Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
, , Yl y l DEVELOPMENT SERVICES PERMIT #: ELR2003 -00163
A 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/16/03
SITE ADDRESS: 11505 SW HALL BLVD PARCEL: 1S135DA-01400
SUBDIVISION: ZONING: C -P
BLOCK: LOT: JURISDICTION: TIG
Proiect Description: TEMPLE: Install low voltage for sound system
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: X 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: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
BRAHMAPREMANANDA ASHRAM /TEMPLE LOGICAL SYSTEMS INC
11515 SW HALL BLVD 20005 SW CHARLENE CT.
TIGARD, OR 97223 BEAVERTON, OR 97006
Phone: Phone: 503 648 - 0246
Reg #: LIC 113613
ELE 671LEA
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 6/16/03 $75.00 Elect'I Final
[TAX] 8% State Tax 6/16/03 $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 pormit will expire if work is not
started within 180 days of issuance, or if work is suspended for more than 180 days. °`TTENTION: Oregon I.w requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are -t 'orth in OA- 9 )2 -01 -0010 throuc "
" Issued by (76 1 Permittee Signaturerr j��
fk- -�,�� • j�v� /,
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
F lectrical Permit Application FOR OFFICE USE ONLY -
Received Electrical
,1 Date/By:6 � /Li, —C t , Permit No .
9 /403
Cit of Ti and Planning Approval
y g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.: -
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
�/�nno�Hl' � l" 1 t Date/By: Case No.:
Internet: www.ci.tigard.or.us ■, �.f I Contact �,luris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: ` Leb Supplemental Information.
A� °. „- `632 a r� . .., _. �,. , ..._ , �is � � �a. � a' ` t r y . 3 � :• .•.¢ 1 :�:�,�� .. �.•���: ° = " � �,:•£.;
; � z: => - tf YPE_®F WORI{ _ 4 sf � �.:=: r } dirt PLANlREMW (Please client ihatfapiM '' ; �. ;:.a
New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
tE. TRUCT •. _ 1 & 2 family dwellings four or more residential units in
111 1 & 2- Family dwelling 11Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder El Other: ❑ Egress/lighting plan ❑ Other:
a raJOBSITE INFO - RIVIAPIO O N andLO CATION ;.'_,,; ; Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: (45 c u . ) t � 7 g U i f5 • ta M :l; ` 6 , -FEE* SCHEDULE:' ' ::.::. .: !ROAN
_ <
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: T L t Description Qty Fee (ea.) Total i
Cross street/Directions to job site: New residential-single or muted garage.
per
� dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: Lot #: Limited energy, non residential ( 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
„t s . 32 DESCRIPTIONa®F �, :` , service and/or feeder 90.90 2
e r Services or feeders - installation,
I'M 0 6,00e-41/
.�' y 5OK4J.P Jp � I alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
3 : : R O P „ E R = T I ' OWNER„ M- I' TEN3 - ' NT,.,.. ai.:� . „ 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85 1
Phone: Fax 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
1 A PPLICAN ¢ ` .,(. ] , . . CON,FACT 3.�k , Branch circuits - new alteration, or
Name: l� ` ,t ,L. 1 ' extension per panel: of
Address: 2.. S t4) C - t A Fee for branch feed rfee,te each ranch circuit ui 6.65 2
service or feeder fee, each branch circuit
City /State /Zip: . e -.) • B. Fee for branch circuits without purchase of •
service or feeder fee, first branch circuit 46.85 2
Phone: A( 1.—cot:f jo Fax: (D c 2 - 1 V Each additional branch circuit 6.65 2
E-mail: ST<Nt. @ L,oCuCAL5 L iCItivN5 I NC. Caw Misc.(Service or feeder not included):
F ,,, , ONT_OACTotinta aZ , ,r I , Each pump or irrigation circle 53.40 2
�- �� ` C Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name: lj/ (ret - 5 l / n ( -- r - Description:
Address: `-ate s Set) cGLa✓, r2,AL er1
City /State /Zip • �4,. JO O2 rf"7( Each additional inspection over the allowable in any of the above:
Per inspecction on hour (m
per hour (min. 1 hour) r 62.50
Phone: by).- `,P ' Lic. #' Fax: 5D3--6. t( v /Q e Investigation fee: 1
CCB Lic. #: of 49 • ‘ 7/ -4e-14- Other:
� fi -0 .�� a�,N,� �:..;.. ; °: ��ElectrlcalPermitFees *N3 . � : ;,��� � ,.
Supervising electrician f 1 J O - 5 Subtotal $
_
signature required: 1 \V' Plan Review (25% of Permit Fee) $
Print Name: SI ►t6t.) gad Lic. #: F1,6.01 State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
Authorized / ' // Notice: This permit application expires if a permit is not obtained within
Signature: '' J �yej Date: 4 -(4. �j 180 days after it has been accepted as complete.
V OF *Fee methodology set.by Tri -County Building Industry Service Board.
rte., J C,1-k 6c r
(Please print name)
i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03
f
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
� and Stereo Systems* .
n Burglar Alarm
❑ Garage Door Opener .
n Heating, Ventilation and Air Conditioning System
I I Vacuum Systems
n Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type rk Involved:
Audio and Stereo Systems
•
❑ . ,
Boiler Controls t � �v �'� '., . 7,'
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
O HVAC
n Instrumentation
n Intercom and Paging Systems I t -ii : ; . e , • ;
"
-'- 1
n ,, /..; Landscape Irrigation Control
I • ,
❑ Medical "; y �' ; : ' . ' .
n Nurse Calls . ... .1)1: ?i ' , • J' Ji ..'.�i :
n Outdoor Landscape Lighting
ri Protective Signaling
n Other t _2:.. , . S:,',. 4'% _y a ;a
Number of Systems
t \ '\ ' A , \ ' 1 ,
* No licenses are required. Licenses are required for all -
• I
other installations
1 ,
- \1r y .
t
i:\Dsts\Permit Forms\E1cPermitAppPg2.doc 01/03
CITY OF TIGAR 24 -Hour
BUILDING Inspection Dine: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171 • -
BUP
Received Date Requested
it � AM 0 P M BUP
Location 1Suite MEC
Contact Person 4 7 it Ph ( ) 3 7— 8'S!6— PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Access:
Ftg Drain ELR 3 — o /6
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 _. -
Service
Rough -In •
UG /SI . •
ow Volta ■ • -
ire A arm
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE • El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA /
Approach /Sidewalk Dat / Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the b site.
PASS PART FAIL