Permit CITY OF T I G A R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
� Ih DEVELOPMENT SERVICES PERMIT #: ELR2003 -00113
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/15/03
SITE ADDRESS: 16550 SW 72ND AVE B -09 PARCEL: 2S113AA -01000
SUBDIVISION: OREGON BUSINESS PARK 1 ZONING: I -L
BLOCK: LOT: OOC JURISDICTION: TIG
Project Description: Low voltage for Voice & Data wire.
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 XTREME COMMUNICATIONS, INC.
15350 SW SEQUOIA PKWY #300 -WMI 901 W. COLUMBIS RIVER HWY.
PORTLAND, OR 97224 TROUTDALE, OR 97060
Phone: Phone: 503 618 - 8816
Reg #: ELE 3- 515CEP
LIC 147263
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 4/15/03 $75.00 Elect'I Final
[TAX] 8% State Tax 4/15/03 $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 throuc
Issued by
41AIAAAA— L, Permittee Signature
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 Received FOR OFFICE m USE USE
Date/By:4 "I 1- 3 -- 05 7,6 Permit No. Z/ OU 3 - C2U 1 1 3
City of Tigard Planning Approval Sign
g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.: ? u 3 -ao' J`'
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Gdn � Post - Review Land Use
Internet: www.ci.tigard.or.us ■ y , o.l � I Date/By: Case No.:
Contact Juris.: ® See Page 2 for
`^ �
24 -hour Inspection Request: 503- 639 -4175 - Name/Method: Supplemental Information.
TYPE OF WORK . • ,' PLAN REVIEW (Please check all that apply) -: 1
New co nstruction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
Addition/alteration/replacement 111 Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
• . CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building Multi - Family ❑ Occupant Toad over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCH ION , Submit _ sets of plans with any of the above.
) b 7 � The above are not applicable to temporary construction service.
Job site address: C FEE* SCHEDULE • - ' ° ' •
Suite #: 1 Bldg. /A t. #: Number of inspections per permit allowed
Project Name: Ko c)aln 1- tic. Gj 5 y51- erns Description Qty Fee (ea.) Total 1
Cross street/Directions to job site: New residential- single or multi- family per
dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: 1 Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
Services or feeders - installation,
vo ice, g W ire, alteration or relocation:
200 amps or Tess 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
• ❑ PROPERTY OWNER 1 ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: • Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or Tess 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
❑ APPLICANT I ❑ CONTACT PERSON Branch n h circuits amps 133.75 2
Branch circuits -new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: 1 Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
• CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: 5218 Signal circuit(s) or a limited energy panel,
yy M' alteration, or extension Pape 2 1 2
Business Name:
/(f rely <. Cnm rm i n i C4(I tm5 Description:
Address: P, D fx z_ 2
/State /Zi �t /� / Each additional inspection over the allowable in an of the above:
C1
ty p: Trovi-c k of q 1 11(8 Per inspection per hour (min. I hour) 62.50
Phone: 5O3••4l$ -R8ti I Fax:50? p, - qq 55 Investigation fee:
CCB Lic. #: I y7.3 Lic. #: 3 - 515 CE p Other:
Electrical Permit Fees*
Supervising electrician Subtotal $ 7 S.
signature required: Plan Review (25% of Permit Fee) $
Print Name: • ' i idfe I T 1 . - . #: 33 g 337-LEA State Surcharge (8% of Permit Fee) $ '
``' t TOTAL PERMIT FEE $ 'RI
Authorized •4 1 v 0 3 Notice: This permit application expires if a permit is not obtained within
Signature: / / j i ' II ate: ` 180 days after it has been accepted as complete.
*Fee methodology set.by Tri -County Building Industry Service Board.
Al 1 i / /• el �
(Please print name)
i:\Dsts\Petmit Forms\ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
Audio and Stereo Systems
Burglar Alarm
❑ Garage Door Opener
0 Heating, Ventilation and Air Conditioning System
L Vacuum Systems
El Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
0 Audio and Stereo Systems
Boiler Controls
El Clock Systems
® Data Telecommunication Installation
Fire Alarm Installation
HVAC
❑ Instrumentation
El Intercom and Paging Systems 1 '
0 Landscape Irrigation Control
El Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting
0 Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations -
•
i:\Dsts\Permit Forms\E1cPermitAppPg2.doc 01/03
CITY OF TIIGARD 24 -Hour
BDILDIWG • Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
�,/ BUP
Received Date Requested `/ 11 AM PM BUP
Location I ( 5 () 7 a.4'1d A-I�-- Suite 6— -` MEC
Contact Person Ph ( 7 /) - 0 4. 9g PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Ftg Drain Access: ELR ' DO 1/
Crawl Drain
Slab Inspection Notes: afv 1 SIT
Post &Beam
Shear Anchors i
Ext Sheath/Shear
Int Sheath/Shear
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 1
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PAS PST FAIL
e ce
Rough -In
UG/SI
r olt
Fire arm
■ Final E Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS FAIL
$rrE 0 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line ,� �
AppP roach/Sidewalk Date d i Inspector Ext
P
Other:
Final DO NOT REMOVE this Inspection record f om the j site.
PASS PART FAIL