Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
it DEVELOPMENT SERVICES PERMIT #: ELR2001 -00223
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/7/01
SITE ADDRESS: 15957 SW 72ND AVE BLDG -A PARCEL: 2S112DC -00701
SUBDIVISION: OREGON BUS. PARK III ZONING: I -P
BLOCK: LOT: 038 JURISDICTION: TIG
Project Description: Data Telecommunication Installation.
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:
NETWORK CONNECTORS INC
P.O. BOX 1718
OREGON CITY, OR 97045
Phone: Phone:
Reg #: 6@3
ELE 3- 313CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 9/7/01 $75.00 2720010000 Elect'l Final
5PCT CTR 9/7/01 $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 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
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:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELECN: DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Sent By: NETWORK CONNECTORS INC; 5036504810; Sep -5 -01 9:44AM; Page 2/3
‘.„ 1 "
Electrical PermitAp . 'i
_cat
bate re eived: 9 ff p 1 Permit no.: a ' .� —
�i 3
!1` 4 : City of Tigard P ro v t/ �. no.: - -
J pP Expir�edate.:
CirynfTigard Address: 13125 SW Half Blvd, Tig: 0 97223
Date issued:
�� Receiptno,:
Phone: (503) 639 -4171 •
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: l J(.........
U 1 & 2 family dwelling or accessory ' Commercial/industrial O Multi- family 0 Tenant improvement
0 New construction : 0 Addition/alteration/replacement 0 Other: ❑ Partial
.1011 SIR; 1Nl ORA1,AT10N
Job address: y ,_ YI& Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot: Block: Subdivision: , it)( . A •
Project name: l , 4 Description and location of work on premises: p, . q , ~ , r. .
Estimated date of coin' lotion/ s .. - lion: • . • ... : -_. _ .. k •t. + ••
(:(1i\ A P11.1 (:A 1 ON .
. rEE S('11! 1)14 .
Job no: Q l ^ a % Fee Max
Business name: A jr tw tic nays hr t fs t _ ve:eni�Oa Qh• 0. Total no. lase
Address: i 8 � 111 dwelling mit. includes . per
New residential -single or 'maid-family
Cit lik ,x.41 4 State: Z - ZIP: � a Scn;ceinchsded:
Phone: , .tiO ���1 ��;11 -mail: 1000 sq. ft. orless • 4
CCB f r. fro ■ ' Ora : Elec. bus. lic. no: i - ' )j{ Each additiona1500 sq. ft. or ponion thereof
_ Limited energy, residential 2
Lily . • Ii Limited energy. non-residential 2 •
ra
1. Each manufactured home or modular dwelling Si . 7 e of su i • i • . -`
• � ' r clan (required) Service and/or feeder 2
Sup. elect flume (pnno; Llcenac no . / ,---. Services or feeders — installation,
alteration orrebcatfon:
700 amps or less 2
Name (Puny: 201 amps to 400 amps . 2
401 amp 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 1 own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to tI1ation. alteration. artrcltkalioa:
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 . 2
F G I N 1111 Branch clrcaits - sew, alteration. •
or extension per panel:
• Name: . A. Pee for branch circuits with purchase of
Address: service or feeder fee, each brunch circuit _ 2
City: I State: 1 ZIP: B. Pee for branch circuits without purchase
of scrvic a or feeder fee first branch circuit: 2
)?hone: Fax. E-mail. Each additional branch circuit:
PLAN 1 EVII W (Please check all that apply) 1 Ilse . (Service or feeder mot Included): —~
12 Service over225 amps - commercial • Q Health-care facility Each pump or irrigation circle 2
0 Service over 320 a/ups• rating of l &2 ❑ Hazardous location Each signor outline lighting 2
family dwellings O 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* _ '� 2
Q Building over three stories Q Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons 0 Manufactured structures or RV park Each additional Inspection over the allowable hi any of the abort:
0 G;ressiliglUingplan 0 Other Per inspection 1 1 I f
Submit sets of plains iv tb any of the above. Investigation fee
The above are trot applicable to temporary construction service. other
—
Not an putsateaor acc
u ept credp car*, please con juai,ilicrion rut =Az iufornutioa Notice: This permit application Permit fee $ _ lJ
U V • asterCard : expires i f a permit is not obtained Plan review (at _ %) $ _ _�
