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Permit
A. CITY OF TIGARD ELECTRICAL ENERGY - RESTRICTED ENERGY ��i1n DEVELOPMENT SERVICES PERMIT #: ELR2004 -00367 ' 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 12/1/2004 SITE ADDRESS: 16101 SW 72ND AVE BLDG A -200 PARCEL: 2S113A6 -00101 SUBDIVISION: ZONING: IP BLOCK: LOT: JURISDICTION: TIG Project Description: Installation of limited energy for data telecommunications. 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 GG TELECOMMUNICATION CO • 15350 SW SEQUOIA PKWY #300 -WMI 121 SW SALMON ST STE P1 PORTLAND, OR 97224 PORTLAND, OR 97204 Phone: 503- 624 -6300 Phone: 503- 295 -2922 Reg #: LIC 59692 ELE 34- 248CEA FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 12/1/2004 $75.00 Elect'I Final [ELPRMT] Investigation 12/1/2004 $75.00 [TAX] 8% State Surchar€ 12/1/2004 $6.00 Total $156.00 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 throw - 911-0100. You may obtain copies of these rules or direct que :• • OUNC at (503) • : -6•99. Is wed by !)".1 , / 1 ' PermitteeSignatur- A 0 - / • • d 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 1..()R ()i2vicl: HSI: UNIX city Of Tigard Received / /' 05/ Permit No.: gc,c9oby - 66 3G 7 • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 i,., ta <r r Date/B . Other Permit: Inspection Line: 503.639.4 (75 _�_ _,;� '_I_i:, Date Ready/By: Ell ID See Page 2 for Internet: www.ci.tigard.or.us Notified/Method Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction ❑ Addition/alteration/replacement Please check all that apply: ❑ Demolition ❑Other: ❑Service over 225 amps, comm'I El Hazardous location ❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft., CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential ❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi - family ❑Master builder ❑Other: ❑Buildin over three stories ['Feeders, 400 amps or more ❑Occupant load ova 99 persons ['Manufactured structures or JOB SITE INFORMATION AND LOCATION , RV DEgress/lighting plan park ❑Health -care facility ['Other: Job no.: Job site address: /4/0/ S. t.t� , 7241 Submit 2 sets of plans with any of the above. t City/State/ZIP: V1 4 The The above are not applicable to temporary construction service. FEE* SCHEDULE Suite/bldg. /apt no.:A oleo Project name: Q t.+t.ALfAP Description Q,y. I Fee I Total Cross street/directions to job site: New residential single- or multi - family dwelling unit. Includes attached garage. 1,000 sq. ft or less 145.15 4 Subdivision: Lot no.: Ea. add'I 500 sq. ft or portion 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 Limited energy, non - residential 75.00 2 DESCRIPTION OF WORK Each manufactured or modular �-� dwelling, service and/or feeder 90.90 2 71/4-1 A- 1.431 eat tAG Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2 D 401 amps to 600 amps 160.60 2 Name: Pip( chi u T' 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/ State/ZIP: Temporary services or feeders installation, alteration, and/or /- , relocation Phone: (555) !Pali - 5 Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2 Owner signature: Date: Branch circuits — new, alteration, or extension, per panel ❑ APPLICANT 1 ❑ CONTACT PERSON A Fee for branch circuits with service or feeder fee, each 6.65 2 Business name: branch circuit B. Fee for branch circuits Contact name: without service or feeder fee, each branch circuit 46.85 2 Address: Each add'I branch circuit 6.65 2 City/State/ZIP: Miscellaneous (service or feeder not included) Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2 Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited- ' CONTRACTOR energy panel, alteration, or B extension. Describe: t Page 2 7 . 2 Business name: �.�e_LstoNMlAkltCt.A_ C. 4-rt9 Address: 1 2( S • (JO. SA bN Su-curt_ ( Each additional inspection over allowable in any of the above Per inspection 62.50 City/StateJZEP:� an. 411413 ©e... Gi 7 2, Q,L4 Investigation per hour (1 hr min) 62.50 Phone: (503) 245. 25 22- Fax: (503 295- o &6 Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* CCB Lic.: 596,012, l Electrical Lic.:34 CL Supry ic.: 1200L EA /ll✓L 16A Tie't 44_ Suhtetah 7 Suprv. Electrician signature, required: ► I, �� I , PEN-, fr(-E 75 -0 0 i1. J.. .3 :_ ii Print name: I t{.g0 bot2 r<j a f}► { n , Oat , �( State surcharge (8% of permit fee) (p . r7 / -O l —O -L �p TOTAL PERMIT FEE 1/ 5(0 , 00 Authorized signature: Ibis permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: ate: 8. Fee methodology set by Tri County Building Industry Service Board [�j,J N o f i per pe rmi t allo wed is\ Building \PermibAFLC- PermitApp.doc 12/03 7 -`+' /J 440- 0615T(10/02/COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: [ WORK ONLY: Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm • El Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial system. $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* • ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations is\ Building \Permits\ELC- PeimitApp.doc 04/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: -(503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 - 4171 MST I BUP / — Received Date Requested 3 AM PM BUP Location / t' O / 7,2 - Suite t A "ZO MEC Contact Person / � . Ph ( ) T g a — 7 g/1 PLM Contractor / Ph ( ) SWR BUILDING Tenant/Owner C v l / ELC Footing Foundation ELC Ftg Drain Access: ELR Oso y - D 033 7 Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing F-P-(L-- F f �1 / Insulation M ;` e1 / Drywall Nailing V Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof 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 UG/Slab Low Voltage Fire Alarm ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL ❑ Please call for reinspection RE: Unable to inspect — no access Fire Supply Line .� / / /at ADA D I D Ins actor L g e" pct Approach/Sidewalk p Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL