Permit �- CITY OF TIGARD RESTRIICALP ENERGY Y
i i DEVELOPMENT SERVICES PERMIT #: ELR2004 -00105
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/21/2004
SITE ADDRESS: 11483 SW 90TH AVE PARCEL: 1S135DB -13000
SUBDIVISION: HOFFMAN PART /MLP2003 -00015 ZONING: R -4.5
BLOCK: LOT: 003 JURISDICTION: TIG
Project Description: Low voltage: All Encompassing.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: X BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: ALL ENCOMP : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: :
TOTAL # OF SYSTEMS:
Owner: Contractor:
HOFFMAN, MICHAEL PHILLIPS ELECTRONICS
1223 NW 24TH #5 (DBA FOR MASTER ALARM L.L.C.)
PORTLAND, OR 97210 1110 NW FLANDERS
PORTLAND, OR 97209
Phone: 503- 810 -3300 Phone: 503 -810 -3300
Reg #: L(ROBERITfi364 i
ELT2- 50826- 213CLE /
FEES Require 4 Inspectio s
Description Date Amount Low Voltage Inspec ion \
[ELPRMT] ELR Permit 4/21/2004 $75.00 Elect'I Final \
[TAX] 8% State Surchart 4/21/2004 $6.00 \
Total $81.00
■
i
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. 4TTENTION: 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 4t--etel'e-' 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
t° Electrical Permit Application
• tl ti a!I ±` City of Tigard RE Datereceived: a� �� Permit n o. ����— QD � O•J` _
P r oject/appl. n .: , Expire date:
City of Tigard Address: 13125 SW Hall Blvd, tg OR 97223
Phone: (503) 639 -4171 AR Date issued: Receipt no.:
9 1004
Fax: (503) 598 -1960
C UILDING uivISION Case file no.: Payment type:
Land use approval: CITY OF TIGARD
TYPE OF PERMIT
Ft 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
0 New construction , 0 Addition/alteration/replacement 0 Other: 0 Partial
• JOB SITE INFORMATION
•
Job address: 11 ` 2e3 ,z 76— Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name:.( e fty Description and location of work on premises: A' e rl e W c o4._.
Estimated date of completion/inspection:
E S.R E
Job no: Fee Max
Business name: Description
o ` cp � P Qty. (ea) Total no. imp Address: uro Kw J tic y�S New residential - single or multi - family per
dwelling milt. includes attached garage.
City: P I State) I ZIP: 7 7 Service included:
Phone:30 2zzsrDa I Fax:$o32 4gg2 I E -mail: 1000 sq. ft. or less 4
CCB no.: 0_51.10 Elec. bus. lic. no: Each additional 500 sq. ft. or portion thereof
%`6 '2 —C Limited energy, residential 2
tw
City/metro lic. no.: •j6,D3 Limited energy, non - residential 2
[./'/( / /)q Each manufactured home or modular dwelling
Sig to e of supervising.electrician (required) Date Service and/or feeder 2
t_ Sup. elect, name',(print): a .. . > " ems: "., j , .,.. -_„ 47„; :iii
w At,. - if? �, , ,.. � �, „ � - • // 22 ►` qq�� Se o f eeders — installation
a -- E - License r-i h7� .J;LEr� Ex a lt att ':r ti local tiir'" 3:31 x t � i
.. PROPERTY OWNER v nt4 o �� �,r -' , .4 ' '^ 1
A r209Amps r less .t x 3.'tt'71' �` ,3 •-' f , e , N 2
,
Name (print): •=-1---,."-:- - - _ _- � . ., - - > , 201 13 to'400'am - ' 2 • " 401 amps'to 600 amps ... _ :: _.__ 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders - • _
which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation:
ORS 447, 455, 479,,670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name. A. Fee for branch circuits with purchase of .
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E -mail:
of service or feeder fee, first branch circuit: 2
Each additional branch circuit:
P LAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
0 Service over 225 amps - commercial 0 Health -care facility Each pump or irrigation circle 2
0 Service over 320 amps- rating of 1&2 0 Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
0 System over 600 volts nominal more residential units in one structure alteration, or extension* l 7.5 TC 2
0 Building over three stories 0 Feeders, 400 amps or more *Description:
0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
0 Egress /lighting plan 0 Other: Per inspection
Submit sets of plans with any of the above. . Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $ 7--S- � -
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
0 Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $ co e
Credit card numlxnumber: State surcharge 8% I / within 180 days after it has been g ( ) $ —
Expires accepted as complete. TOTAL $ .,3!
• Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6/00 /COM)
Electrical Permit Fees: Limited Energy Fees: - ,
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Number of Inspections per permit allowed Restricted Energy Fee $75.00
(FOR ALL SYSTEMS)
Service included: Items Cost Total
Check Type of Work Involved:
Residential - per unit -
1000 sq. ft. or less $145.15 4 I I Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular
Dwelling Service or Feeder $90.90 2 I Garage Door Opener*
Services or Feeders I I Heating, Ventilation and Air Conditioning System`
Installation, alteration, or relocation
200 amps or less $80.30 2
201 amps to 400 amps $106.85 2 I I Vacuum Systems
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 I I Other ,
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders
Installation, alteration, or relocation TYPE OF WORK INVOLVED - COMMERCIAL ONLY
200 amps or less $66.85 2 Fee for each system $75.00
201 amps to 400 amps $100.30 2 (SEE OAR 918 - 260 -260)
401 amps to 600 amps $133.75 2
Over 600 amps to 1000 volts, Check Type of Work Involved:
see "b" above.
