Permit CITY O TIGARD
ELECTRICAL PERMIT -
RESTRICTED ENERGY
I A DEVELOPMENT SERVICES PERMIT #: ELR2002 -00275
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/2/02
SITE ADDRESS: 16640 SW 72ND AVE B -10 PARCEL: 2S113AD -01900
SUBDIVISION: OREGON BUSINESS PARK 1 ZONING: I -L
BLOCK: LOT: 009 JURISDICTION: TIG
Project Description: Low voltage for voice and 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 CAPITOL DATA & COMMUNICATIONS
15350 SW SEQUOIA PKWY #300 -WMI 11401 NE MARX ST.
PORTLAND, OR 97224 PORTLAND, OR 97220
Phone: Phone: 503 255 - 9488
Reg #: LIC 142457
ELE 26- 1054CLE
SUP 3132S
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 12/2/02 $75.00 Elect'I Final
[TAX] 8% State Tax 12/2/02 $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 e /',t,�ti �! �!� Permittee Signature , Y L
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 Gf l � DATE:
LICENSE NO: fig(:,
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
;lectrical Permit Apr/item' o USE ONLY
E D Da te received: etmit no. Da f.0; <j
Pro'ect/a • •1. no.: Ex • ire date:
Aii. City of Tigard Date issued: B i Recei rt no.:
CITY OF TIGARD Address: 13125 SW HALL BLVD, TIGARD, 0J�'I97? f2 200 Case file no.: Pa ent tAte:
Phone: (503) 639 -4171 Fax (503) 598 -1960 UCI. L
Land use approval: CITY OF TIGARD
BU_!►__B 1
TYPE OF PERMIT
❑ 1 & 2 family dewlling or accessory p Commercial /industrial ❑ Multi- family ❑ Tenant improvement
0 New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
Job address: 16640 SW 72ND City: TIGARD Bld•. No.: Suite no.: Tax map /tax lot/account no.:
Lot: (Block: N/A (Subdivision:
Project name: VERIS IND. _ (Description and location of work on premises: VOICE AND_DATA NETWORK_
Estimated date of com r letion/ins . ection: 2 - Feb
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: C22 -250 Fee Max.
Business Name: CAPITOL DATA /COMMUNICATIONS Description Qty. (ea.) Total no. insp
Address: 11401 NE MARX ST. New residential - single or multi - family per
City: Portland State: OR ZIP: 97220 -1041 dwelling unit. Includes attached garage.
Phone: 503 - 255 - 9488 (Fax: 257 -7121 IE -mail: rayt7a,cepdx.com Service included:
CCB no.: 142457 . bus. lic.no: 26- 1054CLE 1000 sq, ft, or less $ 145.15 4
City /metro lic.no.: Each additional 500 sq. ft. or portion thereof $ 33.40
— 11/26/02 Limited energy residential $ 75.00 2
Signature of supervising electrician (required) Date Limited energy, non - residential $ 45.00 2
Sup. elect. name (print): Richard Martin License no.: 2865 - Each manufactured home or modular dwelling
PROPERTY OWN ER Service and/or feeder $ 90.90 2
Name (print): PAC TRUST Services or feeders - installation,
Mailing address: alteration or relocation:
City: I State: (ZIP: 200 amps or less $ 80.30 2
Phone: Fax: IE - mail: 201 amps to 400 amps $ 106.85 2
Owner installation: The installation is being trade on property I own 401 amps to 6G0 amps $ 160.60 2
which is not intended for sale, lease, rent, or exchange according to 601 amps to 1000 amps $ 240.60 2
ORS 447, 455, 479, 670, 701. Over 1000 amps or volts $ 454.65 2
Owner's signature: Date: Reconnect only $ 66.85 1
Temporary services or feeders -
Name: installation, alterations, or relocation:
Address: 200 amps or Tess $ 66.85 2
City: State: ZIP: 201 amps to 400 amps $ 100.30 2
Phone: Fax: E -mail: 401 amps to 600 amps $ 133.75 2
PLAN REVIEW (Please check all that apply) Branch circuits new, alteration,
❑ Service over 225 amps - commercial ❑ Health -care facility or extension per panel:
❑ Service over 320 amps - rating of I &2 ❑ Hazardous location A. Fee for branch circuits with purchase of
family dwellings ❑ Building over 10,000 square ft. four or service or feeder fee, each branch circuit $ 6.65 2
❑ System over 600 volts nominal more residential units in one structure B. Fee for branch circuits without purchase
❑ Building over three stories ❑ Feeders, 400 amps or more of service or feeder fee, first branch circuit: $ 46.85 2
❑ Occupant Toad over 99 persons ❑ Manufactures structures or RV Park Each additional branch circuit: $ 6.65
❑ Egress/lighting plan ❑ Other: Misc. (Service or feeder not included):
Submit _ sets of plans with any of the above. Each pup or irrigation circle $ 53.40 2
The above are not applicable to temporary construction service. Each sign or outline lighting $ 53.40 2
Signal circuit(s) or a limited energy panel,
alteration, or extension* 1 $ 75.00 75.00 2
*Description:
Each additional inspectionover th allowable in any of the above:
Per inspection I I $ 62.50 I I
Investigation fee
Other
❑ Visa ❑ MasterCard Permit fee $ 75.00
Credit card number: / / Notice: this permit application Plan review ( ) $
Expires expires if a permit is not obtained State Surcharge( 8% ) $ 6.00
Name of cardholder as shown on credit card
$ willing 180 days after it has been TOTAL $ 81.00
Cardholder signature Amount accepted as complete.
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 - -
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / 7- // AM PM BUP
/
Location / K / � 7 7 - 1 A/ Suite /9/ MEC
Contact Person KA^ Ph ( _ , D ? ? ) ?V' '7f g( PLM
Contractor Q1 " »Z I Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR Da 0? 7 S
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fire wall
Fire Sprinkler Kerl
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:
Anal
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
EIC
Service
Rough -In
UG/Slab
Yew o a • L,
Fire A arm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
``. • PART FAIL
Cy El Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date IFc. l V �j Ext (7c Inspector
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL