Permit CITY TIGARD RESTRICTEDENERIGY
m t DEVELOPMENT SERVICES PERMIT #: ELR2004 -00194
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/7/2004
SITE ADDRESS: 06655 SW HAMPTON ST 110 PARCEL: 2S101AD 00400
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 034 JURISDICTION: TIG
Project Description: Data Cable
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:
HAMPTON OAKS LLC BRIDGETOWN ELECTRIC
6665 SW HAMPTON 22732 NW GILLIHAN ROAD
2ND FLOOR PORTLAND, OR 97231
TIGARD, OR 97223
Phone: Phone: 503 621 - 7122
Reg #: L6C1- 712303824
SUP 4177S
ELE 26 -887C
FEES Required Inspections
Description Date Amount Ceiling Cover
[ELPRMT] ELR Permit 7/7/2004 $75.00 Wall Cover
Elect'I Final
[TAX] 8% State Surchart 7/7/2004 $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 follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
Issued by ijdu _40 � Permittee Signature Ale ���_ _ A ,
r /
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
,
El- ric l Permit Application• ;. FOR OFFICE USE ONLY
Cl of Tigard �� Received t .. / j 7
Date/By: Pemlit No. / / ..i� I i
13125 SW Hall Blvd., Tigar 7223 Plan Review Other Permit.
Q
Phone: 503.639.417i Fax: 503.n8_1960 " + Date/8 :
Inspection Line: 503.639.4175 i V ltl 2. 3 2004 , !P JJ ': 6`l l 1 Date Ready/By: Iurir. 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
. .....:: . 1 . :: -: - .M.: ; ;;: 5' .. : . " ; . :: : - : ; ,...: 6>:`() q011: v O ue. - .. ;' :....:.: .F:,,::: :- PLAN JiEVit w ...; .
❑ New construction BU - A` tidit ]iiil>'gterd[ion/replacement Please check all that apply:
❑ Demolition Other: ['Service over 225 amps, comm'l ['Hazardous location
g 0 sq. ft.,
CATEGOR OF. ?CONSIRi3CLtoti.'; : :.:•-...: -� -. ['Service
offt rating d
and 2-family 4 or more new residential
❑ 1 - and 2 family dwelling Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
[(Building over three stories ['Feeders, 400 amps or more
❑ Mufti family Master builder [] Offer
, ['Occupant load over 99 persons ❑Manufactured structures or
' _ :J013 SITE'_1NFOP.IIIATIb\_ AND; LOCATIOY: ; ._. _ ❑Egress/lighting plan RV park
Job no.: — 1 Job site address: t 6 55 SWWi' Pf(:JZ ['Health-care facility Other.
Submit 2 sets of plans with any of the above.
City/ State/ZIP: � 722 The above are not applicable to temporary construction service. •
�ll - / Q�.Q ` - .. _ .. ,
FEE* SCHEDULE •.• :.
Suite/bldg. /apt- no.: Project n sue 47 3 e'j , 1C�r Description I Qty I Fee. I Thai r ,
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 I
. Limited energy, residential 75.00 2
Tax map/parcel no.: Limited energy, non - residential 1 75.00 `75 2
;,- : ::i • ...:,:: • ; :: r . `.' is ; '•.:_: .. � .•.
. AESCR)f'TLOiY��OFrWORK >: •.• "::: :'..: ;:,: ': ::.. • • Each manufactured or modular
/ ; n dwelling, service and/or feeder 90.90 2
l ��R 1)•-•0.i_..- Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 • 2
.. - .- -.. amps a
- - .• .. tnpsto400 mps 5 2
❑`. PROPERT ;OWNER:: ;';' TEi• riP]
401 amps to 600 amps 160 -60 2
Name i (Ap 601 amps to 1,000 amps 240.60 2
Address: to 140 5 ' ,44. Prot.) 41 l ' D Over 1,000 amps or volts 454 -65 2
Reconnect only 66.85 I 2
City /State/ZIP7ITO /(&' , 02 97 993 Temporary services or feeders installation, alteration, and/or
( s)3) /_ Q 1- I s 7S " I relocation
Phone: I DD'{ 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
APPLICAN : :•:: ": '' :~ :•: CONTACC kiILSOIV: ' A. Fee for branch circuits with
service or feeder fee, each
1=7)-)0_,/ • � .: ..�
Business name: t l t � r f✓1.L (J� l� .- branch circuit 6.65 2
Contact name: • t f ( f .�� L B. Fee for service circuits
es
1'i }\ S L & without service or feeder fee, 46.85 2
� each bran circuit
Address: ?j LL (�(( �>, ILt1�._( Each ad d ' I b ranch circuit 6.65 2
City/ State/ZIP: 7p'}^ I (Ye-- C. � a.. Miscellaneous (service or feeder not included)
Phone: C56 2 j) ("7.4 7 j d..,)— I Fax:: 663 ) (c2.1 Pump or irrigation circle 5140 2
Sign or outline lighting 53.40 2
. E - mail: _ t t a (-JO r I t5-1-air . C-01,-- Signal circuit(s) or limited-
,. • ..: -,. �!.:. .. -
,,: ,_. :; , .:; �..' : . •': : :. energy panel, alteration, or
extension. Describe: Page 2 2
Business name: I 3r, d n E ez,-hri L
Address: t�7 3J J W I% ( (1 k i 0t Each additional inspection over allowable in any of the above
� Per inspection 62.50
City /State/ZIP: (oh+t a IN d V /� 1 j 10-31 Investigation per hour (1 hr min) 62.50
Phone: ( 5 6 3 ) ( 7 I ;..) -- l F ax: ( 5) (p2 - 7 Industrial plant per hour 73.75
: ::: ELEeTIIICAr. :)'E1,tMFT: ` CEO* . -- . :.
CCB Lic.: to3s,I El Lic.• . s 7 c Suprv. Lic.: if. f 71 5 Subtotal '�
Suprv. Electrician signature, required : _. Plan review (25% of permit fee)
Print name: Ke ti 11 \ Sf� in t tki Date: State surcharge (8% of permit fee) . (ICI
TOTAL PERMIT FEE b l ( V
Authorized - signature: ` This permit application expires if a permit is not obtained ` within ISO
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building industry Servicc Board
T'd EZI iZ9 -EDS PTIsuaagS u'taN e•bI :oI 170 6Z unf
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION ,siness Line: (503) 639 -4171 MST
BUP
7 Received Date Requested - AM PM BUP
Location i i for �! a ..s �� / Suite / /6 MEC
Contact Person Ph ( ) 317-0i 77 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR O O6 e-/ do r 9 y
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 /Slab
Low Voltage
Fire Alarm
40. Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date / Inspector ��t� Ext
Other:
Final DO NOT REMOVE this inspection record from the job/site.
PASS PART FAIL