Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
l A, DEVELOPMENT SERVICES PERMIT #: ELR2003 -00199
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/10/03
SITE ADDRESS: 13535 SW 72ND AVE 140 PARCEL: 2S101 DC -00200
SUBDIVISION: 72ND AVE OFFICE BUILDING ZONING: C -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of limited energy for data telecommunications system. Job No: #100
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: 1
Owner: Contractor:
PACIFIC NW PROPERTIES LTD PTNSHP BRIAN F. JASPERS LLC
9665 SW ALLEN BLVD STE 115 7460 SW 90TH
BEAVERTON, OR 97005 TIGARD, OR 97223
Phone: Phone: 452 - 1004
Reg #: ELE 34- 418CLE
LIC 111072
• FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 7/10/03 $75.00 Elect'I Final
[TAX] 8% State Tax 7/10/03 $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 ollow ru - n adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 throuc
/
Issu by , „ /� � �� - ' � 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
Electrical- Permit Application . FOR OFFICE USE ONLY
Received Electrical c ,,, _
Date/By: 7 /U O 5 Permit No.: GG / <Gw 3 OO/
Cit Cl of Tigard Planning Approval Sign
y b DateBy: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
itrpdi ',W`� t � Date/By: Case No.:
Internet: www.ci.tigard.or.us _ � I I Contact Juris.: ' ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
® Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling A Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit sets of plans with any of the above.
35 � • A The above are not a to temporary construction service.
Job site address: — FEE* SCHEDULE
Suite #: (40 1 Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: Ft.,(( Hari TM S V ✓d. we tL Description Qty Fee (ea.) Total i
New residential - single or multi- family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Lot # Limited energy, residential 75.00 2
:
Subdivision: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
Services or feeders - installation,
1 � M s r b al.:Va Cleja le alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 1 2
Name: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: • 200 amps or less 66.85 1
201 amps to 400 amps 100.30 2
Phone: Fax: • 401 to 600 amps 133.75 2
❑ APPLICANT ❑ CONTACT PERSON Branch circuits - new, alteration, or
Name: 't,C ' 3-t1.S P e r L IL G extension per panel:
q y A. F f branch circuits with purchase of
Address: 7 d w `o 7 N service or feeder fee, each branch circuit
B. Fee for branch circuits without purchase of
6.65 2
City/State/Zip: : P o b q 7 a a 3
service or feeder fee, first branch circuit 46.85 2
Phone: 5b s . I OD 1 Fax: S Q w, t Each additional branch circuit 6.65 2
E -mail: $ 'a s# 4 € sits 0 , 6014A, Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: ( D b • Signal circuit(s) or a limited energy OO
alteration, or extension I Page 2 .S '— 2
Business Name: f5r t test ?d _Description:
Address: 714 o S L4) ?o'.
bit Each additional inspection over the allowable in any of the above:
City /State /Zip: /4-, bit L 9 a) 3 Per inspection per hour (min. 1 hour) 62.50
Phone: Sib; YS.) t mot+ Y Fax: 5 i*M4"- investigation fee:
CCB Lic. #: 111 0*1 Z Lic. #: 3 "flit C,' FA - Other: i
E lectrical Permit Fees*
Supervising electrician R _ _ Subtotal $
signature re wired: ' �" _ Plan Review (25% of Permit Fee) $
Print_Name: r; iv , 4,...1 Lic. #: State Surcharge (8% of Permit Fee) $
^^ 3 it L EA TOTAL PERMIT FEE $
Authorized i a N otice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit FormsElcPermitApp.doe 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
Audio and Stereo Systems
❑ Burglar Alarm
• Garage Door Opener ..•
• Heating, Ventilation and Air Conditioning System
12 Vacuum Systems
▪ Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
Audio and Stereo Systems
El 5 a►' ..� c
Boiler Controls - ..9 A IV 0
Clock Systems
Data Telecommunication Installation
El Fire Alarm Installation
HVAC
Instrumentation
El Intercom and Paging Systems __) t . .„1 P ^�q r_ �► �,� � -� �,ti,�S f
r' a ? : CD1 ,
0 Landscape Irrigation Control* tZ7 - C 7 ��
a.. 07 1
Medical \ J d ax; t 1 ! ?
Nurse Calls { )61.. T rte' �7
at t._ ' Outdoor Landscape Lighting ti .4 (3
Protective Signaling ' • tea, ��S > 1!, j
s
n Other Y. 4 "� cf4; _5111 . - ti I)•�1 �'
Number of Systems f 1 A - , 4 `� 4 241
* No licenses are required. Licenses are required for all
•
other installations r ,. e._
- t e..
i:\Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03
CITY OF ~ TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 7 AM PM BUP
Location 1 3S sS 4 7 „7 /e Suite / MEC
Contact Person Ph ( ) So S7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR 3 - 00/ y
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing (7i
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
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Fi
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date — / Inspector . eri.—ct
Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received � � Date Requested I AM PM BUP
Location ) 3 S3 S 7 a 'M4 Suite f YO MEC
Contact Person Ph ( ) g/' ' 9 I/0 ? PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR 3 -6.01??
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
Service
Rough -In
I.•
Low Oltail
Ir: •.m
1( Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
♦a), PART FAIL
SI 111 Please call for reinspection RE: able to inspect — no access
Fire Supply Line
ADA Date � /✓ 0 Inspector �
Approach/Sidewalk `
Other: �J
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL