Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
Aisr, - 13125 Pk DEVELOPMENT H PMENT r SERVICES ) 639 -4171 DATE SSU 9/20/2004 00299
SITE ADDRESS: 09430 SW CORAL ST 230 PARCEL: 1S126DC -04400
SUBDIVISION: LEHMANN ACRE TRACT ZONING: C -P
BLOCK: LOT: 007 JURISDICTION: TIG
Project Description: Low voltage permit.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: X 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: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 3
Owner: Contractor:
MARTIN OFFICE BUILDING ERIC MOREHOUSE
1672 SW WILLAMETTE FALLS DR 3580 SW 104TH #3
WEST LINN, OR 97028 BEAVERTON, OR 97005
Phone: 503 -557 -8000 Phone: 503- 643 -0888
Reg. #: ELE 2695LSA
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 9/20/2004 $75.00 Elect'I Final
[TAX] 8% State Surchart 9/20/2004 $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
through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
Issued by 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 lL(L � DATE: �� —6 y
LICENSE NO: , a r, 5 L Lig
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
. ,
E lectrical Permit Application .----- - ------ . ---- FOWOFFICE - USE - ONLY -7---- " - ---- -- - -
dity of Tigard EIVED Ai Received ,...--) , __, 7 z i9,67 y /4
Date/By: 7
Plan Review L, _ "0 --.0 , r
13125 SW Hall Blvd., Tigard, (0, . , Q
Permit No.:
Phone: 503.639.4171 Fax: 513. 4 %. - * /11 §4ilitivA Date/B : Other Permit:
Inspection Line: 503.639.4175 -41. 0 i 1‘
1 .,,,_,, ., Date Ready/By: IIME Ii3 See Page 2 for
Internet: www.ci.tigard.or.us SEP 2 0 NilIt Notified/Method: Supplemental Information
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121 New construction ittiaiiiGaDiMil ''' :' acement Please check all that apply:
['Service over 225 amps, comrn'l ['Hazardous location
01 Demolition Other:
S,, 1=1 enrice over 320 amps - rating EBuildng over 10,000 sq. ft.,
OS' of 1- and 2-family dwellings 4 or more new residential
a',4
fl 1- 1- and 2-family dwelling II-Commercial/industrial El Accessory building 0System over 600 volts nominal units in one structure
LiBuildin over three stories CjFeeders, 400 amps or more
El Multi - 0 Master builder 0 Other:
POccupant load over 99 persons DManufactured structures or
kt fi-4. i4 , ' . ':'•.:rciAr• ii- -.•:-:11:•;-- qi, , .: , ,i'iri DP /1 i h tin 1 RV park
k4a:ge 44:: , ,..'..., -,::,. ,,, .1:" , • ::,::40,..,,, ,. .4,. -gess--g----g Ilan
Job no.: O 3 4, Job site address: c7v -5-"6,„, ri;"1- 3 6 ['Health-care facility DOther:
Submit 2 sets of plans with any of the above.
City/State/ZIP: The above are not applicable to temporary construction service.
Suite/bldg./apt. no.: ),.. 3 0 Project name:i0fik 1 thO474n•Z Description Qty. 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'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
Mr' agANEIOtg,,Pftg'W:*kqa;' 41. a5-1 Each manufactured or modular
- dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, ancUor relocation
200 amps or less . 80.30 2
klitMgraajiti.V 74,-; jt,N Mit,V*Maftititig-0 201 amps to 400 amps . 106.85 2
,.=.,,,#4,,,,,,at,....,,,,,A1-4e...d.,;4:1= - ''''', 4 0010&..,'0.-aWk.*Aaa' 4 :21,44M 401 amps to 600 amps 160.60 ,.. 2
Name: ' 157' - /711_7 /1,1,44.A,- t 601 amps to 1,000 amps 240.60 2
• Address: 551 5 ''''' 6 4 0 2.3 0 Over 1,000 amps or volts 454.65 2
Reconnect only - 66.85 2'
City/State/ZIP: 7 74/ k 2 l . Temporary services or feeders installation, alteration, and/or
Phone: ( )6n7/ 4 4 Fax: ( ) 41Y-S 6. relocation
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
41111y .'!;,- 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,
46.85 2
each branch circuit
Address:
Each addl branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) FaX: : ( ) Sign or outline lighting 53.40 2
E . Signal circuit(s) or limited-
Mil energy panel, alteration, or
extension. Describe: . Page 2 2
Business name: ie/ / 0 0 -4-4 1)(4
Address: 51 5 bs / 4 L # 3 Each additional inspection over allowable in any of the above
Per inspection 62.50
‘1 .. :
City/State/ZIP: Z, 14 Al 0 / 76 03 Investigation per hour (1 hr min) 62.50
1 .
/ Phone: ( 9)) 6 1 /3- 0, ffy Fax: ( ) - Industrial plant per hour 73.75
2 . - S.:'.• ;: r
CCB Lic.: Electrical Lic.: ):4 9515,,V, "Suprv. Lic.:
0 - Subtotal
-
Suprv. Electrician signature, required: Plan review (25% of permit fee)
SI-
)! Print name: ,:gle..- hoki-40vii_ Date: , - )_ 0 1.. - 0 y State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: c 4 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: 141, / vf C Date: * Fee methodology set by Tri-County Building Industry Service Board
** Number of inspections per permit allowed.
iABuildingTermits \ELC-PerrnitApp.doc 12/03 440-4615T(10/02/COM/WEB
' _,
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information t
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined ... $75.00 .
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
El Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
El Instrumentation
n Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
El 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.\ Bui lding\Permits\ELC- PemutApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection (563) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received q Date Requested /b — 2 AM PM BUP
Location / qav &2 4 Suite MEC
Contact Person o Ph ( ) 5 7 3 PLM
Contractor Ph ( ) SWR
BUILDING . Tenant/Owner ELC
Footing
ELC
Foundation Access: e �D �� ,R-1e7
Ftg Drain ELR �' l
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fi rewal I
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 J/
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL :
Post& Beam r
Rough -In
Gas Line
Smoke Dampers
Final A - ,
PASS PART FAIL — -
ELECTRICAL
Service
Rough-In
UG /Slab
Low Voltage u C e -
Fire Alar
PASS PART FAIL
fl Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE - ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date • Inspector / Ext
Other:
Final DO NOT REMOVE this inspection record from the j site. .
PASS PART FAIL