Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
' ok DEVELOPMENT Tigard, ) 639 -4171 DATE SSU 9/23 3 -00287
/03
SITE ADDRESS: 10215 SW HALL BLVD PARCEL: 1S135AA -01400
SUBDIVISION: METZGER ACRE TRACTS ZONING: C -N
BLOCK: LOT: 037 JURISDICTION: TIG
Project Description: Installation of limited energy for HVAC.
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:
INTEGUMEND LLC BY SCOTT COLLINS MD OREGON HEATING +AIR COND
& MARIA ROSS MD PO BOX 397
9495 SW LOCUST STREET DUNDEE, OR 97115
PORTLAND, OR 97223
Phone: Phone: 503 - 538 - 2953
Reg #: ELE 522LHR
LIC 125815
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 9/23/03 $75.00 Elect'I Final
[TAX] 8% State Tax 9/23/03 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speaalty 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. .w ru es . e. pted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throuc
CI
Issu- • by l M , ' , v 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
Sep 19 03 10:27a Oregon Heating and Air 503 - 537 -2172 p -1
,
0 9/15/2003 10:22 FAX 5035981960 CITY OF TIGARD 10 002
. --- - - - - -- FOR OFFICE, 1.5E ONLY
Electrical Permit Application. m�8
Date/BY. /9 03 �9 y Pem it No.: 4,e ,3
Planning Approve) Sign
City of Tigard Platrlan: �""'t No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Dated : Permit No.: .
Poet - Review land Uee
Phone: 503- 639 -4171 Fax: 503 - 598 -1960 ,, ,_ k ( _.Date /By:
Case No,:
Internet: www_ci.tigard•or.us ■ i• •1 If...:•,
Contact 1 ®See Page 2 for
p 9 'r-----"-- _ /�. I Supplemental Information, '
• 24 hour Inspection Request • 503- 639 -4175 NameJMethod:
,: .;, + :, 1 r•. =y cliteiCa • sittS�liiikkI " ":t: ,; ;4 .
: ..v;. ' • { _a;ria':IYA.i RK:" i: l .; . = i ,a %i:5 tic.'•'.. pl: a S !� X258'. lilt
'': �:,:. ?` r, a:; ' ='':: �..•r .r = h t ., OF =S'Vi(J ' c ;._-�. . :,,. � Health-cane facility construction ❑Demolition Service over 225 amps-
commercial l 0 H�ardous lawtion
Addition/alteration/ •lacement Ogler ❑ Service over 320 amps- rating of 0 Building over 10.000 square feet,
��WM.LE001(• tC, I y n ..� • ranee residential units in
�;M�it�.�_E i'S' >� . • r ".,6 1. a • �.�rO �.51..1n:bt' : H,:c..' - ! i:':i`; 1 � 2 family d wellings four or
❑ l & 2-Family dwelling
❑ System over 000 volts nominal one structure
r COZnmerctallindtis�al 0 bpildin ova three stories ❑ Feeders, 400 amps or more
j =lAccessory Building r Multi - Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
IIII Builder [ ] Other: ❑ EgresaAightngplan t 0 Other:
Master Builder secs of plans with any of the above.
.r _ .; . �P jiJ ijd:T; o.E t Ol!i i :xt,. The above are no applicable to tem o ary coudrnctien service.
Job site address: jC .) 5 SW 14A LL.. p `i 3k. iiWg
Suite #: 1 Bldg /At t. #: Number of inspections per permit allowed
P
N p m Oa.) Total
Project Name: .�K T 3�1 E Description New residential- WLtglo or malti- family per
Cross street/Directions to job site: dwelling sett. )swedes attached garage.
