 00001077
LIC 33135
ELE 26- 993CRE
FEES SUPS Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 5/14/03 $75.00 Elect'I Final
[TAX] 8% State Tax 5/14/03 $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 follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 throuc
Issued by k it t i t , a ,t a 't/1,c Permittee Signature i"��s % / 1
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, le :: e, 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
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. A Electrical Permit App OFFICE USE ONLY
Date received:5 4-03 Permit no.: ' . e Q 3
M1 City of Tigard
ProjectJappl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 9722 Date issued: IM Phone: (503) 639 -4171 Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory XCommercial/industrial 0 Multi- family Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other: 0 Partial
JOB SITE INFORMATION
Job address: / / ...1'w (58 Bldg. no.: Suite no.4 Tax map /tax lot/account no.:
Lot: Block: ISubdivision: Bose.,- er4A..44 ha j aftl
Project name: I Description and location of work on premises: ikii 7 -1:4-
Estimated date of completion/inspection:
CONTRACTOR AI'I'LICATION FEE SCHEDULE
• Job no: ,5 1- - Fee Max
Business name: riean Heating, Inc. Qty. (ea.) Total no. An>�_
New residential - dngkormaid-family per
Address: 1339 SE .Gideon Sr. dwe0mgadlindudesattacbedgarage.
City: Portland 'State: OR I ZIP: 97202 -2418 Serv1celndmded:
Phone: 239-4600 I Fax: 239 -7038 1E-mail: 11») sq. ft or less 4
Each additional 500 sq. ft or portion thereof
CCB no.: 331' 5 I Elec. bus. lie. no: 7E gSi'1('rR Limited energy, residential 2
City /me 0114 ` 26 - 9y -zedee Limited energy, ran- residential 2
0 . A' r4 2450 Each manufacwred home or modular dwelling
Signature of supervise e lac n (required) Date Service and/or feeder 2
Sup. elect name (print): Th omas S. y. i • License no: 264012'EP Services or feeders- Installation,
PROPERTY OWNER alteratlonorrelocation:
200 amps or less 2
Name (print): 201 amps to 400 amps 2
Mailing address: 401 amps to 600 amps 2
601 amps to 1000 amps 2
City: I State: 17H: over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only l
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 hutdlation , alteration, orrelocation:
ORS 447, 455, 479, 670, 701. 200 anys or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
Branch circuits - new, alteration,
Name:
or extension per panel:
/9/�'7e4. - / e_ad /�' "L A. Fee for branch circuits with purchase of
Address: J339 ,s, 6 eon service or feeder fee, each branch circuit 2
City: pry /and I State4e I ZIP:97& a . B. Fee for branch circuits without purchase
Phone: Fax: E - ma il : of service or feeder fee, first branch circuit: 2
- yj / / 7 Each additional branch circuit:
PLAN REVIEW' (Please check all that apply) Misc. (Service or feeder not included):
0 Service over 225 amps-conunercial 0 Health -care facility Each pump or irrigation circle 2
0 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,
0 System over 600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over three stories 0 Feeders, 400 amps or more *Description:
O Occupant load over 99 persons 0 Manufactured stnrcduas or RV park Each additional Inspection over the allowable in any of the above:
O Egress/lighting plan O Other.
Per inspection 1 1 1 J.
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 $
O 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 $
accepted as complete.
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6/00/COM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
• // BUP
Received Date Requested 4 � — �P AM PM BUP
Location / 3 �- a ( (' E `., -- 7 -Suite MEC
Contact Person Ph ( ) Q-37- 1 46 co PLM
Contractor Orr, Eicefr j c Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR -60431/
Crawl Drain
Slab Inspection Notes: 3 ✓Le SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm 4 � ■=1
Susp'd Ceiling
Roof
Other:
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r
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
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
Mb PART FAIL
SITE 111 Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA /
Approach/Sidewalk Dat I/ [� �� j Inspector ��y� Eat
Other: -
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL