Permit •
CITY OF TIGARD
A-7- ELECTRICALPERMIT -
RESTRICTED ENERGY
Oil DEVELOPMENT SERVICES PERMIT #: ELR2004 -00172
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 6/23/2004
SITE ADDRESS: 14100 SW 72ND AVE PARCEL: 2S112AA -01000
SUBDIVISION: PP1992 -007 ZONING: I -H
BLOCK: LOT: 001 JURISDICTION: TIG
Project Description: Installation of access control at south warehouse door.
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:
INSTRUMENTATION: OTHER: ACCESS CON X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WILLIAMS CONTROLS INDUSTRIES INC SELECTRON INC
14100 SW 72ND AVE 7225 SW BONITA RD
TIGARD, OR 97224 TIGARD, OR 97224
Phone: 503- 684 -8600 Phone: 639 -9988
Reg #: MET 00002446
LIC 64341
ELE 26- 497CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 6/23/2004 $75.00 Elect'I Final
[TAX] 8% State Surcharl 6/23/2004 $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
throw • • • R • 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699. •
Issu - • by 4 / � , l 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 II. ,o I FOR OFFICE USE ONLY
Electrical -
A A
Cit of Tr and ED Re ceiv e d /
DateDate/By: W /p Q s•1 X , PermitNo.: i � �! ^ •,„
13125 SW Hall Blvd., Tigard, OR 97 n n Plan Review
Phone: 503.639.4171 Fax: 503.598.19 4 2 2004 .. ' i'{t Mate Other Permit:
Inspection Line: 503.639.4175 W . 6:12 I Date Ready /By: !a ® See Page 2 for
Internet: www.ci.ugard.or.us CITY QF' TIGAR Notified/Method: /IA• Supplemental Information
BUlLyytkR Wirth . PLAN REVIEW
❑ New construction • 2 Addition/alteration /replacement Please check all that apply:
❑Demolition ❑Other: ❑Service over 225 amps, comm'l ['Hazardous location
— - -� -- ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1 - and 2 family dwelling g Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi family ❑Master builder ❑Other: ['Building over three stories [Weeders, 400 amps or more
DOccupant Toad over 99 persons ['Manufactured structures or
I JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
1 ❑Health -care facility ['Other: Job no.:5 f _ 3 )0D Job site address: I1 { � SW -71 ne� ' � Submit 2 sets of plans with any of the above.
City /State /ZIP: po e r d pp q 04 The above are not applicable to temporary construction service.
Suite /bldg. /apt. no.: I Project name: \` I \C `�
FEE* SCHEDULE
I fV II � A Description I Qty. I Fee. I Total I 'r
Cress streetdirections 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'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90.90 2
1 014 YV' 01Cce- __C� 'Y2A C. '- 'b Services or feeders installation, alteration, and/or relocation
'(e
- ::- • 200 amps or Tess 80.30 1 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
r\�
�� 401 amps to 600 amps 160.60 2
Name: W 1 . l YYl e.b4r1AS 601 amps to 1,000 amps 240.60 ■ 2
Address: µ€ Al 4 ' .0 L., Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
(' ) (pg • 53600 Fax: relocation
Phone: ( ) 200 amps or less 66.85 I
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
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with 1
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
each branch circuit
Address: Each add'l branch circuit 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( ) 2
Sign or outline lighting 53.40
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe,- � 1 Page 2 - OD 2
Business name: ���.� t �� � �L / -�$S (,OAvi .
Address: 7 ����
Each Each additional inspection over allowable in any of the above
Per inspection 62.50 1
City/State /ZIP: �br'�1 ,,tnt: t Gk C Jj investigation per hour (1 hr min) 62.50
A Fax: tc ) - : �`�i 4 . --
Phone: ( ) �� _ c(� Industrial plant per hour 73.75 1 ELECTRICAL PERMIT FEES*
CCB Lic.: (0 ; Electrical Lic.: •2L_ aCrict Suprv. Lic.: CI'71.4 LE Subtotal - `jj, CD
<✓ .-:
Suprv. Electrician signature, required: .;� ` �� Plan review (25% of permit feel
•-- ' I �) t i State surcharge (8% of permit fee) i , tit) Print name: r Date: b
St�`n �P TOTAL PERMIT FEE , OD
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: I Date: • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i` Building ? Permits \ELC- PermuApp. doc i 2/03 440 -46I 5T(10/02 /COM/WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection .Line:- 4503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
7 BUP
Received � (p Date Requested /) 9 AM PM BUP
Location 1 4 1 CO �l� tea - Suite MEC MEC
Contact Perso ��(�, Ph (_2 b° p z PLM
Contractor Ph (, ) SWR
BUILDING Tenant/Owner (A .ep Cdryt fro is ELC
Footing
Foundation ELC
Ftg Drain Access: ELR ?V 4 — w1 - 7.D-
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Int Sheath/Shear Sheath/Shear
Int
Framing
Insulation PD�J ) I
Drywall Nailing ], 1 V
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
EL TRIC
Servic
Rough -In at.e2
�
UG/Slab
• ww Voltacaj
i PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
kiiiko ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA ` � Q klll {�
Approach/Sidewalk Date ( - I In spect or l -' M L. M � Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL