Permit CITY TIG ARD ELECTRICAL RESTRICTED ENERGY PERMIT
i � DEVELOPMENT SERVICES PERMIT #: ELR2005 -00126
" '�J I� 13125 SW Hall Blvd., Tigard, O 97223 503 - 639 -4171 DATE ISSUED: 5/20/2005
PARCEL: 2S101 DC -00200
SITE ADDRESS: 13535 SW 72ND AVE 150 ZONING: C -P
SUBDIVISION: 72ND AVE OFFICE BUILDING LOT: JURISDICTION: TIG
Project Description: Voice and Data cabling.
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 BROADWAY ELECTRIC - COCHRAN INC
9665 SW ALLEN BLVD STE 115 626 SE MAIN
BEAVERTON, OR 97005 PORTLAND, OR 97214
Phone: 503- 626 -3500 Phone: 503- 234 -6564
Reg #: LIC 72942
SUP 3447S
FEES ELE 37 -546C
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 5/20/2005 $75.00
[TAX] 8% State Surcharl 5/20/2005 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through OAR 95 001 -0100. You ma obtain copies of these rules or direct ques ' ns to OUNC at 503 - 246 -6699.
Issued By: Permittee Signature!- --D10 ie z?..2.p
OWNER INSTALLATION ONLY J
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE:
LICENSE NO:
Call 503 -639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit AppliA E 0 VE fa FOR OFFICE USE ONLY
City of Tigard Received _
MAY
13125 SW Hall Blvd., Tigard, OR 97223 1 b 7 plan Review .. r 3`i'� -
� \
Phone: 503.639.4171 Fax: 503.598.1960 2 i r . , .i,�' �I ' Date/3 Other Permit:
OF TI Inspection Line: 503.639.4175 CITY ., ,
• ' 4� t ` - 1 Date Ready/By: el See Page 2 for
Internet: www.ci.tigard.or.us ' ' •r' Notified/Method: \ Supplemental Information
". , , 4 'F .:.1' :A 4!• i.i:T 'E.;OF . - .. a' . L,_ . -.. y � `P.I:,A N.;R*YUN.v
A A New construction Please check all that apply:
❑ Addition/alteration/replacement
❑Service over 225 amps, comm'l Hazardous location
❑ Demolition ❑ Other
; „�. ,- ;� a � .ssr ❑Service over 320 amps - rating ❑Bwldng over 10,000 sq. ft.,
y
' < t i t 6v :> ...... � 3 a$'*C(� S`tI^R `N ^ r . _ - - - . } *. - : - ..'17.: W --,..::..-J' of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling Or- co mmercial/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
- + mot; , .• » , , r 4 q e b L ['Occupant load over 99 persons ❑Manufactured structures or
* h3 ihB , f: ��fi101d, �I�F ' CS A �1 f s r� a E e s s/ li htin plan RV park
�, tk i y ;ix =r- r . R ..�. , ; . ; s, i_ r a.4 o g g P> P
Job no.: 5-30 �9 Job site address: / 3.53 s St) 7 — Ad a ❑Health -care facility ❑Other:
n Submit 2 sets of plans with any of the above.
City /State/ZIP: Tt 7 y�r 1 b 2 The above are not applicable to temporary construction service.
Suite/bldg./apt. no.: ) S [) Project name: C U. I-L C " ` M .� t4C p �• --
b 'k n Q hT Pf Description I Qty. I Fee. 1 Total
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'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.:
414,.?--.,::-",- � Limited energy, non - residential 75.00 2
• ,; M r.•c . :s Each manufactured or modular
/ ( � dwelling, service and/or feeder 90.90 2
1) D l C l k t e e C v' Services or feeders installation, alteration, and/or relocation
CAA ( ( Aap 200 amps or less 80.30 2
r , �1 �, ;, , t 7 ; w ; ate n;
,.,. };: 201 amps to 400 amps 106.85 2
•R - 4 "' 4 ' � I� ` y ~it r '` ` 401 amps to 600 amps 160.60 2
Name: Cc e k K t o o µ e 1....024.4. Ce ,c ? e / 601 amps to 1,000 amps 240.60 2
Address: 13 S 3 5— S (-0 72 ~ 4tr—e_ Over 1,000 amps or volts 454.65 2
�1 Reconnect only 66.85 2
City/State /ZIP: / � t _. r�x Q2 Temporary services or feeders installation, alteration, and/or
(•So3 ) 6 4 6 ^ S 3 (( ( ) 6 6 ^ D3 t-{ 2 a
Phone: Fax: SD3 6 200 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 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
= .71 r i t,V :. 1.1 f . ; ,, , " . r i F .r; - A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: 'l � if l L 6'Z fill C, branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address: (13 �C � Ma E 7 Each add'l branch circuit 6.65 2
City/State/ZIP: (.i.4')O ()IC C l 72 1 y Miscellaneous (service or feeder not included)
Phone: (al?) 234 b) �` . Pump or irrigation circle 53.40 2
Fax: (` 2._ f � Sign or outline lighting 53.40 2
E l0 �s C(xi•1 Z' Va IY C CiYY' Signal circuit(s) or limited
,.+ f4_ 4 `. -";� ft C w,'�t �, ' r.' ^
��n � .,,u.�, 0!R � '. J�•+�,, .>.,,.,:'��'.l" =a'� �:. m• energy panel, alteration, or D o
extension. Describe: Page 2 / S 2
Business name: ( 5( - - , L,(� C ` ! of I CQ i
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: Investigation per hour (1 hr min) 62.50
Industrial plant per hour 73.75
Phone: ( ) Fax ( ) -0 b t an a` :.r :.. ; -.-
CCB Lic.: 1 29 4 Z Electrical Lic.: x'37' 1: Suprv. Lic.: 3 Li�R5
Subtotal 7s- �=
Suprv. Electrician signature, required: l Plan review (25% of permit fee)
\ � State surcharge (8% of permit fee) 6 o
Print name: e " .N' Date: ,
TOTAL PERMIT FEE gl �^
Authorized signature: 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 \PermitsELC- PermitApp.doc 12/03 440 4615T(1 0/02/COM/WEB
Electrical Perniit. Application .- City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
u i 0 q ''li 7 {� pti J �... ✓f+f ,.�� t" y .�e S's}.t'�; - +, .a: {r^
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:
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
c,a
❑ Other Total number of commercial systems: 751
*No licenses are required. Licenses are required
for all other installations
\ Building \Prnnits\ELC- PamitApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2006 -00126
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/20 /2005
Phone: (503) 639 -4171 /meri����jll
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/25/2005 TIME: 7 :12AM PAGE: 46
SITE ADDRESS: 13535 SW 72ND AVE 150 CLASS OF WORK:
SUBDIVISION: 72ND AVE OFFICE BUILDING LOT #: TYPE OF USE:
PROJECT NAME: CREDIT UNION HOME LOAN
DESCRIPTION: Voice and Data cabling.
OWNER: PACIFIC NW PROPERTIES LTD PTNSHP, PHONE #: 503 - 626-3500
CONTRACTOR: BROADWAY ELECTRIC - COCHRAN INC PHONE #: 503- 234 -6564
Inspection Request Scheduled For: Date: 5/26/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 007696 -01 971 - 219-9278 N
Corrections/Comments/Instructions:
•
_J
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Dater.5 7— olz-5 Phone #: (503) 718 -