Permit ..
A ELECTRICAL PERMIT -
CITYOFTIGARD RESTRICTED ENERGY
v 9y; DEVELOPMENT SERVICES PERMIT #: ELR2001 -00318
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/21/01
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 alarm system. Job No. 724 -01.
•
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: X OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: :
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC REALTY ASSOCIATES HONEYWELL INC
15350 SW SEQUOIA PKWY #300 -WMI 15495 SW SEQUOIA
PORTLAND, OR 97224 STE 100
PORTLAND, OR 97224
Phone: Phone: 968 -3300
Reg #: SUP 941 -JLE
LIC 57824
ELE 26- 207CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 12/21/01 $75.00 2720010000 Elect'I Final
5PCT CTR 12/21/01 $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
r • s you • • 'low rules adopted by the Oregon Utility Notification Center. Those rules are set forth ' . • AR
2- 001 -0010 thro. • h OAR 9,001 -0080. You may obtain copies of these rules or if -ct questio• : 1. OUNC at (503)
246 -1987.
Issued by , !„1 al .V Permittee Signature A;,,
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
Ai..
Electrical Permit Application
Date received: / A p/ Permit no.: 24 g /..
.1,1, ..ai City of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
Tl'PE OF PERMIT ,
❑ 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family ❑ Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other: 0 Partial
Job address: 2 OS 5 co 7a 14 V e Bldg. no.: 3' k Suite no.: Tax map /tax lot/account no.:
Lot: Block: 'Subdivision:
Project name:• - J s'{.Nc 6oIF r(c.t4, 3escr ton and location of work on premises:
Estimated date of completion/inspection: (- y -0 1
CONTRACTOR APPLICATION FEE SCHEDULE .
Job no: 72.y -p/ Fee Max
Business name: F- \vr-•� t, .� \
Description w Qty. (ea.) Total uo.iusp
s \ New residential - single or muhl- family per
Address: / 5'-/Q v > w Se v cl) v C 7 IL... y 1 t 0 dweling unit. Includes attached garage.
City :T{ r .4 k r c\ I State: Q zI ZIP: qt7 Z z y • Service included
Phone: S °3 96 8- 33001Fax:54)-1y68.334 E -mail 1' Ho .. ate cc Kt e- Isq.ft.orless 4
�� `Y Each additional 500 sq. ft. or portion thereof
CCB no.: S7 fay I Elec. bus. lic. no: 26 .Z 0 7 - L -6
Limited energy, residential 2
Ci /metro lic. no.: Limited energy, non- residential 2
/Z - 7 r - C.) / . Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): (.4z_ /-( o rQlsc'..) • License no: �'9 TLC
Services or feeders — installation,
alteration or relocation:
PROPERTY OWNER 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:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
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 REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps- commercial 0 Health -care facility Each pump or irrigation circle 2
O Service over 320 amps -rating of 1 &2 0 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, / 2
O System over 600 volts nominal more residential units in one structure alteration, or extension*
O Building over three stories 0 Feeders, 400 amps or more *Description
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
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other t, —
Not all Jurisdictions accept «edit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ 1
❑ Visa MasterCard expires if a permit is not obtained Plan review (at _ %) $ .
C)
00 071 State surcharge 8%
credit card wrtiber: OS • ql�' yy'�l� � / /� within 180 days after it has been g ( ) •••• $
,..c Moe .. Ex accepted as complete. TOTAL $ e,
$ N of 'der as shown on credit card
Cardholder signature Amount 4404615 (6/00/COM)
•
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
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 r-,
201 amps to 400 amps $106.85 2 ` I Vacuum Systems
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, ri see "b" above. l i Audio and Stereo Systems
Branch Circuits ❑
New, alteration or extension per panel Boiler Controls
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 ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 �
Each sign or outline lighting $53.40 I I Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension I $75.00 ) . ❑ Landscape Irrigation Control
Minor Labels (10) $125.00 .
Each additional inspection over ❑ 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 $ s n Other
8% State Surcharge $ Number of Systems
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 $
All New Commercial Buildings require 2 sets of plans.
i:\dsts \fomu \elc- fees.doc 08/30/01
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
L BUP
Date Requested J — `7 AM PM BLD
Location /S10,5 7;L �J�-�� Suite MEC
Contact Person 640 Ph 7'9 9 c: -9 4 PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR 2-60 / Od 3
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 �!
Fire Sprinkler 0 t L ' .
Fire Alarm
S
I
usp'd Ceiling �►��_��W
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Slab - �O C rE
Under Slab c.,� --ta
Top Out
Water Service ° ,40
Sanitary Drains Sewer 3 � 4,
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL ; U
ELECTRICAL `l
Service 1
Rough In WaraWLYAMI
UG /Slab
O0 -Voltage)
Fiilarm
i na
S) 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
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk D f - '/ --Q Inspector G 'j Other Ext
L se
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
-CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested k 3-r) / AM PM BLD
Location ) g 1 7E4 5 2? � Suite MEC
Contact Person go b ,E -f a) , , C 1°7n PLM
Contractor Ph SWR
____14044e44,42th______ BUILDING Tenant/Owner
Retaining Wall ELR_ i:422“,r23Lc4
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab c,� /
Post & Beam — V ° SIT
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall OPP
Fire Sprinkler — II I _ 41r7 -- ' i !
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
i
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In '
UG /Slab
Fir- Alarm
S PART FAIL
SITE
Backfill /Grading :1r
Sanitary Sewer ,,
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd .
Catch Basin `a►,.
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date k 4.3
— �v J Inspector Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
GITY OF TIGARD BUILDING INSPECTION DIVISION
c4-Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST BUP
Date Requested 1? ..-
.— AM PM BLD
Location / `� � ('s ) /4 Suite MEC
Contact Person Ph PLM
Contractor H Cr) F c C / Ph SWR
BUILDING Penant/Owner ELC
Retaining Wall ELR iZOO���i'�
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
Fire Sprinkler
Fire Alarm ro-ip P/1-s Susp'd Ceiling /
Roof
Misc:
Final
PASS PART FAIL
110
PLUMBING •
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains At as IN)
Final
PASS PART FAIL �—
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Fire Alarm
Final
gp , 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 j� A Q�
Other Date / — per() "6 Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.