Servicelnrinded: 145.13 4
1000 sq. R or teas
Each , , x_1500 • . R or • •rdon thereof 33.40 1
Lisreiwd enemy; residential 15.00 1111111M 2
. Subdivision: I Lot #: . Limited eneraY, non maiden iai 1 75.00
Tax ma. • areel #: Each manufactured bane or modular dwelling
y �
'% qL';: �ti: i y:i.��l:.' °: •iiltii VI'. - o r.l . .s .'•c. " . r:;: -t". ! •r2`r :•'. arrvice and/or feeder g
Services or feeders - tasutuarba,
. ' V / A C alteration or relocation: 80.30
Y 200 amiss or ion 180.30
201 amps to 400 ammo 2
401 amps to 600 30 160.60
�( ;77-'k.7.4.7-:.- r 601 to 1000 amp, 1/10.60 2
— E 9 $ J 'hr `t :'0,`. :' jY �� .'t�itl +'''I i�Tf: ap :c a Over 1000 454.66 2
` � / or volts
Name: J • (� jI F U (�1 t—° v 3� Reconnect only _ 66.85 2
Address: I (,Q VS S A./L.) \ L`-- Temporary seniors or feeders - installation,
alteration. or relocation: 85 1
City /State/Zip: l F Z_� 2.00 amps or less - ioo.ao 2
201 amps to 400 amps 100.30 2
Phone:1SL � .� Fax: . 401 to 600 amps
.N1 .i e • C :r 14:11 ■
<:3 tgltrr Fax: ineRso 1ki vii out Hraneb circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase- of 6.65 2
Address: service or feeder fee, each branch Circuit
D. Fee for branch ciretdtt without purchase of
City/State/Zip: : br
strviet or feeder fee, fast branch circuit 46.85 2
Phone: I Fax: `Each additional branch circuit 6.65 2 •
E -mail: Misc.(Sesvice or feeder not included): 2
1111 �����w�!•��t wyra•p .. .y, lad' tnanp imRation circle 53.E
,•;rrfrel��3i�� t� r_ht. -r., �� �'t:.:::w '`� �';•1•:c:`�'" � fachsiRrt 53.
Job No : • iens ' Signal ens-unto) or a limited energy panel,
aae 2 2
Business Na>tiEEGON HEATING & AIR CONDITIONING 1 INC Aeration. w extension P Description:
Address: C('JR_# 1 751315 ' ` Each additional inspection over the allowable in a of the above:
City /S tate/Zik P.O. BOX 397 - Per in eririon per hour (min. I hour) 62 -50
Phone: • .: 1610HWAY 99W Investigation fee:
CCB Lic. #: 1 ;5 / $ tr 1 r II , E• s 1 • y }soya1lG' , it fllc8l m e. 104460:? `i:
Supervising electrician / % - — 5 .7a "/2 Subtotal S IS- A O
Si u. aiure re • lured: 4o / /0 a Plan Review (25% of Perini! Fee) S
Print Name: Lic. #: State Surcharge (8% of Permit Fee) S 6. • •
TOTAL PERMIT FEE $ - •
Signature: Notice: This permit application a expire: permit is not obhhn : wit in
Signaturure: � Date: +80 days after, It bas been accepted as ■s complete- '
'Wee methodology set.by - County Building Industry Service Board.
asa print name) -... __
(Pk .. RECEIVED
iAnsts\Pamit Forms \ElePemritApp.doc • 01103 ,
SEP 19 2003
CITY OF TI GARD
BUILDING DIVISION
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
t BUP
Received 12123 Date Requested / 2 a t /d3AM PM BUP
Location / . / 6'--e-e Suite MEC
Contact Person - • ' _� << F��i � ( ) PLM
Contractor (Y -P ( 24.. Ph ( ) SWR
BUILDING Tenant/Owner _ r r 2 e 7
Footing
Foundation ELC
Access:
Ftg Drain ELR
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 C.."
Roof
Other:
Final
-71
PASS PART FAIL i
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
Service
Rough -In
UG /Slab
Low Voltage
F' - arm
� SS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• SITE. 0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA Date f 7-- a" /& �3 Inspector
Other:
Final DO NOT REMOVE this inspection record from the • b site.
PASS PART FAIL