Permit • �' ELECTRICAL PERMIT -
CITY TIGARD RESTRICTED ENERGY
M I , DEVELOPMENT SERVICES PERMIT #: ELR2004 -00102
-i 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/22/2004
SITE ADDRESS: 12256 SW GARDEN PL BLD.1 PARCEL: 2S101 BB -01500
SUBDIVISION: CROW PARK 217 ZONING: C -G
BLOCK: LOT: 003 JURISDICTION: TIG
Project Description: Limited energy to relocate thermostats.
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:
SPIEKER PROPERTIES LP HVAC INC
4380 SW MACADAM AVE STE 100 5188 SE INTERNATIONAL WAY
PORTLAND, OR 97201 MILWAUKIE, OR 97222
Phone: Phone: 503 462 - 4822
Reg #: LIC 50897
ELE 26- 571CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 4/14/2004 $75.00 Elect'I Final
[TAX] 8% State Surchari 4/14/2004 $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 R 4
952 -01 -0100. a[0 obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
Issue si ' ` by , A / 4 Permittee Signature �C. /�0� Lnjsk oQyL
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
�+E1eCt►a�Ca1 Permit A 1', _ Rt�. FOR OFFICE USE ONLY
Tigard Received
City f T1 Permit No Q ^� D.-
Y g ryoo Date/By
A �� W
13125 SW Hall Blvd., Tigard, OR 97223 p pR l• Plan Review
Phone: 503.639.4171 Fax 503 598 1960 N l b'� IN +° ?\ DateB Other Permit
Inspection Line: 503.639.4175 G £ r ell . Date Ready/By- Jens El See Page 2 for
Internet: www.ci.tigard.or.us ail It Notified/Method- Supplemental Information
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< °., "rc- _- ,. :,,. _
0 New construction ❑ Additto . teration/re.' acement Please check all that apply
['Service over 225 amps, comni'I ['Hazardous location
❑ Demolition ❑ Other:
*< " - Y_ ; + k; ° E- S
OTy y , yx ❑ Service over 320 amps — rating ['Bulldog over 10,000 sq. ft.,
t, ";` F' �' CATCAR OF <SCNTRIICTION ;` i,,`" - . ; '- ' - may , <,
-,:, , ,; , _ I ,,. H, - � , ,vt,.; , :.,._ -, ` . ; : t ', ;" =b of 1 -and 2-family dwellings 4 or more new residential
Y g
❑ 1 and 2 family dwelling Commercial /i ustrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Building over three stories ['Feeders, 400 amps or more
❑ Multi ❑ Master builder 0 Other: ❑Occupant load over 99 persons ❑ Manufactured structures or
J t !l Fr , F ION AND' LOCATION' : _ ° 2.' ❑E ress /h htin plan RV park
- f _ a at ❑ Health -care facility ['Other
l 2
Job no.: Job site address: 1 au, si 1 G(i(d s „,,Res Submit 2 sets of plans with any of the above
City /State /ZIP:'�C Pro
,� (ec C - c - 7 2 2-3 The above are not applicable to temporary construction service
Project ame: / `� -, r.�I�t.!r`1 ` x= :':-- 'i ° 'k: F•E * "S CIIEDUtiE' ,3 =l'; -
e/ A/ A p /��/� Q (Q Description Qty. Fee Total **
Su ite bldg. /apt. no..
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
r - _ - $ , V F , - , _ " Limited energy, non- residential 75 00 2
q ,_
r ; 'hf,: -,, DE5CRIP O ` , ar , „ z � :. ?„ fir
�;, � a - -_ _ _ .. �y, ,,��,;,, i ,, , ..„ 7 --,, * ,, � -���� Piw, Each manufactured or modular
1 dwelling, service and /or feeder 90 90 2
t Q - VhlA�� cat �Itlf�c� Services or feeders installation, alteration, and/or relocation
200 amps or less 80 30 2
„ - '«' _ . ;4 k .�_i, _ -s ; ;..<1,. !n 201 amps to 400 amps 106 85 2
=PRO . OWNER° " . % .. ,ltA �` ?: �. 1"
�' ». -..__: �.,.. -9 �;a;�. _ .° .`3a`,3 '� .-",�k> .�^=^" "iv�t �.a °.v=, .�us� -s -,� :ti'.:'.r�,`�F`'�,v�:
- 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
:';;a: ":' `' "' A Fee for branch circuits with
, : :: , u 014:60, ', < F,. -w :,, n z . : = ®!CONTAG1 PERSON ,, } „
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'I branch circuit 6 65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax: : ( ) Pump or imgation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
? -:
;, 1�t: °T = — = r ` - energy Panel
p;;; f;,_:,W -;,,:, � ;. _ - CONTRACTOR „h "viim . t'. _ , . < .
c extension De , alteration, or ril7'b. J / Pa 2 75
2
Business name: �� . � \vr„^c��7 �Y /n4f➢`
Address- 5 kn ,. f ,,,,,, � CQ t Each additional inspection over allowable in any of the above
"6' Per inspection 62.50
City /State /ZIP: {1 , i f � ,, Investigation per hour (1 hr mm) 62.50
) I ' Fax. ( ) Industrial plant per hour 73 75
Phone:
( 503 yo L4g� 603 4 (c2 - 4,scs
� ” �.° ._. �,:
�, . ; s - » >, ELE_CTR 7.4 PERkYIIT4:0 - Ali , §; ' -'4
CCB Lie.: R '7 Electrical Lica6_S71 Supry Lie.: Z.J.q (0 LE---10 Subtotal 79 ' O''
Suprv. Electrician signature, required: , Plan review (25% of permit fee)
- y .- ---........„
j State surcharge (8% of permit fee) V
Print name: �O 1 ,) ` 15 Date: L/ 0� a.O
V� (( TOTAL PERMIT FEE Q /. OD
Authorized signature:S� ('�- . O- \. d., p This permit application expires if a permit is not obtained within 180
`^ �yi / days after it has been accepted as complete
�'�
Print name: e ipX r I t `oo L ) ' Date: ( / q IO ( 4 * Fee methodology set by Tn- County Building Industry Service Board
/ i ** Number of inspections per permit allowed
i \Budding \Permits\El C- PermitApp doc 12/03 440- 4615T(10 /02 /COM/WEB
Electrical Permit Application - City of Tigard ,a
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
n Vacuum Systems*
n Other:
., COe11 VI RT ' WUR W-1 : : , : = .< i
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
‘Bu lthn Pemuts'ELC -Perm tApp doc 04/03
CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 4 /4 AM PM BUP
Location — �� � , % �., Suite MEC
Contact Person Ph ( ) z / f & PLM
Contractor / Ph ( ) SWR �
BUILDING Tenant/Owner --Ete- , '"
Footing
Foundation ELC
Ftg Drain Access:
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear - - I4
Int Sheath/Shear
Framing
Insulation T- 5Th' Gv lR- [/cIlr R ✓ F l t /1
Drywall Nailing � P It--
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
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL,
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
RICAN
rvice
Rough -In
UG /Slab
Low Voltage
Fire Alarm
`'ter Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
4442) PART FAIL
SI_ - ; Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA Approach /Sidewalk Date 1 c/ I `v y Inspector kt'rt ' J rT � � �'� � Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL