Permit CITYOFTIGARD ELECTRICAL ENERGY
RESTRICTED ICAL ENERGY
��� DEVELOPMENT SERVICES PERMIT #: ELR2001 -00322
�=-- 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 12/28/01
SITE ADDRESS: 15705 SW 72ND AVE PARCEL: 2S112DC -00100
SUBDIVISION: OREGON BUS. PARK III ZONING: I -L
BLOCK: LOT: 002 JURISDICTION: TIG
Project Description: Installation of data /telecommunication system. Job No. 51 -05184
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 REALTY ASSOCIATES CHRISTENSON ELECTRIC INC
15350 SW SEQUOIA PKWY #300 -WMI 111 SW COLUMBIA
PORTLAND, OR 97224 STE 480
PORTLAND, OR 97201
Phone: Phone: 241 -4812
Reg #: LIC 458
SUP 3289S
ELE 26 -34C
FEES Required Inspections
Type By Date Amount Receipt • Low Voltage Inspection
PRMT CTR 12/28/01 $75.00 2720010000 Elect Final
5PCT CTR 12/28/01 $6.00 2720010000
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 -001 010 OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -19 �
Issue by k Permittee Signature s
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
Date received: iR s8 0 Permit no.: � app -3
, j;-' ' i i City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF I'ERIIIT
O 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family ❑ Tenant improvement
0 New construction ❑ Addition/alteration/replacement 0 Other: O Partial
Job address:15705 SW 72ND (T) 97224 Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot: I Block: (Subdivision: BLS G903
Project name:BRIDGESTONE SPORTS I Description and location of work on premises: LOW VOLTAGE DATA /TELECOMMUNICA ^ION
Estimated date of completion/inspection: MARK BRADWELL (503) 806 -9353
QNjlR: CI:OR.ArpLICATION , . . : . . s -a ..:. : FEE SCHEDULE. ..... _ • .
Job no: 51 -05184 Fee Max
Qty, (ea) Total so. hup
Business name:CHRISTENSON ELECTRIC, INC. New residenl1ai-single or multi - family per
Address:111 SW COLUMBIA, SUITE 480 dwelling unit. Includes attached garage.
City: PORTLAND I State: OR I x:97201 -5886 Service htcluded:
Phone503 2414812 IFax503241051$E -mail: 1000sq. ft. orless 4
Each additional 500 sq. ft. or portion thereof
CCB no.:458 I c. bus. lic. no: 26 -34C _ Limited energy, residential 2
City /metro ' o.: 5 46
Limited energy, non - residential 2
Each manufactured home or modular dwelling
Signal of supervisi ectrtcr required) Date 1 / 2 6 / U 1 Service and/or feeder 2
Sup. elect.name(print): BRIAN CHRISTOPHER License no: 873S Services or feeders — installation,
alteration or relocation:
200 amps or less 2
Name (print): • 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration,orrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701. • 201 amps to 400 amps 2
Owner's signature: • Date: 401 to 600 am s 2
Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: • I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E -mail: Each additional branch circuit:
PLAN REV! ENV (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps- commercial O Health -care facility Each pump or irrigation circle 2
O Service over 320 amps -rating of 1 &2 O Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
0 System over 600 volts nominal more residential units in one structure alteration, or extension* 1 75 . 2
o Building over three stories 0 Feeders, 400 amps or more •Description: DATA/ TELECOMMUNICATION
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional Inspection over the allowable in any of the above:
O Egress/lightingplan 0 Other. Per inspection 1 1 1 1
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more infom nation. Notice: This permit application
Permit fee $ 75.
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ 6 • /
Expires accepted as complete. TOTAL $ 81.00 /
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (6/00/COM)
OCT.2000 +FEES ON BACK OF FORM
Electrical Permit Fees: Limited Energy Fees:
•
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 4, Check Type of Work Involved:
Residential - per unit -
1000 sq. ft or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
- portion thereof • $33.40 1 ❑ Burglar Alarm
Limited Energy • $75.00 •
Each Manufd Home or Modular El Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation
200 amps or less $80.30 2 ❑ Vacuum Systems'
201 amps to 400 amps $106.85 2
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 ❑ Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders. TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918- 260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts, ❑
see "b "•above. Audio and Stereo Systems
Branch Circuits ❑ Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 El HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 El Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over El Medical
the allowable in any of the above
Per inspection $62.50 ❑ Nurse Calls
Per hour $62.50
In Plant - $73.75 ❑ Outdoor Landscape Lighting*
Fees: ❑ Protective Signaling
Enter total of above fees $ ❑ Other
8% State Surcharge $ N umber of Syste
25% Plan Review Fee
See "Plan Review" section on $ No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
i :\dsts\forms\elc- fees.doc 10/09/00 ++OVER FOR PERMIT FORM
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested /-- 3.17 AM PM BLD
Location Suite MEC
Contact Person LQ r Ph _8(24 PLM
Contractor _Ci3t_iM3gdriSpi Ph SWR G
BUILDING Tenant/Owner ELC
Retaining Wall ELR 2x70/ —Ci9 31-2•
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab _ SIT
Post & Beam LOCO O ba _
Ext Sheath /Shear !+�/ V l/ �
Int Sheath /Shear
Framing �
Insulation !s C4 U0/14.e
Drywall Nailing
Firewall
Fire Sprinkler FAph011e V 0/
Fire Alarm C F %�77 � c
Susp'd Ceiling ��(
Roof
Misc:
Final
PASS PART FAIL
PLUMBING aro
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
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
.1:.W PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk
Date
Other , 3 !'
0/ Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
- - , CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP
Date Requested /a - AM PM BLD
Location / S 70 3 7 / -(-- Suite MEC
Contact Person LreLL Ph 3 06 PLM
Contractor C Air; 5tV K5" /PCIWG Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR ,Zd27 / 3 Z�
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall eriCir.S.tetriet Fir e Sprinkler Fire Alarm 1,okf
Susp'd Ceiling 1
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
o�ugh`T�n
UGTSlab
Low Voltage
Fire Alarm
Final
gip PART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk
Other Date /2-31-o/ Ins Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.