Permit CITY OF T I GA R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
s� DEVELOPMENT SERVICES PERMIT #: ELR2003 -00085
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 3/18/03
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 T- stats.
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: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC REALTY ASSOCIATES PROTEMP ASSOCIATES INC
15350 SW SEQUOIA PKWY #300 -WMI 807 NE COUCH
PORTLAND, OR 97224 PORTLAND, OR 97232
Phone: Phone: 233 - 6911
Reg #: ELE 26- 1063CRE
LIC 38868
MET 00004556
FEES SUP gehilikiil Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 3/18/03 $75.00 Elea! Final
[TAX] 8% State Tax 3/18/03 $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 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699. ge-z7Y- Issued by 1,1�I -4 Permittee Signaturfi
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:
CaII 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Permit Application FOR OFFICE USE ONLY
Received Electrical
Date/By: '5—/W-03 - 13R Permit No lVD3 ,e2OO 85
Planning Approval Sign
City of Tigard
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503 -639 -4171 Fax: 503 -598 -1960 GMvA + Post - Review Land Use
�
Internet: www.ci.tigard.or.us ■ L1J. t Date/By: 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) .
•
ew c onstruction ❑ Demolition ❑ Se over 225 amps ❑ Health care facility
comme ❑ Hazardous location
A dditio n/alteration /replacement ❑ Other: ❑ Servi over 320 amps - rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION I & 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 load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: /4.,,A-s- 442 g✓ 7 AO ' FEE* SCHEDULE ' • •
Suite #: T Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: / < v &iv i Description Qty Fee (ea.) Total i
New residential- single or multi- family per
Cross street/Directions to job site: 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: 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,
S ! A L alteration or relocation:
200 amps or less 80.30 2 ,
201 amps to 400 amps 106.85 2 .
401 amps to 600 amps 160.60 2 '
' 0 PROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 2 '
Over 1000 amps or volts 454.65 2
Name: ,23ed �X va Reconnect only 66.85 2
Address: /3o Sw ScVJrnx pew/ Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: f wr /7„.. 200 amps or less 66.85 1
201 amps to 400 amps 100.30 2
Phone: ���/ • 401 to 600 amps 133.75 2
❑ APPLICANT :: ❑ CONTACT PERSON 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: Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name:l pT0,.,e A s.5 � 2. Description:
Address: g76 �.. 1 ` A LIC
Each additional inspection over the allowable in any of the above:
City /State /Zip: � Gk 027e2- Per inspection per hour (min. 1 hour) 62.50
Phone: 0233 - v9i/ Fax:, 3 T q 76,1 Investigation fee:
3 Lic. Q Other:
CCB Lic. #: gg!, g G.3 ge - Electrical Permit Fees*
• Supervising electrician Subtotal $ %! /20 signature required: rvl) dz Plan Review (25% of Permit Fee) $
Print Name: An, 4 � outgo F Lic. #: 0 /e * /3 Rc State Surcharge (8% of Permit Fee) $ 4 .o U
TOTAL PERMIT FEE $ S2/ . ()
Authorized — / / - Notice: This permit application expires if a permit is not obtained within
Signature: Date: .y / �/ c j 180 days after it has been accepted as complete.
` *Fee methodology set by Trl- County Building Industry Service Board.
J eG�l�i,N
(Muse print name)
is \Dsts\Petmmit Forms\ElcPermitApp.doc 01/03
CITY OF TIGA.RD 24 -Hour _ ;,
BUILDING ' Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested L I ( - 7 AM PM BUP
Location l eo ssZ) 7 oZ Suite MEC
Contact Person Ph ( ) ✓7 g f PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation ,/
Ftg Drain Access:
ELR 3 — DO?) gJ
Crawl Drain
Slab Inspection Notes: , /,� SIT
Post & Beam v 1 - 1
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing �)
Firewall �
Fire Sprinkler (V! 1
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/1 •
ow '• =ge
- . m
1 � PART FAIL Ej Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
Please call for reinspec on RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA Approach/Sidewalk Date 7/(7 d_ Inspe ' ��" `� i Ext
Other:
Final DO NOT REMOVE this inspection record f ' m the job /site.
PASS PART FAIL