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Permit
-A: CITY OF T I GA RD ELECTRICAL PERMIT - RESTRICTED ENERGY r DEVELOPMENT SERVICES PERMIT #: ELR2003 -00297 l 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/29/03 SITE ADDRESS: 13535 SW 72ND AVE 170 PARCEL: 2S101 DC 00200 SUBDIVISION: 72ND AVE OFFICE BUILDING ZONING: C -P BLOCK: LOT: JURISDICTION: TIG Project Description: Low Voltage: Protective signaling. 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: PROTECTIVE SIGNAL: X INSTRUMENTATION: OTHER: TOTAL # OF SYSTEMS: 1 Owner: Contractor: PACIFIC NW PROPERTIES LTD PTNSHP LIVE WIRE TECHNOLOGIES LLC 9665 SW ALLEN BLVD STE 115 PO BOX 952 BEAVERTON, OR 97005 TUALATIN, OR 97062 Phone: Phone: 503 670 - 9910 Reg #: ELE 34- 599CEP LIC 151771 SUP 3345LEA FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 9/29/03 $75.00 Elea! Final [TAX] 8% State Tax 9/29/03 $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 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699. Issued by ��L //� . Permittee Signature 7 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 pplication FOR OFFICE USE ONLY Received Electrical ,� p ' ■ Date/By: 4:9 /U3 b�/ Permit Not L /(�`3 - ®U „...w� - -i Planning Approval Sign City o f Tigard Date/By: Sign No.: 13125 SW Hall Blvd. ,,..•• , Plan Review Other Tigard, Oregon 97223 � .. ( _ - Date/By: Permit No.: Phone: 503- 639 -4171 <.Fax: -598 -1 po 0 1 Date/By: Case No.: Post - Review Land Use � i� : Internet: www.ci.tigaxd.or.vs -� -- , -- e!� 1 Contact Juris.: [s] See Page 2 for 24 -hour Inspection Request: 503 -639 -4175 � Name/Method: �'/ 7 Supplemental Information. q ay - 6 3 - . TYPE OF WORK - . .. --PLAN REVIEW (Plea se check all that apply) ❑ New construction n 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 IN 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 LO ATION Submit _ sets of plans with any of the above. `� 5 c� LJ `10) The above are not applicable to temporary construction service. Job site address: '^ n U Q. -- . - FEE* SCHEDULE `•' ' .• ' Suite #: ( h b 1 Bldg. /Apt. #: Number of inspections per permit allowed _�,�, < Ce�k s Description Qty Fee (ea.) Total Project Name: r i� New residential- single or multi - family per it 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 Subdivision: I Lot #: Limited energy, residential 75.00 2 Limited energy, non residential 75.00 2 Tax map /parcel #: Each manufactured home or modular dwelling service and/or feeder 90.90 2 _: DESCRIPTION OF WORK �`�f::�: `• = Services or feeders - installation, 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 • 601 amps to 1000 amps _ 240.60 2 ❑'PROPERTY OWNER ❑TENANT Over 1000 amps or volts 454.65 2 Name: Reconnect only 66.85 2 Address: Temporary services or feeders - installation, alteration, or relocation: 66.85 1 City /State /Zip: 200 amps or less 201 amps to 400 amps 100.30 2 Phone: Fax: 401 to 600 amps - 133.75 2 El APPLICANT'` , _ . ❑ CONTACT PERSON Branc c - new, alteration, or Name: extension per panel: A. Fee for branch circuits with purchase of 6.65 2 Address: service or feeder fee, each branch circuit City /State /Zip: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit 46.85 2 Phone: J Fax: Each additional branch circuit 6.65 2 E -mail: Misc.(Service or feeder not included): Each pump or irrigation circle 53.40 2 - , - • r — � . . . CONTRACTOR - - Each sign or outline lighting 53.40 rt C 2 Job No: (�,8q - h `- as 8' Signal circuit(s) or a limited energy panel, 5� 2 alteration, or extension 1 Page 2 1 Business N a m e : 5 i n k \ *Y � z f , \ � r 1 ace___. Description: Address: �� -�- U 1T�`r Each additional inspection over the allowable in any of the above: City /State /Zip: part-k I oe q1 a %--1 Per inspection per hour (min. 1 hour) 62.50 Phone: JI`'33- a -5g ;a f Fax:533- x'13-I-1 -13 Investigation fee: 535 S Oth- CCB Lic. # 3, Lic. #: �� -310 e- Supervising electrician Electr P ermit Sub Fees* tal $ 5 - U6 ,f to ' signature required: 7 � Plan Review (25% o Permit Fee) $ Name: Seo I Lic. #: i'G LM-- State Surcharge (8% of Permit Fee) $ D t Q Print TOTAL PERMIT FEE $ � t C� Authorized Notice: 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 Fotms\E1cPermitApp.doc 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 O Burglar Alarm El Garage Door Opener 0 Heating, Ventilation and Air Conditioning System 0 Vacuum Systems ▪ Other COMMERCIAL WORK ONLY: Fee for each system 575.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: Audio and Stereo Systems n Boiler Controls El Clock Systems D Data Telecommunication Installation 0 Fire Alarm Installation El HVAC 0 Instrumentation 0 Intercom and Paging Systems • Landscape Irrigation Control 0 Medical E l Nurse Calls El Outdoor Landscape Lighting 0 Protective Signaling n Other Number of Systems * No licenses are required. Licenses are required for all other installations ' 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 ) /— 3 AM PM BUP Location ) 3 S3 S 72 " 2 V • Suite / 7 0 MEC Contact Person 5C _O 7 Ph ( ) 5 9 — 31 6,0 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Ftg Drain Access: 3 — ©��c� 7 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 1 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 11\ Rough -In Gas Line �. Smoke Dampers Final PASS PART FAIL TRICAL Sery Rough -In UG/Slab • ow Volta. e Fire arm Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. • ; RT FAIL Please call for r= 'nspection : Unable to inspect — no access Fire Supply Line ADA A pproach/Sidewalk Date 0 _ 6 Inspecto � 24- Ext Other: Final DO NOT REMOVE this inspection record rom the j site. PASS PART FAIL