Permit CITY OF TI GARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
LAii� DEVELOPMENT SERVICES PERMIT #: ELR2004 -00386
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/29/2004
SITE ADDRESS: 16101 SW 72ND AVE BLDG A -200 PARCEL: 2S113AB -00101
SUBDIVISION: ZONING: IP
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of limited energy for data communications. Phase II.
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 G G TELECOMMUNICATION CO
15350 SW SEQUOIA PKWY #300 -WMI 121 SW SALMON ST
PORTLAND, OR 97224 STE F -1
PORTLAND, OR 97204
Phone: 503- 624 -6300 Phone: 503- 295 -2922
Reg #: LIC 59692
ELE 34- 248CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 12/29/2004 $75.00 Elea! Final
[TAX] 8% State Surchart 12/29/2004 $6.00
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 -0100. You may obtain copies of these rules or direct que :. , to OUNC - (51. 24^ .699.
Issued by :,p1�.. � Permittee Signatu �� • _ _ .., ; � ; ",-
OWNER INSTALLATION ONLY {
The installation is being made on property 1 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 Perm * - �,1` �
tit: }! D . FOR OFFICE USE ONLY
City Of Tigard Date/By: PemritNo.: r-,/07 -cos,A
13125 SW Hall Blvd., Tigard, OR 9722 Plan Review
Phone: 503.639.4171 Fax: 503.59 0 2 9 2 0 04 0 4 . 1 1 ' It Date/By: Other Permit:
Inspection Line: 503.639.4175 e I Date Ready/By: Juris: ® See Page 2 for
Internet: www.ci.tigard.or.us G 9 ` _ '_' Notified/Method: I Supplemental Information
Y 0 TI I
CIT N IS 0 1 1 i � PLAN REVIEW
❑ New construction 1 31• "Adttton/alteration/replacement Please check all that apply:
❑Demolition ❑Other: - ❑Service over 225 amps, comm'l ❑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
['Building over three stories ['Feeders, 400 amps or more
❑ Multi- family ❑ Master builder ❑ Other:
['Occupant load over 99 persons ❑ Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
o ❑Health -care facility ❑Other:
Job no.: Job site address:
/( 1 SO '7V - AIL / fat:, A Z,00 Submit 2 sets of plans with any of the above.
City/State /ZIP: .---- exv,rin nQ- q 1 2 2.4 The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg. /apt. no.: 200 Pr oject name: Q t-
R �i A ' "� /M Description I Qty. 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'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90.90 2
VOl CS- � 1 4-1— A• 1,3(121- A-I Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
Dif PROPERTY OWNER ❑ TENANT
401 amps to 600 amps 160.60 2
Name: PAOARC 45 SODA S 601 amps to 1,000 amps 240.60 2
Address: I 5 350 s w agttelq awy It Over Over 1,000 amps or volts 454.65 n 2
� Reconnect only 66.85 2
City/State /ZIP: Poext.4 tD l� CI Temporary services or feeders installation, alteration, and /or
Sv3 �C nn (a Qo Fax: ( )
relocation
Phone: (
,�„'t - � 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 ❑ 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'l branch circuit 6.65 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( )
_ Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: 1 Page 2 2
Business name: G G vra,20K1'f wile 4 1 7 0 Al a
Address: S I,(, S -� l� Sr S K f (-� ( Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: VIO ex D 0E. q-7 204 Investigation per hour (1 hr min) 62.50
Phone: (5p3) 2q5- 272 Fax: (593 ) zq5- Q 6 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 59 Electrica 4-24a e Suprv. Lic.: /2 c j LEA Subtotal
Suprv. Electrician signature, requir : Plan review (25 %ofpermit fee)
Print name: ' I ' R,F{ Dat . ii.. z 4 -04 State surcharge (8% of permit fee)
boa. TOTAL PERMIT FEE V' C
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri-County Building Industry Service Board
1 •• Number of inspections per permit allowed.
i:\ Building '.Permits\ELC- PerrnitApp.doc 12/03 440- 4615T(10/02JCOM/WEB
Electrical Permit Application - City of Tigard =
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00 .
Check Type of Work Involved:
❑ Audio and Stereo Systems*
•
❑ Burglar Alarm
❑ 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
❑ C lock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ H VAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ M edical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Permits\ELC•PermitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / 3 f AM PM BUP
Location Flo / 0 I 7a 1 / Suite' - 2 _ MEC
Contact Person / Ph ( ) 1- /U 78/( PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access: JJ // //� 22 /
FtgDrain ELR�I � T - ' b� J ��o
Crawl Drain
Slab Inspection Notes02 „ n SIT
Post & Beam �y / � Anch
Ext Sr ea h /Srs � 71�� -r' RS �1/YI"L J J7
Int Sheath/Shear
Ext Sheath/Shear / p o
U
Framing
Insulation
Drywall Nailing
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
T FAIL
ECTRtC
Sea
Rough -In
UG/Slab
Low Voltage
Fire Alarm
PART FAIL E Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line _ / 1
ADA
Approach/Sidewalk Dat 3 1 Inspector ' - = Ext
Other:
Final DO NOT REMOVE this Inspection record from the ' b site.
PASS PART FAIL