Branch Circuits I I Audio and Stereo Systems
New, alteration or extension per panel
a) The fee for branch circuits I I Boiler Controls ,
with purchase of service or
feeder fee. I I Clock Systems
Each branch circuit $6.65 2
b) The fee for branch circuits • I I Data Telecommunication Installation
without purchase of service
or feeder fee.
First branch circuit $46.85 I I Fire Alarm Installation
Each additional branch circuit - $6.65
Miscellaneous
HVAC
(Service or feeder not included)
Each pump or irrigation circle $53.40 Instrumentation
Each sign or outline lighting , $53.40
Signal circuit(s) or a limited energy I Intercom and Paging Systems
panel, alteration or extension $75.00
Minor Labels (10) $125.00 n Landscape Irrigation Control
Each additional inspection over
the allowable in any of the above 7 Medical
Per inspection • _ • $62.50
Per hour _ $62.50 _ v I I Nurse Calls
In Plant $73.75
Fees:
I I Outdoor Landscape Lighting*
I Protective Signaling
Enter total of above fees $
8% State Surcharge $ I I Other
25% Plan Review Fee Number of Systems
See "Plan Review" section on $
front of application. * No licenses are required. Licenses are required for all other installations
Total Balance Due $ • Fees:
El Trust Account # Enter total of above fees $
8% State Surcharge $
•
Total Balance Due $
•
is \fists \forms \elc- fees.doc 10 /09/00
CITY OF TIGARD 24 -Hour
BUILDING — inspection Line: (501) 639 -4175 —
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested ' AM PM BUP
Location / f C g3 Suite MEC
Contact Person -- yn,t.I..ez. • .0 Ph ( ) g/ ' — 33ca PLM
Contractor Ph ( ) SWR n c
Tenant/Owner ELC 4-0 Oi vJ
Footing
Foundation Access: � -��,, ELC
Ftg Drain - . <.,,.,�
Crawl Drain . , _ sou ;v'k . '4i :; .;a;
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear c3 . . J tv L _ l �
Framing
Insulation 7/ _1 � ' Q1 2 \ A 1 _, !`,;,�C'� ._,, 1 60 ` ,�'r
Drywall Nailing J�i� yl
Firewall � 3 1" 1®, l! v _ l
Fire Sprinkler ��Y"'
Fire Alarm
Susp'd Ceiling
Roof J___p vre?ct I k\--L 5ikc3AA a<4
Other:
Final ]" _ VLO O cz°
PASS ART FAIL
(PQMB ,. = 2: -�_
Post & Beam
Under Slab
Rough -In 1W I I I NIAN I MI
Water Service �
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
• S PART VD
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PAS RT FAIL
ECTRI
Service
Rough -In
U _ ..
ow Volt -
• Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
'A PART FAIL
SITE = =' n Please call for reinspection RE: s [] Unable to inspect — no access
Fire Supply Line �Q
ADA . 22.C�
Approach/Sidewalk Date 1111 Inspector#
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hou n- BUILDING Inspection Line: (503) 639 -4175 • � . •
INSPECTION DIVISION Business Line: (503) 639 -4171
MST o'
�� �
p BUP
Received Date Requested /o AM PM BUP
Location /J ' 3 ' 7 - Suite p MEC
Contact Person Ph ( ) / -s/0 O PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner
Footing
Foundation Access: E _ ire
Fog Drain
)
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors 7
Ext Sheath /Shear
Int Sheath/Shear O ?(Z4) J 101 120 v • O _-'� W � �. ' `
Framing 1 L N
Insulation 2 �u 6- olk 5 1 ' 6�' — � A - S N�
Drywall Nailing V� •
Firewall
Fire Sprinkler
Fire Alarm p(.0\j1 F "r` v .) C Y/ o bN Cr i /
Susp'd Ceiling
Roof N \�13 . �LL 'V� pk -a
Other:
Final O ■J1 Lia -
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer ,L,
Rain Drains �i►" `� (� V
Catch Basin / Manhole
Storm Drain
Shower Pan
Other: �\
Final <JO A /� ► �! Vim'
PASS PART FAIL •
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers _ J
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /S
m ow Volta.:
• a ll
n Reinspection fee of $ required before next ins section. Pay at City Hall, 13125 SW Hall Blvd.
ASS PART
SITE LI Please call for reinspection RE: •. Un..le to inspect - no access
Fire Supply Line
ADA /
D _ ! �✓ I`�
Approach/Sidewalk Inspector ZIr Ext
Other:
Final DO NOT REMOVE this inspection ecord from the job site.
PASS PART FAIL