Permit ` CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
41 1 I DEVELOPMENT SERVICES PERMIT #: ELR2004 -00362
AA 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/22/2004
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: Installation of security system.
Job # 4804 -274.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER: .
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC REALTY ASSOCIATES SONITROL (AKA SOUND SECURITY)
15350 SW SEQUOIA PKWY #300 -WMI 8220 N. INTERSTATE AVE.
PORTLAND, OR 97224 PORTLAND, OR 97217
Phone: 503- 624 -6300 Phone: 503- 223 -5822
Reg #: LIC 53535
ELE 26- 370CLE
SUP 1812LEA
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 11/22/2004 $75.00 Elect'I Final
[TAX] 8% State Surcharl 11/22/2004 $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 _._,11..g.17±&± Permittee Signature S2 p 1
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 AppliFI E I V E D. • FOR OFFICE USE ONLY
City of Tigard NOV 2 2 1004 !
1 PermitN „110.10ts, 5 Z.- 131SW Hall Blvd, Tigard, OR 97223 w
Phone: 503.639.4171 Fax: 503.598.1960 ° % �' i Date/By: Other Permit:
Inspection Line: 503.639.4175 T' ' , 1L a'.j it Date Ready/By: Juris: f0 See Page 2 for
Internet: www.ci.tigard.or.us 11_ ! Notified/Method: f I es.
Supplemental Information
_ t
' • TYPE' OF WORK 'PLAN .REVIEW_
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
['Service over 225 amps, comm'I EHazardous location
❑ Demolition ❑Other:
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY :OE'CONSTRUCTION ;�� of 1- and 2- family dwellings 4 or more new residential
12 1- and 2- familyrdwelling N 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 DManufactured structures or
., : ..JOB "SITE :• INFORMATION AND LOCATIOi , :,:,; • - ❑Egress/lighting plan RV park
❑Health -care facility ['Other:
Job no.: Ag6 Job site address: 0 CO3% O.-\ `^' t1 a �
Submit 2 sets of plans with any of the above.
City / State/ZIP: 1 ` 9 - 1 D a `A The above are not applicable to temporary construction service. • ; FEE* : SCHEDULE : •: Suite/bldg. /apt. no.: ti Project namey �� , ' \Ai,N Description I Qty. I Fee. I f g 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
. D ESCRIPTIOhI OF. WORK •= ,
s -; Each manufactured or modular
• Q p dwelling, service and /or feeder 90.90 2
4 �
O Q 0. k-k l C ,Q Vk ` ( \ Services or feeders installation, alteration, and/or relocation
{--„ • V 200 amps or less 80.30 2
` t Y 1 201 amps to 400 amps 106.85 2 • ROPERTY` "OWNER ❑ TENANT - - 401 amps to 600 amps 160.60 2
Name: 3( u S -l r (� r v e c � 601 amps to 1,000 amps 240.60 2 •
Address: \ ? (`\ �W . ) G� t (\'iG . , Q"p t � � Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2
City/State /ZIP: pC\ �('L r 1 I 1 1 ci a `1 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (56 ) (0D lC, a — ti 9 m j I 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 - ❑ 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)
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: I Page 2 15 1 2
Business name: Sea - Ytk CISLA.° - -k,
G .p Each additional inspection over allowable in any of the above
Address:
O �C\ (J . ` i/\ LJt &_:,__e Per inspection 62.50
City /State /ZIP: \7(--), & c v , ` Cv.. - 1 D__.( -7 Investigation per hour (1 hr min) 62.50
Phone: (�, `3) "� Cj vra j-
Fax: ( 39" ) � 1 3 Industrial plant per hour 73.75
✓V ot� - .. :ELECTRICAL PERMIT FEES*
CCB Lic.: 5 3 5 3 5 Electrical Lic.: /4._ 31 6 Suprv. Lic.:g0(SL£4 Subtotal I-1S , i
Suprv. Electrician signature, required: '1U'p Plan review (25% of permit fee) 0 `� A " I State surcharge (8% of permit fee) 6,c6
Print name: ( Date: '
��tn t � 1�t � TOTAL PERMIT FEE N
t
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. ��
i:\ Buiidiag \Petrits \ELC- PcrmitApp.doc 12/03 440.46 15T(l0 /02/COM/"EB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
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*
• 111 Other:
atil ERCIAI; Mk.ONa -` w ` 7 7 - .. 7 37 - 7.
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
i:\ Building \Permits\ELC- PemutApp.doc 04/03
CITY OF TIGARD 24 -Hour ;
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Butiness Lire: (503) 639 -4171 MST
BUP
Received Date Requested U AM PM BUP
Location / 6 Suite D d MEC
Contact Person ' - Ph ( ) � - 2 3 - S 8 Z PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR =a069
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof C
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 7 g,
Service
Rough -In P °� -D ' - °
UG/Slab
Low Voltage �� ) - �' `� .� 3?
Fire Alarm
-y
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
4 PART FAIL
SITE Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA 9
Approach/Sidewalk Date \ u Inspector u..-. Ext
Other:
Final DO NOT REMOVE this Inspection recor from the ob site.
PASS PART FAIL