Permit a CITY OF TI GARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
,.�I DEVELOPMENT SERVICES PERMIT #: ELR2004 -00222
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/22/2004
SITE ADDRESS: 10763 SW GREENBURG RD 110 PARCEL: 1S135BC-00201
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of phone (gray) & data (blue).
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:
BUSINESS PROPERTY DEVELOPMENT A & 0 TRINITY WIRING
22020 - 17TH AVE SE SUITE 200 2900 SW CORNELIUS PASS RD
BOTHELL, WA 98021 SUITE 335
HILLSBORO, OR 97123 ,
Phone: 425 483 - 3442 Phone: 503 643 - 6723
Reg #: LIC 159676
ELE 34 597CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 7/22/2004 $75.00 Elect'I Final
[TAX] 8% State Surchar€ 7/22/2004 $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 f linty rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
thro gh OAR 9 ' 001-1100. You may obtain copies of these rules or direct questions t• • - C at (5030 1.699.
0 •
Iss ed by . � # 4 I & _ _ Permittee Signature J
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
Elec 'al Permit Application FOR OFFICE U SE O NL Y . ,
City of Tigard
A ��' I I Date /B : -- °�� 7 77.0 Permit No.: j` z , 4,0„,„,/.....,, 4,0„,„,/.....,, 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 y4 Date/I3 Other Permit:
� I
Inspection Line: 503.639.4175 0 4,1, - 11, ll., Date Ready/By: a See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: S Supplemental Information
ii". ,y w .Y. % k p,';t `k u�-. .. � R �.':`4;�.'ei °, {a ^.'. �'�F.':5 �p.�� 'u5i*"u .4.- S<' <i�4�!j.'"R.rw.:u .'.'6'.: x+.A�.��,.�aKA _
R��:. a:..�';_:_'��' -{° TYP > � +W - RK• ,.�- :��:t�� = ����;.: <;:.: s
._�_: �� :ls.: - r OF O e ��`- � °�s,..a: - a»��<y:.:a. . x . PAN�;I2L:�IEW:'-
s,.�Y.�,:z��:�€s "'� €= �:W.�.s.1�cc;...:�z5 -,- �--,:, » - . �. �.V�r.::s:?;..- ".;:.:.:._ -�+:.� � :M..-�.�3..N ..�.n ' '.��, .. �;: a�....... _. �,.._'_:. x.,:€ r:•, ,. , s � , ._� ..:..........n:.: ...
5--,. ,.»ifs"' "' ;. �ss�m,�:• a.-xr, rx " : ::�.�,: •
❑ New construction j Addition/alteration/replaccment Please check all that apply:
Service over 225 amps, comm'l ❑Hazardous location
❑ Demolition ❑ Other: Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
- '� 'R x {+�.+ -;, xa � w, �'¢ �, �. �'•mx:.+a >•,as�., °�o-t�s�•� �:,�, ': '3, �., ^ser s ° �.,s�� ^ � ^ ;'� ,. ;p a:�
;; fir.. g f', ' CATEG®R- O STR �° �IO 1 W , of I- and 2- family dwellings 4 or more new residential
El 1' and 2 family dwellin �" ommercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
Building over three stories ❑Feeders, 400 amps or more
❑ Multi - f amily ❑Master builder ❑Other:
,_. . ^s-.�a.F h ,.._, ,.,: a„,.a.rs m .�s. -�..� „ z - Y �, Occupant load over 99 persons Manufactured s tructures o
r
wz,:
SITE- IN:1P ° • - ' 9 ❑Egress /lighting plan RV park
�_ a. �. i ;a`.t'n,a.< . `IIOB B 0�. r��. 9 ,,5.ax » -..a.L CATLO : - " a ..�.:a- �e,sns.> .. sx. ,��:
Job no.: Job site address: f `03 �S /_� e � ' ❑Health -care facility ❑Other:
C' .) /� Submit 2 sets of plans with any of the above.
City/State /ZIP: 7 '� pl , f v / The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: 1// Project name: ' &/ c., r , � =? ' E °* SCHEAU E .
Description 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: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
6,N Limited energy, non-residential 75.00 2
gY,
f ; rf IIE TON .4 WO ' „ _ Wag � r, i t � � r��
�, � , .�`°� , ..__.�.�.,�. �,. .. �. ... .� � 3 ?, � � k � ���. ���. � - � � �; Each manufactured or modular
,�—fU 7 ., f ( P J pN C �� / S f , dwelling, service and /or feeder 90.90 2
L {) l �0� Services or feeders installation, alteration, and /or relocation
C G /'AV) (CQe 200 amps or less 80.30 2
4AV g a ;u - , �n 201 am s to 400 am s 106.85 2
. ,' RO Y OWNERw ,k A t " `1ET,Ma erg,f i P P
""�'� '� �. rI" �'�„ � '��F <�'..' N` "` � .���t 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'
gym' ,❑ APPIt CANT aONTA T{t R Ql, , 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
Address: each branch circuit
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: ( ) Fax: : ( )
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
�� . v .; . s, . ;:;�, . t, , - , 1 ; � aa. w " m ama .= `'; A'' s oma energy panel, alteration
�� +.���� ' ,, . � ��'��.:.i�� :��CO,�I,TR e�CTOR`€rz'�i.. � ' =s'^ys: � s �,� gY P , or
extension. Describe:
Business name: t Page 2 1 1, *-
2
/1 — 7 - 7 R i t - f / '' A) G
Address: �CtOO J W t �Od' id s' / ✓ 5 F p sf �s �. 3 3 Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: N f / f, b Ur0 f O A. ?'--I ( Z ? Investigation per hour (1 hr min) 62.50
Phone: ( 0 3) C L( 3— to "7,2,? Fax: CIO 3) G{ 3 0 - 7 (p S'y Industrial plant per hour 73.75
MM., CALI',
CCB L ic : I S-I o ''7 ( Electrical Lic.: 3 �- .5'q7 C[L - Suprv. Lic.: 35 ? [ EB f . �—
Subtotal 1
Suprv. Qctrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) w OD
Print name: r c. ti ouc Date: ota !d y
uG ( / TOTAL PERMIT FEE 9?
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: � 1 ` 1 L .5 Date: 7/) 2/ ci * Fee methodology set by Tri- County Building Industry Service Board
Iv l ** Number of inspections per pemnt allowed.
i:\ Building \Penults\ELC- PernutApp.doc 12/03 440- 4615T( I0 /02 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
, ter. A � ��F�_ ; �,.., „�; �,. .,. ,..: .
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
• ❑ 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 \Permits\ELC- PemiltApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection,_ine: * (503) 639 -4175
I ' ECTION DIVISION Business Line: (503) 639 -4171 MST
^� BUP
Received Yg 2 / Date Reque ed : 0)-6 AM PM BUP
Location / 0 3 ( .fd frA---/g Suite // 0 MEC
Contact Person / P h c ( e c t — 6 6 7CPLM
l ( )
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ( S LC
Footing ELC
Foundation Access: t`
Ftg Drain 0 0���
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall • •` �� ' t / g
Fire Sprinkler
Fire Alarm
Susp'd Ceiling t
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
CT CAL
Service
Rough -In Dttfr
UG /Slab
Vol
e larm P /11.")
• Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
Please call for reinspection RE: 0 Unable to inspect – no access
Fire Supply Line /
ADA ZO — o �' / /CI M
�-Gt3 /f
Approach /Sidewalk Date t Insp ector vyL Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL