Permit CITY OF TiGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
�e DEVELOPMENT SERVICES PERMIT #: ELR2004 -00323
'�-I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/19/2004
SITE ADDRESS: 13482 SW 122ND AVE PARCEL: 2S103CB 11400
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5
BLOCK: LOT: 072 JURISDICTION: TIG
Proiect Description: Limited energy for burglar alarm.
Job No. 4792 -244
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:
Owner: Contractor:
JEFF MALDONADO SONITROL PACIFIC
13482 SW 122ND AVE 8220 N. INTERSTATE AVE.
TIGARD, OR 97223 PORTLAND, OR 97217
Phone: 212- 227 -1371 Phone: 223 -5822
Reg #: LIC 53535
ELE 26- 370CLE
SUP 4045LEA
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 10/19/2004 $75.00 Elect'I Final
[TAX] 8% State Surcharl 10/19/2004 $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
throug • . • ' • 101 - 0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699. •
Issue. by - �, 4 ' Permittee Signatur
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
I
Electrical Permit Application , FOR OFFICE USE ONLY
City of Tigard -611 Received �,/
Date/By: hp / ' p c/ i ( /k/ Permit No.:gG2 p ' - e 3,`'3
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review a �j
Phone: 503.639.4171 Fax: 503.598.1960 / :A I iA Date/By: �"J Other Permit:
_d Inspection Line: 503.639.4175 . ty J . Date ReadyBy: Ju /1 _ , ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: I i Supplemental Information
, k -i "TYPE OF C ORK "PLAN "REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑Service over 225 amps, comm'l ❑Hazardous location
❑ Demolition 0 Other:
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION ° ..- : of 1- and 2- family dwellings 4 or more new residential
1 - and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi family ❑ Master builder ❑ Other: ❑Building over three stories ['Feeders, 400 amps or more
DOccupant load over 99 persons ❑Manufactured structures or
JOB SI.T.E INFORMATIOS A'ND>`LOCATION ❑Egress/lighting plan RV park
Q Job site address: �j y�� ❑Health -care facility ❑Ocher:
Job no.:
1�' D4& D� a �' -" Submit 2 sets of plans with any of the above.
City /State /ZIP: — /q - The above are not applicable to temporary construction service.
( v � ^ if l (� FEE* SCHEDULE "
Suite/bldg. /apt. no.: Project name: maid �d I ,.
Qty. Fee. Total
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
- 1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: _ Limited energy, non - residential 75.00 2
DE SCRIPT I ON CM F WO o ' , ,"," Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
,, 200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
PROPERTY WN
OER L TENANT
� , . 401 amps to 600 amps 160.60 2
Name: _e_c,c 5 IY\ ( �--- Cy^y o 44 601 amps to 1,000 amps 240.60 2
Address: c -, Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: (a1)) as r 1 - 1 I Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
. ❑ : APPLICANT , O. CONTACT PER A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address: -
Each add'l branch circuit 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) I Fax:: ( )
Sign or outline lighting 53.40 2
E -mail Signal circuit(s) or limited-
'CONTRACTOR ; energy panel, alteration, or 6 6
'' " � l'-',.,''
exfit nsion. Describe: 1 Page 2 (5 — 2
C �
Business name: Y ^ `' r \" S j 2/j ‘ /etii_6• AL4 9 •
Address: AD , �� - y "t(._ ( (.1_51... Each additional inspection over allowable in any of the above
/� n `�-( Per inspection 62.50
City /State /ZIP: PQY A ,(1,_� l
Phone: C 2/11 _ , �\ l Investigation per hour (1 hr min) 62.50
+�
() 'aa� 5 a� Fax: (~,63) 13- 1 1 13 Industrial plant per hour 73.75
," "ELECTRICAL PERMIT +FEES*
CCB Lic.: 5- 3 5 Electrical Lic.:a(, -316 Suprv. Lic.: Y Q J Subtotal 1 5 , (so
Suprv. Electrician signature, requir - I t Plan review (25% of permit fee) / cb
Print name: ^" \ s Cull Date: % // State surcharge (8% of permit fee) � t
�`��\ \, / TOTAL PERMIT FEE ‘ , L)C1,
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: ' Fee methodology set by Tri- County Building Industry Service Board
.. Number of inspections per permit allowed. ^ ^
is\Building'.Pernits ELC- PermitApp.doc 12/03 440- 4615T(I0 /OJCOM/WEB '�J„pf /`,.
Electrical Permit Application - City of Tigard
r
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
T RESIDE�ITIAT, tiV.ORKONLY:... _ �x_.. .
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
5 0 Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
E Vacuum Systems*
❑ Other:
film IRCLOR(ONLY -: `'
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Pem PermitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 63 • 1 75
INSPECTION DIVISION t - Business Line: (503) 6 - -4171 MST
BUP
Received Date Requested • — I BUP
Location • of - Al! Suite / MEC
Contact Person �ti Ph ( ) 1- 2-3 SR'Z 2 - PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation • 5 r ELC , �=
UAcc. `T 3
Ftg Drain ELR l�U� �
Crawl Drain — -
Slab Inspection Not - • - SIT
Post & Beam
Shear Anchors ' wl
Ext Sheath/Shear - - — - - --
Int Sheath/Shear V
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
Rain Drains
Catch Basin / Manhole
Storm Drain �� r
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/Slab
Low Voltage
Fire AI • rm
PAS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
E 0 Please call for reinspection RE: ' M - • - .le to inspect - no access
per
Fire Supply Line
ADA
Approach/Sidewalk Date /o ~ Inspector Ext
Other: •
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL