Permit CITY OF TIGARD ELECTRICAL PERMIT-
RESTRICTED ENERGY
�� � ; � DEVELOPMENT SERVICES PERMIT #: ELR2003 -00256
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/19/03
SITE ADDRESS: 14160 SW 72ND AVE 110 PARCEL: 2S112AA -00900
SUBDIVISION: NELSON BUSINESS CENTER ZONING: I -H
BLOCK: LOT: JURISDICTION: TIG
Project Description: Tenant Improvement - data /voice wiring
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:
SPIEKER PROPERTIES LP COMMUNICATION RESOURCES INC
4380 SW MACADAM AVE STE 100 PO BOX 2685
PORTLAND, OR 97201 WILSONVILLE, OR 97070
Phone: Phone: 503 699 - 9300
Reg #: LIC 154557
ELE 3-5610EA
FEES Required Inspections
Description Date Amount Ceiling Cover
[ELPRMT] ELR Permit 8/19/03 $75.00 Wall Cover
Elect'I Final
[TAX] 8% State Tax 8/19/03 $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 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:
• TRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE: r
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
I
Electrical Permit Application FOR OFFICE USE ONLY
Received ,.., Electrical c / ��
DateBy: 17i 03 Permit No.: G€2cc07)3 '6' 2,j �eo
Ci}� of Tigard Planning Approval 9 n t Sign
`J g Date/By: 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
/ /� I Date/By: Case No.:
Internet: www.ci.tigard.or.us • 'i Contact Juris.: ® See Page 2 for
^
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information.
. ` TYPE' OF WORK ' " 1- * ' , FLAN REVIEW (Please check all that apply) .
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
gl commercial ❑ Hazardous location
Addition/alteration/re p lacement ❑ 0 over 320 amps-rating of Other: amp g ❑ Building over 10,000 square feet,
- ' CATEGORY OE CONSTRUCTION . • 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling 0 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 SITEINFORMATIONand LOCATION Submit _ sets of plans with any of the above.
�d
y / � O - The above are not applicable to tem ora construction service.
Job site address 7 2 fir/ w , x = FFE* SCl3EDUl; - Suite #: //Q 1 Bldg. /Apt. #: Number of inspections per permit allowed
Pro'ect Name: A A : A 4J 4 _ rte, �., Description Qty Fee (ea.) Total
Cross street/Directions to job site: New residential-single or multi- family per
l Qf A. ' , 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
DESC O OF WORK . service and/or feeder 90.90 2
/� � j� ! Services or feeders - installation,
eq ,, /- J6 S. L(/ i� 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
jill`ROPER'Iy OWNER . - '`:{ -.❑ TEINANT ... • ,: - 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: / E, --- 2.7 e� Reconnect only 66.85 2
Address: 7,2 , -L/ �a� I } �7 2/o Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 7 ems - 97- c' ' 200 amps or less 66.85 1
it. one :.3v 9SS S - 3 - 5` I Fax: 201 amps to 400 amps 100.30 2
133.75 2
; APPLICANT • _: ; . 40 to 600 amps
CONTACT PERSON Branch circuits - new, alteration, or
Name: ip. A,, "e2. .�- RS ®v - t;' ,ef' ./.t,G extension per panel:
Address: / o 27 0 .1 6 Fy ' A Fee i c e branch feeder fee, with branch of 6.65 2
service or feeder fee, each branch circuit
City /State /Zip:@)//...<-0-4-1/; 1/E zr Q' E ti , B. Fee for branch circuits without purchase of
Phone:S � Gc' yy� e ' o 1 Fax: Each or first branch circuit 46.65 2
ch addi tional al branch circuit 6.65 2
E -mail: 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: Signal circuit(s) or a limited energy panel,
Business N alteration, or extension Page 2 2
�, -,sue , t-i z -' Description:
Address: Po Be t A F'5 4 S 0,, f. L s 1 aG `7
l �/£ ��- �� o� Each additional inspection over the allowable in any of the above:
City/State/Zip: !!,, U Per inspection per hour (min. 1 hour) 62.50
Phone: S'o) 6 y C- ' `' Fax Investigation fee:
.5525-7 CCB Lic. #: ' g Lic. #: 2 - _S - 6/G °�`
Supervising electrician' " Electrical I'ermiboe�* ` $
signature required: ) O .O Plan Review (25% of Permit Fee) $
Print Name: , Y' ,,,.. 1 � //36 -e g/? State Surcharge (8% of Permit Fee) $ 0.--d
TOTAL PERMIT FEE $ / ,
Authorize Notice: This permit application expires if a permit is not obtained within
Signature:'/ Date: 2- ''"- 180 days after it has been accepted as complete.
- _ s "Fee methodology set.by Tri- County Building Industry Service Board.
(Please print name) 3 — 5 l c E / of I /
i:\Dsts\Permit Fomis\ElcPermitApp.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
❑ Burglar Alarm
E Garage Door Opener
Heating, Ventilation and Air Conditioning System
❑ Vacuum Systems
Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
El Audio and Stereo Systems
O Boiler Controls
fl Clock Systems
❑ Data Telecommunication Installation
0 Fire Alarm Installation
HVAC
❑ Instrumentation
0 Intercom and Paging Systems
• Landscape Irrigation Control
Medical
Nurse Calls
❑ Outdoor Landscape Lighting
fl 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 -Hodr '
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
q 1'
Received Q Date Requested AM PM BUP
Location / qi 6 0 at) 7 2 Suite / /D MEC
Contact Person O (Ylo eA A c. Ph (_) 8l 3 PLM
Contractor 0 0444 44 - Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access: /
Ftg Drain ELR �� — 2 %
Crawl Drain
Slab Inspection Notes: �� � SIT
Post & Beam ( 1 W.1Z.-
Shear Anchors 1
Ext Sheath/Shear -tiekl)
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 k
'1(, /Slah
L o w Vol
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
L Ig4" , PART FAIL
SITE L Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Date � � O3 Inspector — 4 11 % - ■ , & — •d -
Approach/Sidewalk
Other:
Final DO NOT REMOVE this Inspection record fr . m the jo Ito.
PASS PART FAIL