A . I I 1 within 180 days after it has been State surcharge (8%) ..__ $
t V Y /t taiwoi t - • . i tss accepted as complete. TOTAL $
cardholder ass, . moo credit . •
Cardholder dgr,ature Amount V 00 ` /- 4441615 (6io0/Ct)M)
3 7
1 /..,c,o,
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Sent By: NETWORK CONNECTORS INC; 5036504810; Sep -5 -01 9:45AM; Page 3/3
Electrical Permit Fees: • Limited Energy Fees:
COm late Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p
Number of Inspections per permit allowed Restricted OR $75 00
ALL SYSTEMS)
EMS)
•Service included :: Items Cost Total 4,
Reslderltfaf - per unit : Check Type of Work Involved:
• 1000 sq. ft. or less
• _ I $145.15 . 4 t Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy : 575.00 •
Each Manufd Horne or Modular
Dwelling Service or Feeder 590.90 _ 2 p Garage Door Opener
Services or Feeders • ❑ Heating, Ventilation and Alr (`,pnditioning System"
Installation. alteration, or relocation
200 amps or less
• _ 580.30 2
201 amps to 400 amps 5108.85 2 CI Vacuum Syste
•
401 amps to 600 amps 5160.60 2
601 amps to 1000 amps $240.60 2 ri Other
Over 1000 amps or volts 5454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders
Installation alteration orrrelocsiltion TYPE OF WORK INVOLVED - COMMERCIAL ONLY
200 amps or less : $66.85 2 Fee for each system 575.00
201 amps to 400 amps _ 5100.30 2 (SEE OAR 918 - 260 -260)
401 amps to 600 amps $133.75 2
Over 600 amps to 1000 volts, Check Type of Work Involved:
•
see "b" above. .
Branch Circuits ri Audio and Stereo Systems
New, alteration or extension per panel ❑
a) The fee for branch circuits Boiler Controls
with purchase of service or
feeder fee. ❑ Clock Systems .
• Each branch circuit $6.65 2
branch b) The fee for prcuils Data Telecommunication Installation
Without purchase Of service
or feeder lea ❑ Fire Alarm installation
First branch circuit : $48.85
Each additional branch circuit _ $6.65 ❑
HVAC
Miscellaneous
(Service or feeder not included) n Instrumentation
Each pump or irrigation circle $53.40 -
Each sign or oottine lighting 553.40 ❑
Signal rsrcuit(s) or a limited energy Intercom and Paging Systems
panel, alteration or extension 575.00
Minor labels (10) $125.00 ❑ . Landscape Irrigation Control'
Each additional Inspection over
the allowable in any of the above Medical
Per inspection $82.50
Per hour 562.50 ❑ Nurse Cans
In Punt • $73.75 ❑ Outdoor Landscape Lighting'
• Fees: •
• Li Protective Signaling
Enter total of above fees $
8% State Surcharge $ LI Other
25% Plan Review Fee Number of Systems
See 'Plan Review" on $
front of application * No licenses are required. Licenses are required for all other installations
Total Balance Due $ Fees:
El Trust Account h Enter total of above fees $ -75.—
•
8% State Surcharge $ CO.
•
Total Ba lance Due $ ? I
•
iAdsts\forms\elc- fees,doc :10/09 /00
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CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested /b - /c -- AM PM BLD
Location 7 (e3 2— D cicAi -e Suite MEC
Contact Person I - 1, D r • Ph C)' 7 7 5 (v q ! qS PLM
•
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR ? CU/ Dv Z 3 3
Footing Access:
Foundation FPS
Ftg Drain # SGN
Slab
Crawl Drain Inspection Notes: c 9
SIT
Post & Beam
Ext Sheath /Shear .
Int Sheath /Shear
Framing
Insulation , —
Drywall Nailing _ /-o . , Ai.io.t_s L lr
Firewall
Fire Sprinkler s Jr - - Ar • - - - e. _ _ • /f" iorL Jr
Fire Alarm
Susp'd Ceiling - - - ��� - - - - , / 0 i / / /
Roof yi S /i� sk5(� Arc rv` [— ci, Misc:
Final 4 �! r . /�
P ASS PART FAIL
PLUMBING
Post & Beam / /
Under Slab _., - - .ice 4'
Top Out
. Water Service 1 /x / nI> a c 1. d' ) //?c...7 (..27/7/ o 7 v`
Sanitary Sewer
Rain Drains F11L77 1
Final
PASS PART FAIL
MECHANICAL
Post & Beam /
Rough In c�� , FI WA 0 I
Gas Line �—v
Smoke Dampers
Final 1
PASS PART FAI kr,; - zo o m , m , � A
ELECTRICAL
•
Service
Rough In
. 1 IS/Ria
w 4
Fire Alarm
ilti.a.. 0F
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
Other Date dee rc6 Inspector _. _ _ ..i.r Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.