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Permit
• CITYOFTIGARD ELECTRICAL PERMIT - RESTRICTED ENERGY AN DEVELOPMENT SERVICES PERMIT #: ELR2004 -00373 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 12/9/2004 SITE ADDRESS: 16398 SW 72ND AVE B -08 PARCEL: 2S113AA -00200 SUBDIVISION: OREGON BUSINESS PARK I ZONING: I -L BLOCK: LOT: 002 JURISDICTION: TIG Proiect Description: Phone & Data. 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 TELEPHONE CONNECTION SERVICE 15350 SW SEQUOIA PKWY #300 -WMI PO BOX 2075 PORTLAND, OR 97224 BEAVERTON, OR 97075 Phone: 503- 624 -6300 Phone: 642 -7374 Reg #: LIC 50013 ELE 34- 142CLE SUP 458LEA FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 12/9/2004 $75.00 Elect'I Final [TAX] 8% State Surchart 12/9/2004 $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 questions to OUNC at (503) 246 -6699. Issued by Permittee Signature 0_9 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 • • E1ecttical Permit AD INo ,' • MIVED FOlt OFF1rL: IiSr ()NIX City of Tigard D Received . /, . 9 --/ t Pem,;t No. G 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review - Phone: 503.639.4171 Fax: 503.598.1960 0 9 2004 „ n �= Pl an Date/B R . Other Permit: Inspection Line: 503.639.4175 —i _ ' - i J Date Ready/By: IMII El See Page 2 for Internet: www.ci.tigard.or.us CITY OF TIGARD ^ Notified/Method: Supplemental Information BW LDIr gral tISION PLAN REVIEW ❑ New construction ❑ Addition/alteration/replacement Please check all that apply: ❑ Demolition ❑Other ['Service over 225 amps, comm'I ['Hazardous location ['Service over 320 amps — rating ['Bulldog 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: ['Building over three stories ['Feeders, 400 amps or more ['Occupant Toad over 99 persons ['Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park Job no.: , site address: /(, '/.'A 5O 7 — � rf / . ` ❑ Health - care facility DOther: Submit 2 sets of plans with any of the above. City/ State/ZIP: 1 l l?'►p_+/ dee j The above are not applicable to temporary construction service. Suite/bldg./apt no.: Project name: (,�- /3 I-'S, S it i FEE* SCHEDULE Description I Qty. I Fee I Total I ** 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 I Tax map /parcel no.: Limited energy, residential 75.00 2 Limited energy, non - residential 75.00 t 2 DESCRIPTION OF WORK Each manufactured or modular Tel p � /� � , dwelling, service and/or feeder 90.90 2 ` p ( W Awn Ails u 9 V, Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER 1 ❑ TENANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: S & e N ��t/ N _ to , 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: ( ) 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 extension. Describe: Page 2 2 Business name: 7.0,ep e d_x,V p,, S-ee4)4 Address: ��' it) y Each s Each additional inspection over allowable in any of the above Per inspection 62.50 City/ State/ZIP: 68..0.e 4 , v ©4 97075" Investigation per hour (1 hr min) 62.50 ! Phone: ( ) 6,q)... 73 � Fax: ( s cy3) 6,t/ — v Sq, Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES * CCB Lic.: 6 Electrical Lic.:• ./v Suprv. Lic.: L!s21 (, _ Subtotal 7S! p p Suprv. Electrician signature, required: 0 Plan review (25 %ofpermit fee) ! - Print name: t/4. Kin f _ Date: i 0/0 L State surcharge (8 %ofpermit fee) (P'491) TOTAL PERMIT FEE bier) 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 •• Number of inspections per permit allowed. is\ Building \Pennits \ELC- PamitApp.doc 12103 440- 4615T(I0/02/COM/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: FCONIIVIERCIAL 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 / �iData Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical El 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 \Pennits\ELC- PcunitApp.doc 04/03 CITY OF TIGARD 24 -Hour AV : BUILDING Inspection Line: (503) 639 -4175 INS ECTION DIVISION Bwsines's Line: (503) 639 -4171 MST il f BUP Rec v ed? S I U Date Requested /� /� AM PM BUP Location / 39 a `7,? #.� Sui o MEC Contact Person ' I v • Ph ( ) 1p') - 7 37 V PLM Contractor Ph ( • ) SWR BUILDING Tenant/Owner Cit _ i S(' ELC Footing Foundation Access: CD ndation ELC >O 00.573 Ft Drain Crawl Drain ' Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear . Int Sheath/Shear Framing Insulation Drywall Nailing Fire wall Fire Sprinkler Fire Alarm (._/ Susp'd Ceiling Roof (`p n 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 P ART FAIL LEC ICAL Service Rough -In ow Volta Fire m LI: ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. •ART FAIL TE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Date /2 d Inspector (. Ext Approach/Sidewalk Other: Final DO NOT REMOVE this Inspection record from t job site. PASS PART FAIL