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Permit e • I C CITY OF TIGARD ELECTRICAL PERMIT - RESTRICTED ENERGY , ��I'r DEVELOPMENT SERVICES PERMIT #: ELR2003 -00303 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/6/03 SITE ADDRESS: 10215 SW HALL BLVD PARCEL: IS135AA 01400 SUBDIVISION: METZGER ACRE TRACTS ZONING: C -N BLOCK: LOT: 037 JURISDICTION: TIG Project Description: Installation of limited energy for data telecommunications system. A. RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: DATAITELE COMM: X NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: : HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: TOTAL # OF SYSTEMS: 1 Owner: Contractor: INTEGUMEND LLC BY SCOTT COLLINS MD COCHRAN ELECTRIC & MARIA ROSS MD BROADWAY ELECTRIC 9495 SW LOCUST STREET 626 SE MAIN PORTLAND, OR 97223 PORTLAND, OR 97214 Phone: Phone: 234 - 6564 Reg #: LIC 77942 SUP 3184S ELE 37 -546C FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 10/6/03 $75.00 Elect'I Final [TAX] 8% State Tax 10/6/03 $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 follew -rule - adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throuc Is ed by j ; �' 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 t�f t � Electrical Permit Application � Datereceived: / ..Do Permitno.: / �4 - '" ° °e '� i l ` C ity of Tigard " � J PP Pro'ect/a 1. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd Tigard OR 97223 Date issued: By: Receipt no.: Phone: (503) 639 -4171 ' Fax: (503) 598 -1960 Case file no.:. Payment type: • Land use approval: -- • gig TYPE OF PERMIT ' a '= ❑ 1 & 2 family dwelling or accessory _. Commercial/industrial ❑ Multi- family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial x ' JOB SITE INFORMATION . ` 1 ' Job address: I 5 S I ci I S I 1/ AIIM Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: Block: Subdivision: Project name: fill p r , L, Description and location of work on premises: IMIFIVIIMECallE timated date of completlo -!inspection: : ,CONTRACTORAPPLICi1T 0 _ : ` •i ';. :-`asFEE S CIIEDULE `` '�: Job no: r , pc:, , Vi • _ Fee Max • ' Description • - Qty. (ea.) Total no. insp Business Hanle: (p a we, 2 I t. - New residential - single or multi - family per Address: (p , _ A I tr1 dwelling unit Includes attached garage. City: . '0 r 1- BMW ZIP: r 7 Z I' Serviceincluded: Phone: 31/- „ V Fax: E-mail: 1000 s q. ft or less 4 P _ Each additional s . ft. or portion thereof _ CCB no.: Elec. bus. lic. no: "7 — I Limited energy, residential ___ 2 City /me r :c. 0.: Limited energy, non - residential ___ 2 VI -- • ©6 Each manufactured home or modular dwelling ■■. �eR Signature of supervisi g electrician (required) Date Service and/or feeder 2 L icense no: 3 \ 5 Services or feeders ti installation, Sup. elect. . t name (print): .e,�N �' alteration or relocat r _ _ PROPERTY OWNER:: ; . ,- -, 200 amps or less ___ 2 Name (print): 201 amps to 400 amps ___ 2 2 401 amps to 600 amps Mailing address: 601 amps to 1000 amps ___ 2 City: State: ZIP: Over 1000 amps or volts ___ 2 Phone: Fax: E -mail: Reconnect only �_ i • Owner installation: The installation is being made on property I own Temporary , arvicesorfeeders - 11.111. installation, alteration or relocation: which is not intended for sale, lease, rent, or exchange according to 200 amps or less 2 ORS 447, 455, 479, 670, 701. 201 amps to 400 amps ___ 2 Owner's signature: Date: 401 to 600 amps MEM_ 2 ENGINEER , . Branch circuits - new alteration, or extension per panel: Name: A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit III 2 City: State: • ZIP: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit: ■■ 2 Phone: Fax: E -mail: Each additional branch circuit: ___- PLAN' REVIEW (Please check all that apply)' Misc. (Service or feeder not included): irrigation circle or irri m Each pump g ME . 2 O Service over 225 amps - commercial 0 Health -care facility Eac O Service over 320 amps -rating of 1&2 0 Hazardous location Each sign or outline lighting ME_ 2 family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, 111■■ 2 0 System over 600 volts nominal more residential units in one structure alteration, or extension O Building over three stories 0 Feeders, 400 amps or more *Description: O Occupant load over 99 persons O Manufactured structures or RV park Each additional inspection over the allowable in any of the above: 0 Egress/lighting plan O Other. Per inspection MEIN Submit sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other Permit fee $ —7 ` 6 0 Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Plan review (at _ %) $ O� O Visa O MasterCard expires if a permit is not obtained 6 / / w i t hin 180 days after it has been G (. Credit card numbs State surcharge (8 %) $ y TOTAL $ -• • ( 0 2 0 � Expires accepted as complete. Name of cardholder as shown on credit card $ Cardholder signature Amount 440 -4615 (6/00/COM) CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received 12 3' 2/ D ate Reque ted ) 21 AM PM BUP Location /0 2 / Suite MEC Contact Person ...9A-4d 24 I -U & h ( ) COI " 6 as / PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain C 3 -60 3 03 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 PART FAIL ELECTRICAL 3 p Service / Rough -In CA (./-A G " c' °a 7 ,vir�G Y Voltage.- L L B G3 ' U ..ca I 4•1 f Fire Alarm final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call for einspection RE: Unable to inspect — no access Fire Supply Line ADA //0- Approach/Sidewalk Date / `� PP Inspector Ext Other: / Final DO NOT REMOVE this inspection record from th Job site. PASS PART FAIL