Permit -
4 IA CITY O F TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
. DEVELOPMENT SERVICES PERMIT #: ELR2002 -00181
. 411 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/5/02
SITE ADDRESS: 13995 SW 102ND AVE PARCEL: 2S102CC -03600
SUBDIVISION: FRELEON HEIGHTS ZONING: R -3.5
BLOCK: LOT: 004 JURISDICTION: TIG
Project Description: Low voltage for Burglar Alarm.
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: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: :
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PECK, ALAN W DYNASTY SECURITY
RATHBUN, ELIZABETH A 8301 SW 135
10255 SW MCDONALD ST BEAVERTON, OR 97008
TIGARD, OR 97224
Phone: Phone: 503 - 647 -6179
Reg #: ELE 34- 501CLE
LIC 135086
SUP 2227JLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
5PCT CTR 9/5/02 $6.00 2720020000 Elect'I Final
PRMT CTR 9/5/02 $75.00 2720020000
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 set forth in OA'
952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or di 'At- i . .. e ICi t - 13)
246 -1987. 2
Issued by (/ ,�( " "�( Permittee Signature n
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:
0 NTRA TOR I . LA • N O ■
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO: oZ 7 T1_j -'
Call 639 -4 5 by 7:00 P.M. for an inspection needed the next business day
Electrical Permit Application
Date received: ( ?/0"")/0 a- Permit no.;(2, 0 _00 g/
: t t �; l t
�,L 1, .. � City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: b1:) Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
X U 1 & 2 family dwelling or accessory ❑ Commercial/industrial
New Cl Tenant improvement
New construction Addition/alteration/replacement ❑Other: ❑Partial
JOB SITE INFORMATION
Job address: . /� S 2, L 'Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name: I Description and location of work on premises:
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: p�'c Fee Max
Business name: ,4Sr�.EC Description Qty. (ea.) Total no. insp
y New residential - single or multi - family per
Address: 6 -... 3 0 /3 _ dwelling unit. Includes attached garage.
City: 0G/• I St. A. ZIP: 5'7670E' • Service included:
Phone: c f — ( I Fax: I E -mail: 1000 sq. ft. or less 4
g6 I .3 S0/ 6 C Each additional e 500 sq. ft. or portion thereof
/3 , O
CCB no.: E l e c. bus. lic. no: Limited energy, residential 2
City /me lic. no.: z.i- —03 /0- i- 0 Limited energy, non- residential 2
y� j1 2 — c" Z Each manufactured home or modular dwelling
Sign. re of supervising electtjn (required) Date gyp— , — ._ Service and/or feeder 2
S i. elect. name (print): ,30 In/ /C F L License no: 7027‘.744- Services or feeders— installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): 201 amps to 400 amps 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,orrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701.
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
of service or feeder fee, first branch circuit: 2
Phone: Fax: E-mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps- commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps - rating of 1&2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lighting plan ❑ Other: Per inspection 1
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ 7
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
`
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ &
Expires accepted as complete. TOTA $ 1 X I
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6/00 /COM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee $75.00
Number of Inspections per permit allowed
l `I (FOR ALL SYSTEMS)
Service included: Items Cost Total ' Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ❑ 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 Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders ❑ 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 Vacuum Systems
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 n Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918 - 260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see "b" above. n Audio and Stereo Systems
Branch Circuits n Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or 0 Clock Systems
feeder fee.
Each branch circuit $6.65 2 LI Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 n HVAC
Miscellaneous El Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 n Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 n Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over IT Medical
the allowable in any of the above
Per inspection $62.50 n Nurse Calls
Per hour $62.50
In Plant $73.75 D Outdoor Landscape Lighting
Fees: 0 Protective Signaling
Enter total of above fees $ n Other
8% State Surcharge $ Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
All New Commercial Buildings require 2 sets of plans.
i:\dsts \forms \elc- fees.doc 08/30/01
CITY OF TIGARD - 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 ,;,
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested 740 AM v PM BUP
• Location S // :� ' uite MEC
Contact Contact Person ..& /L_/ Ph ( ) 7(r / 0 ‘ ,z 1 — PLM
Contracto Ph ( ) SWR
DIN Tenant/Owner ELC
Foundation ELC
Ftg Drain Access: C,O 6 C.J - bU / (% ) Crawl Drain 0
Slab Inspection Notes: . ( j"= � '7 C a SIT
Post & Beam
She- - o
. -i
`i1ll1 •
Drywall Nailing 7 y� t /
Firewall L1 X / � - L//ti {� cCIKL C9-(
Fire Sprinkler
Fire Alarm O - ; e /,-/ k✓Liz/ c+-7 W
Susp'd Ceiling
Roof /IA
Other: MIL.
I V PART FAIL
• - ING
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
P T FAIL
CTRICAL'
S e •
• g -n
N as
ow Voltage
�Flrs
E Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
C� PART FAIL
Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date / (V - 1-- Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL