Permit 4 CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
:,, e I a DEVELOPMENT SERVICES PERMIT #: ELR2002 -00118
� "� 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 7/2/02
SITE ADDRESS: 15862 SW 72ND AVE 150 PARCEL: 2S112DD -00200
SUBDIVISION: OREGON BUSINESS PARK III ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: Low voltage: Data Telecommunication.
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 NETWORK SOLUTIONS, INC.
15350 SW SEQUOIA PKWY #300 -WMI 1820 SW. VERMONT
PORTLAND, OR 97224 , SUITE J
PORTLAND, OR 97219
Phone: Phone: 244 -7244
Reg #: LIC 00102482
ELE 34- 264CLE
SUP 1051JLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 7/2/02 $75.00 2720020000 Elect'I Final
5PCT CTR 7/2/02 $6.00 2720020000
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 thro . h OAR 952 - 001 -0080. You may obtain copies of these rules or direct gas ns to OUNC at (503)
246 -1987.
Issued by = L _ _ •`� ; . - Permittee Signature I
OWNER INSTALLATION ONLY /j
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
AIL
- A Electrical Permit Application
Date received: _ 3 _ 69. Permit noZ74
AO -rte / i
,•III 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:
. - TYPE OF PERMIT .
❑ 1 & 2 family dwelling or accessory Commercial/industrial 0 Multi - family ❑ Tenant improvement
❑ New construction U Addition/alteration /replacement 0 Other: 0 Partial
' `, •, JOB SITE INFORMATION.....
Job address v Bldg. no.: Suite no.: Ito Tax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name: / f Wir_j • .ption and location of work on premises:
Estimated date of completion/inspection:
. . • CONTRACTOR APPLICATION,? • • - .. '' FEE SCHEDULE
Job no: Fee Max
Business name: f �� + ' '' _ Description . Qty. (ea) Total no. insp
— C � � ew residential - single or multi -family per
Address: .. .e) , .. 1( ` , dwelling unit . Includes attached garage.
In rJ State& ZIP: 7A Service included:
Phone: 7i 1),1„,..,, t � 1 ii�f.�ii�ia %ii �• 4
CCB no.: ♦ Elec. bus. lic. no:'
o i ch a. di tonal 500 sq. ft. or portion thereof ___—
Limited energy, residential --_ 2
City /metro lic. no.: . -7 -1J 3 ■ 0— / — 0 Y Limited energy, non - residential MII__ 2
Each manufactured home or modular dwelling IME
Signature of supervisin: • trici, - • uired) Date 47v - AO Service and/or feeder 2
�. lr i ; , � . Services or feeders — installation,
Sup. elect name (pnnt `�� L no: L`
IIII
alteration or relocation:
4: ; ' . PROPERTY OWNER 200 amps or less 2
Name (print): (-to - ! -o2- 201 amps to 400 amps ___ 2
401 amps to 600 amps ___ 2
Mailing address: 601 amps to 1000 amps ___ 2
City: State: ZIP: Over 1000 amps or volts ___ 2
Phone: Fax: 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 amps ___ 2
ENGII\'EER 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: State: 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):
❑ Service over 225 amps- commercial ❑ 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,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* Ill.
❑ Building over three stories ❑ Feeders, 400 amps or more ■Descri . tion:
O Occupant Toad over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other. Per inspection __
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 infomtation. Notice: This permit application Permit fee $
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
Expires accepted as complete. TOTAL $ V O (]
Name of cardholder as shown on credit card
Cardholder signature Amount 440 -4615 (6/00/COM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT F .
1
•
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 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
Dwelling Service or Feeder $90.90 2 n Garage Door Opener
Services or Feeders Fl Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less • • - W.30 2 , • «
201 amps to 400 amps "110.85 2 ❑ Vacuum S�step1s • • ••• z
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 ❑ Other.. • • . , e • e, • • , _,,e , p., . 14, •
Over 1000 amps or volts $454.65 2 ° ` t •' ' ' °+ �� '
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 • 3 .. • • ..( E 914 -2,QP -260) ,` : • , - -.., r . ,
201 amps to 400 amps $100.30 2-''• ' a .3 . • 1- " • - ., ) ,• 401 amps to 600 amps $133.75 2 • Gheck s f y0.of�IV idn4ol'v�d;•1. ::.!%:_ D I. .3•
Over 600 amps to 1000 volts, • .. ' °' - . •
see ..b., above. , �( ' ,� Audio art�,ptpregp. - • • r • ` .
Branch Circuits . T . • • . • • ,
Ne alteration or extension per panel + L' oiler Controls
a) The fee for brancti•eiccuits • d , • • '
with purchase of service or ❑ lock Systems '
feeder fee. .
Each branch circuit $6.65 2 - . • Data Telecommunication lostaltatisn
b) The fee for branch circuits ' � _ •
without purchase of service .,
In Fire Alarm Installation 4 '
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 ❑ Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 n 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 $ 1 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 A $
❑ Trust Account # 8% State Surcharge $
All New Commercial Buildings require 2 sets of plans. Total Balance Due $
i:\dsts \forms \elc- fees.doc 08/30/01
CITY OF TIGARD 24 -Hour
BUILDING ` Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MSS
BUP
Received Date Requested • -N1 AM PM BUP
Location (SS s w r. 2 ad Suite I5 MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC Access:
Ftg Drain ELR s�• OOHS
Crawl Drain
Slab
Post Notes: Dx -n \ Lg SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm R \LS.
Susp'd Ceiling
Roof ci -
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
4221i6
ire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 7 -" 0— 0 Z Inspector yer-;-2 Ext
Other:
Final DO NOT REMOVE this Inspection record from thite.
PASS PART FAIL