Permit CITY OF TI G A R D ELECTRICAL PERMIT
PERMIT #: ELC2001 -00327
la DEVELOPMENT SERVICES DATE ISSUED: 6/21/01
" „ � I 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 112DC -00701
SITE ADDRESS: 15957 SW 72ND AVE BLDG -A
SUBDIVISION: OREGON BUS. PARK III ZONING: I -P
BLOCK: LOT : 038 JURISDICTION: TIG
Project Description: Job No. 8266
Tenant Improvement
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 19 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
. Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner:; Contractor:
PACIFIC REALTY ASSOCIATES BRIDGETOWN ELECTRIC
15350 SW SEQUOIA PKWY #300 -WMI 22732 NW GILLIHAN ROAD
PORTLAND, OR 97224 PORTLAND, OR 97231
Phone: Phone:
Reg #: 1 -6213 2
SUP 4177S
ELE 26 -887C
FEES Required Inspections
Type By Date Amount Receipt Ceiling Cover
PRMT� , CTR 6/21/01 $173.20 2720010000( Wall Cover
Elect 1 Final
5PCT • CTR 6/21 /01 $13.86 2720010000(
Total $187.06
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable Taws.
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: Or-. Ow requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -I +t Throug OA' •52 -0080. You may obtain copies of these rules ordirect questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
Permit Signature: / ;i Issued By: �^
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
Call 639 -4175 by 7:OOpm for an inspection the next business day
Electrical Permit Application
Date received:(, _a _ O l Permit no€QL�,001 -o63 i7
,I,' ,) L City of Tigard Project/appl. no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I 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 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement ❑ Other: 0 Partial
JOB SITE INFORMATION
Job address: 1 5 5 SW 72 in Avg Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision:
Project name: NW IZt ij qa 1 es . I Description and location of work on premises: fet of vcLJ.. O reject- .1-0 “ s
Estimated date of completion/inspection: (p — Z 5 — 01
CONTRACTOR APPLICATION FEE SCI !EDUCE
Job no: ' 7 to (o Fee Max
Business name: 01/ Y c GAG Pflatk 7t I� - v - L Descdpdon Qty. (ea) Total no. insp
l New residential - single or multi- family per
Address: a 7 - 7 3 a --7/1.1A.) q
r. 1 { t kA a- -e - R dwelling unit. Includes attadtedgarage. •
City: 'PO ) a tea( I State: (S)( I ZIP: `( - 7a11 -IV i3 Service included:
Phone: & 3'(il/ -7 al I Fax: (011 .70-3 I E-mail:
L e (,a cr(O(o{3 r' • C l O sq• ft. or less 4
CCB no.: 103 4 2-4+ I Elec. bus. lic. no: 7-0 $ 7 C Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
City /m • tro - . no • Limited energy, non - residential 2
Each manufactured home or modular dwelling
Signatu - of supervising electrician (required) Date Co - Z 1 •p t Service and/or feeder 2
Sup. elect. name (print): A'ei -y► Si.ein s td License no: Lit -11S 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: Fax: 1 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 installallom ,alteradoa,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: ( t /�_ " ��(IT,-
71 2
Phone: Fax: E -mail: Each additional branch circuit: ' p.t//0 (1 0 s 1 x .3S'
PLAN REVIEW (Please check all that apply) MI sc. (Service or feeder not included):
O 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* - _ 2
❑ Building over three stories 0 Feeders, 400 amps or more *Description:
❑ Occupant load 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 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 information. Notice: This permit application
Permit fee $ 1-7 3.20
O 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 %) .... $ 1 3 ' s(O
Expires accepted as complete. TOTAL $ t -
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6r000/COM)
Electrical Permit Fees: Limited Energy Fees:
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 ❑ 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 6, 8 ❑
Each additional branch circuit (cj $6.65 We . 3'� HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 ❑ Intercom and Paging Systems
Each sign or outline lighting $53.40
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 El Nurse Calls
Per inspection $62.50
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting
Fees: '1 ❑ Protective Signaling
Enter total of above fees $ ( 3' a () r Other
8% State Surcharge $ ) A 8 b 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.
6' Fees:
Total Balance Due $ (81
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
i:\dsts\forms\elc- fees.doc 10/09/00
CITY OF TIGARD BUILDING INSPECTION DIVISION • ° .
24 -Hoot Inspection Line: 639 -4175 Business Line: 639 -4171 MS;
BUP
Date Requested '3 ( AM PM BLD
Location 6 MEC
Contact Person Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner AI u J R ELC D-66 — vCZ3
Retaining Wall ELR <
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
Susp'd Ceiling
Roof
Misc:
Final i/fe?
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
Rough In
UG /Slab
Low Voltage
Fire Alarm
ma
A SS 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 J _v Ins ` 1 . � i�!I _ Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.