Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
,'t DEVELOPMENT H PMENa Tigard. (503) 639 -4171 DATE ISSUED: 12/2/2004
SITE ADDRESS: 10775 SW CASCADE AVE PARCEL: 1S135BC-00600
SUBDIVISION: ZONING: I -
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of limited .energy for HVAC.
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:
AMB PROPERTY L P AMERICAN HEATING
BY TRAMELL CROW SERVICES INC 1339 SW GIDEON ST
4949 SW MEADOWS RD #150 PORTLAND, OR 97202
LAKE OSWEGO, OR 97035
Phone: 503- 644 -9400 Phone: 239 -4600
Reg #: LIC 33135
ELE 26- 993CRE
SUP 2640LEP
FEES Required Inspections
Description Date Amount Elect'l Final
[ELPRMT] ELR Permit 12/2/2004 $75.00
[TAX] 8% State Surchaq 12/2/2004 $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 OAR 952 - 001 -0010
through ' 95 -a 11 -0100. You may obtain copies of these rules or direct questions to at (503) 246 -6699.
Issue • by #4' Permittee Signature / r . `// `Dal
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, I ? • e, 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
`Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received t xs37o
Date/By: / , Q A Permit No.: Ea
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 4i: : r dl'' i� Date/B : Other Permit:
Inspection Line: 503.639.4175 2 rll Date Ready/By: El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method:
K.
M Supplemental Information
u '�'c P,3;'�'2'�`�`. ". ,aka � � � re.; ,t ":s 7 . �.:, . .v:.. �,., � °`? . '� .;y s ra
asp �....., w. `�'� �... =.. ��m:�- .:�s.+� - ,� -�;�. �,�x.��r -'3 �- t+'...,,.�_.��.� .
El New construction n Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other ❑Service over 225 amps, comm'l ❑ Hazardous location
❑ Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft,
d 1M1 'tea, .'" . i
;:kl wf9,9RY�,OE . CONS T R f twi „ -. , .. . of 1- and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling (I Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
Building over three stories ❑ Feeders, 400 amps or more
❑ Multi - family ❑Master builder ❑ Other:
❑Occupant load over 99 persons ❑ Manufactured structures or
; , ` y O B I lV
Sq FO Ii A IO E AiTION t= b rirA -' ❑E plan RV park
Job no.: Job site address: /N 77 -- 5-LJ /� ❑Health -care facility ❑Other:
! a- �"x tie- Submit 2 sets of plans with any of the above.
City /State /ZIP: t ' t: 4. G '. The above are not applicable to temporary construction service.
Suite /bldg. /apt. no.: ( Project name: w `' lA 4 FEE* SCHED LE � ry ` °i " ,.
S' J'mile' C\ 1::::: O .4...0„..) -Ds�_ . ,�.. �,. .: -"T'-o-;.1 ,° .. *
Descri ption I Qty. l Fee. I 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: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map/parcel no Limited energy, residential 75.00 2
Limited' energy, non residential 75.00 2
y - ij'AatI , STOR!'y0 i .
a` 1. , ._. .. ,._ .. Each manufactured or modular
�; dwelling, service and /or feeder 90.90 2
"---.....> S-1 � N e- tLi / r.' �'..V LT.9y� Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
` ` r° ROP)6RT®IERv a 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160:60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: 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: ( ) 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
s a 4 ati. I ", t � '' ' CO, A isr t Ra A. Fee for branch circuits with
service or feeder fee, each
Business name: A �.eulC /,L , ,. branch circuit 6.65 2
B. Fee for branch circuits
Contact name: k/In J /4� /� L/ il,( without service or feeder fee, 46.85 2
Address: �J G l each branch circuit
/3/ l SC Gt o. C 1.- Each add'l branch circuit 6.65 2
City /State /ZIP: / - 6 ✓aL . • 02 T72-‘1z- Miscellaneous (service or feeder not included)
Phone: (f J )Z) f . 4 o� Fax: : ( - 7) Z Scl _70 1 Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
A4. -£rtsc ` . tag CQ i A PTOR Er;,.r s ef', Axe
;. ;7 ` ..- energy panel, alteration, or
extension. Describe: Page 2 2
Business name: a KA t L � t l -ri c
Address: 3 , � f SC: t O �"i sr: Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: ( OA_ i72.0 Z Investigation per hour (1 hr min) I 62.50
Phone: (3) 23?= 121400 Fax: ( 'Sc13) Z3 r -7e,7S-- Industrial plant per hour 73.75
CCB Lie.: 3 .71 3T Electrical Lie.:Z, 0Jf13 Suprv. Lie. a5'
Subtotal 7 5 .
Suprv. Electrician signature, required: j Plan review (25% of permit fee)
Print name: S 4-P I!-e GU y Q��� Date. I 'Z /� / ( / State surcharge (8% of permit fee)
/ 6 •.'
TOTAL PERMIT FEED
Authorized signat t , , 4 4, 4 This permit application expires if a permit is not obtained within 1.80
days after it has been accepted as complete
Print name: L � .4.4 / 4 6444/14# Date: rt to /2„1 / * Fee methodology set by Tri- County Building Industry Service Board
( / ** Number of inspections per permit allowed.
i:\ Building \Pernits\ELC- PermitApp.doc 12/03 440 -461 ST(10 /07JCOM/WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection.Line:, ,(503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
Received / , / , : - ) - - c ) Date Re• ested /tea / AM PM BUP
Location / 5 c) Imo. ' - _ a.e,/ Suite _ �� I
Contact Person Ph (_525 ) e9 PLM
Contractor Ph ( ) -
�� DUI , Tenant/Owner _.ad Q,, G 21� — ( �� g
o ng 6/
Aim.. ELC.
Fou , dation ACC : s: _
Ftg Drain Irlir ' ELR ,
Cra I Drain
Slat Inspection Notes: � � SIT .L:�
Pos & Bea _ 'IOW
She.; r Anc • rs V � � u -
Ext ' heat Shear l "J
Int S' Shear 51j�,
Fram " w '� � / / ' • . AI fL ' r
g
Insula io
Drywa ailing
f I
Irew_ `
F ire • kllr
Fire ' ar R iM CDtA) you i-F; 6/
Sus C ing s F/A/79—
at
PASS PART FAIL
PLUMBING : ',
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
'nal
'ASS 'ART FAIL
Pos ' eam
Rout t n
Gas , e
S�.
i•e I - mpers
Ot PART FAIL
ECTA
ice
Rough -In" A
.loi-1laltage
,, Firearm
,,
PART FAIL 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
0 Please call for reinspection RE: 0 Unable to inspect– no access
c el‘.......,
Fire Supply Line /� 4 ADA !/J l� j� I.�j J�' Approach/Sidewalk Date l Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
•