Permit - r , CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
,T�_�lll DEVELOPMENT Tigard, � 639 -4171 DATE ISSUED: 10/20/2004 00326
SITE ADDRESS: 13125 SW HALL BLVD PARCEL: 2S102DA -00401
SUBDIVISION: ZONING: CBD
BLOCK: LOT: JURISD ' TION: TIG
Project Description: Installation of limited energy for voice & data cabling.
Job No. 60 -7181 .
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:
TIGARD, CITY OF BROADWAY ELECTRIC - COCHRAN INC
13125 SW HALL 626 SE MAIN
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: Phone: 503 234 - 6564
Reg #: LIC 72942
SUP 3447S
ELE 37 -546C
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 10/20/2004 $75.00 Elect'I Final
[TAX] 8% State Surchar€ 10/20/2004 $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 wi hin 180 days of issuance, or if work is suspended for more than 180 days. ATTI NTION: Or:'• on law requires
r yo. o follow ru - adopted by the Oregon Utility Notification Center. Those rules are set '�rth in ')AR •i.2- 001 -0010
rough OAR 952-I q 1 -0100. 'u lay obtain copies of these rules or direct questions t• , UN• ..t (5b 31 246 -6699
�
Issued by ■ ��_ � 4 ! 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
s
Electrical Permit Application • FOR OFFICE USE ONLY
City of Tigard Datewea O ma CZIEW-- 003a2 I'
13125 SW Hri`idlvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 /t'ato-4,.•'+; t\ B Date : Other Permit:
Inspection Line: 503.639.4175 �, LJ. 4111 • Date Ready/By- 0 See Page 2 for •
Internet: www.ci.tigard.or.us Notified/Method: MI Supplemental Information
. ?. :y� yd . r '�' �.'RV Z' �& ,�LI 4 °p *r S"rSa -u' iF" .+.. 4:"Je:= '°3"C�:r .F �i.:.:�r i� ]a .t�::�. .�.
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BNh a� .••b.a.,, - 3(^�.A W w , '. -f'' mt .;: 'r"44,5; : u • �,
S:xl.... :��N � - .._i �i". �ba�i `n�rt€' h��.:±�;� ». �d.4?so ✓��t.a `�.a '�� .'u�zi� ,.,+u..°t. :�.P��rv..ksHS •..�. �.- .k.., -: i.,.�_,_ ..�. ^ .. " ,
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❑ New construction Addition/alteration /replacement Please check all that apply:
El Demolition Other: ❑Service over 225 amps, comm'l Hazardous location
,, _ ti -3 - v sin •,, p , , , ;- y ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
� We'2' a
`' ,. � � .,, :. i- a ' m ' 0r.2Y 0 � CO1V, L w T ONr x LiA: f of 1 -and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling Commerciallindustrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family 0 builder
EBuilding over three stories ['Feeders, 400 amps or more
❑ Other:
_� �' I .,�� _ Occupant l oad over 99 persons red structures or
❑ Manufactured
O �I°I= ° ` TIO gA D 1rCA I IO -" +, E essfli htin plan V P
_8ta .:.�t$� b. _.4 ,_..: , _ _��� _sa�� ❑ gr g g P R ark
Job no.: 40 4 1 a t Job site address: V 31. 5" .J --G.L 4L r) ❑Health -care facility ['Other: Submit 2 sets of plans with any of the above.
City /State /ZIP: \ `G A a o 1 C3 lZ The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: � t • .` . r'''' =idi Pik E 6 ' '
`' `T f! L 4. � � ! / � �h' ip tlon Qt I Fe T otal
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
}k ...,. 'R- ,�� `t� �}:. k m M _ Limited energy, non - residential 75.00 2
r: K' ` 7! r43 tJCn 41;)if V r. °� . �t Q W� � " T 1' 'd.a`btlry ^• R .'. '
°.r; �, ��:: =X"�?::i:��'��:,:;�s.. Each manufactured or modular
dwelling, service and/or feeder 90.90 2
1 I4 3 r A . UO ► r s. } 4 O Art' 64-0 i - t tJ b Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
m sx ee : `� � �x =• r; 201 amps to 400 amps 106.85 2
R . gitaki TY y iF.. tf. ® f kri,W ;� `'"'_s '
P
's ..1'�k. .: �,; w'r.t•.�9 i "I:.,.L...., .._�.''', -. � .a.�:..... " - ,
�' " " ' ` "` �` 401 amps to 600 amps 160.60 2
Name: C t r '-( O . • � l9"�� 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: � 7 �` (7 / 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 70,1. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
'� ,.`,, "l nigP << '" I '�° ®?-C� `"� �rsealt ;7 y{ ` A. Fee for branch circuits with
} 5.,�;' .. ^r•+ +•`"'k.''6'x' ?Y:e • I':u' .�. �t: te;s ::.• '.�v"."ait5y;'
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
Address:
each branch circuit 46.85 2
Each add'I 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 -
+Pa.� "'i ' " A' �'�' 3 , o'E . IM. ' I " r"= energy panel, alteration, or
.:..�;:�.:� : ��..`� 4.` <-Ci0 T3 �UR�:�° .. �"�'" - ik'= z,.s� �'��� gYP
` {aM tl , ter. extension. Describe: Page 2 oQ 2
Business name: ��o c+•�. c........1 .-- ..c._ s
Address: ( S C 1(v\ \r- Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: -2o S k-` q ,„., p •1 2■.L Investigation per hour (1 hr min) 62.50
Phone: (56) 234 ( F ax: (5 2:32, 2 g Industrial plant per hour 73.75
It '" 41Mk. .WitTGAI EERY . �_ S*:,. ; ,T -2 ,
CCB Lic.:
Electrical Lic.: . ,_ xt
�2� 3-1- 5`(0C- Suprv. Lic.: 3 '-kt{� s Subtotal "1 5 40
Suprv. Electrician signature, required: \ Plan review (25% of permit fee) /
Print name: y( e � , \ 6_40 Date: State surcharge (8% of permit fee) cc) 1 " ` TOTAL PERMIT FEE `
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: ' Fee methodology set by Tri- County Building Industry Service Board
.Fee Number of : inspections per permit allowed.
i:\ Building \Permits\ELC- PmnitApp.doc 12/03 440- 4615T(10/02/COM/WEB
•
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
�nnry�'�ti° %�.e.'k,r ni stir k ;��i =,"� �,4�;�'S5Y2"�Cx
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*
n Vacuum Systems*
❑ Other:
T ... .- v.h F r .- ww -. a: �Sr. ..i�. � iL_ M!Ft14... ,
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 \Pcrmits\ELC- PermitApp.doc 04/03
CITY OF TIGARD 24-H07
11 11 60 Inspection L, 3) 639 -4175
INSPECTION DIVISION Business Line: (503) 63974171 MST
BUP
Received Date Requested / / AM PM BUP
Location / 3 / S to MEC
Contact Person j DY Ph ( SoZ —7 'V PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing / ELC
Foundation Access:
Ftg Drain ELR Q� .d 23a�
Crawl Drain
Slab Notes: Inspection - SIT
�
Post & Beam P L � � /t
Shear Anchors
Ext Sheath/Shear /C- .!.!
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 / j
F PASS PART FAIL �� o — ��� r r/ / (--/
ELECTRICAL 64-C. 4 — r v 3 6) PJ f C L 1,4 C �S
Service
UG
Fire Hiarm -
Final
•
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S El Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL