Permit CITY O F T I G,A R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
AWN DEVELOPMENT SERVICES PERMIT #: ELR2004 -00125
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/13/2004
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 for voice & data.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: 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:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
SPIEKER PROPERTIES LP BACHOFNER ELECTRIC INC
4380 SW MACADAM AVE STE 100 55 SE MAIN
PORTLAND, OR 97201 PORTLAND, OR 97214
Phone: Phone: 233 - 2006
Reg #: LIC 44569
SUP 1769S
ELE 26-451C
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 5/13/2004 $75.00 Elect'I Final
[TAX] 8% State Surcharl 5/13/2004 $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 a low r. adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
thr. gh OAR 952 -061 -I 00. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
Is- ued by , � ,u _:..a� ' 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 DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
604 14:51 5032332963 --- BACHOFNER ELECTRIC PAGE 03
O �
.� F11�E�� ;
lcal Permd.tt`Applucation F;;ii'(II I 1( 1 . 1 ,tt. 0.1.N
Received
city of Tigard an ► �1f �0h Date/B 5/ D ' 7 ' . / � „pis --.air ...AP
13125 SW Hall Blvd„ Tigard, OR 97223 Plan Review
Phone; 503 639 4171 Fax: 503.598 1960 F
VISION �Gj\t D ' I I Date1B • Other Ptrmit:
Inspection Line: 503 634.4175 GI ' 0 •r '' Date Ready /By: 1� ✓ El See Page 2 for
[ttterncInternet; www.ci tigard.orus BUILDING Not / Supplemental D � n � - e - Iararmaaoa
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❑ New construction El Addition /alteration /replacement Please cheek all that apply;
0Servicc over 225 amps, comm'l ['Hazardous location
❑ Demolition ❑ Other ❑Service over 320 amps - rating ❑Buildng over 10,000 sq. ft.,
., ) . u4 1 nM1 � t c I i 111 : 4 3frr y .I' ? 17 t ur of I- and 2-family dwellings 4 or more new residential
El I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ['System over 600 volts nominal unity in one structure
OBuilding over three stories ❑Feeders, 400 amps or more
❑ Multi - family El Master builder
❑ Other ❑Occupant load over 99 persons ❑ Manufactured structures or
a } f 4rc s tr o . , r " i .wa e .e � n r i l - r
Wr ,t k t - r A ,, > A n t av l' / r 4 'A 15 i h n A 'l ak t I )4 ❑(_ RV park
^� ,, y � .rkP,AUt4 Ar( r r - t:::+S'+ , t ,., l v, �tw..., r +'�.2,,r r11"`� ° ' � ° ,'ii 1� . i)' gress/lighttng plan P
bo
Job no,: 7006 lob site address: 1 2256 SW GARDEN PLACE ❑b it care facility ❑v
,Z sets of plans with any of the above
City /State /ZIP: TIGARD OR 9 72 2 3 The above are not applicable to temporary construction service.
1r'.,!11; fd��tr ) kJ,..af:: ' .r 4 , i. '�
Suite/bldg. /apt. no Project name: — _ `' •" " n ° _ I :i . � i
r. .. betcrlptioo Qty. rice- Total
Cross streei/direetions 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', 500 sq R. ar portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: c 500 2
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�r Limited energy, non-residential 7
!+ 9 lr t 1 J :eir.:h1 ,,i...', ,i a ,: 6 S t t+ t tA- p; ,, Nat yf ta t; , i1 . ,. 1 1' �: Y t £ a t r - E anufactured or modular
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dwellln; service and/or feeder 90.90 2
INSTALL VOICE & • z Services or feeders installation, alteration, and /or relocation
200 amps or Iess 80.30 2
.... , rc::.: . . . .. . .. ... ... : : , r ,,..,,, . .,., .. ..,. - .0 -, d 1 i ,f . t 4 106 S 2
p , .r � �1. a 6 A td t �`t rAl�. ...:,, : t• r,nf'" i t r 41'd R' r srr t � kg .l.' . 1 amps t0 00 amps .8
q v • a t •: , . 1;I;,jrf., 1 1.» w,>hr9';{�ttt � }j %i I r "d. t ;}�, ,.r. •:•'. r P� r ,
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�, •,v,. .r,,, ..r...RY....�'k *. , rma , •.2•;r ,tr ,:;r, raj r r;..,x.,Y. ?�itPi.M .,o ,r�rc4�l. i ...,,off? c /.;,,,r•q,•l'�....:�,�._:• 401 amps to 600 snips 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
) ( ) Fax: ( ) 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 I
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
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'r :, t � t i � a f �iP t , �� 1 3 ��,� , i1r�, „ /� x, ,
, „ rr S t t ilk, t #7" A Fee for branch circuits with i
., ,
, ,,a r.,.,,ttr.,.l., t, ^.•, ..r..,,ib,,t t A ,, ,.,.,fir,.,.,..r.l -4, a ( ,t, ,1, service or feeder fee, each
Business name: branch circuit 6.65 2
B, Fee for branch circuits
Contact name: without service or feeder fee,
46.85 2
each branch circuit
Address: Each add') 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 -mail: Signal circuit(s) or limited -
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Business name: RACHOFNER ELECTRIC, INC. extension, Describe Page 2 2
Address: 5S SE MAIN Each additional Inspection over allowable in any of the above
-- - ---- -- Per inspection 62.50
City / State/ZIP: PORTLAND, OR 97214 Investigation per hour (I hr man) 62.50
Phone: (503) 233 -2006 Fax: (503) 233 -2963 Industrial plant per hour 73.75
Ills iiilatig(;tr'Z1 a,.1,,. . , /:.w . ,H.,. 4s„ .,r
CCB Lic.: 44569 Electrical [,1c.' 26 -451C up L1 1769S I769S Subtotal 75.00
Suprv. Electrician signature, required' 4a/ Plan review (25% of permit fee)
State surcharge (8% of permit fee) 6. 00
Print name. ROBERT H . BACHOFNER pat f 5 - 2 - 04
TOTAL PERMIT FEE 81.00
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: pate: . Fee methodology set by Tri- County Budding Industry Service Board
•• Number of inspections per pet mit allowed
r\ Building \Permits \EI.C- Perrnit App doc 12103 440464 ST(t0/02/COM/W1=a
CITY OF TIGARD 24 -Hour
BUILD INQ Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received �� Date Requested Glya AM PM BUP
Location 41IoL_ f /, _ ! uite -� I MEC
Contact Person ,�_ Ph ( ) PLM
Contractor Ph ( SWR
BUILDING Tenant/Owner CAtlAt ELC
Footing
ELC
Foundation
g AccesS•
Ft ELR r `L
Drain
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear —
Int Sheath /Shear
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
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS ART FAIL
CTR L
Service
Rough -In
Slolt
ow
ow Volta.
Fire arm
s� ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA �
Approach /Sidewalk Date L Inspector h Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL