Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
— 13125 h DEVELOPMENT H PMENa r SERVICES ) 639 -4171 DATE PERMIT #: ISSUED: 12/20/2004
SITE ADDRESS: 07125 SW HAMPTON ST PARCEL: 2S101AC 01400
SUBDIVISION: BEVELAND NO. 2 ZONING: MUE
BLOCK: LOT: 020 JURISDICTION: TIG
Project Description: Additional access.
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: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: ACCESS X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
SPECIAL DISTRICTS ASSOCIATION OF OR SONITROL PACIFIC
727 CENTER STREET, NE #208 20 8220 N. INTERSTATE AVE.
SALEM, OR 97301 PORTLAND, OR 97217
Phone: 503- 371 -8667 Phone: 223 -5822
Reg #: LIC 53535
ELE 26- 370CLE
SUP 4045LEA
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 12/20/2004 $75.00 Elect'I Final
[TAX] 8% State Surcharl 12/20/2004 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through OAR 952-001-0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699. 2
Issued by > ___Z � Permittee Signature /^
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
, !/ ED t o I F .r I x • L'lec4ric fI Permit Ap i% r; } _ z ; x ; r t-- , :.FORO { *, � r� Y ,� n'
City of Ti GQU Da e ed � w o! , ,,� 37
Phone: 503.639.4171 Fax: 503.598.19
DEC Perm No.: � BOO
13125 SW Hall Blvd., Tigard, OR 97223 C Plan Review
Q � i� Date/B : Other Permit: - -
�,ITY OF TIGA 4I 'V •
Inspection Line: 503.639.4175 � ?>t Date Ready/By: 0 Page 2 for
See Pa
a..cv 1 - -, �...iv Y Y� 7uris: .rte g
Internet: www.ci.tigard.or.us BUILDING DIVISI- Notified/Method: / �C. Supplemental Information
t.? ' £ :s. vx.aan:.c" - , + >.+''r$':...' €i;�.` . - ^4� »= .,'i 7'F`.w:. ' 4 x2:. , ' 'gi
+.:»c iAA"'� 6 .:.. .... -A r'.',r,'' «- .rs;."- '.:% 'x�:,.eyes. 5". �a. ... ":.` 5�4,., ..k
r s r, t ..� �4 a. � r'°SR�'°�.C.` ....r&�. rew.:: Ii. �:1'.
?.-'" ari , :is ik "� "•ii''s� -r3� ' ^?+. `:: ,� 1 _ _
TYEE�.OR .CO � � ° r - , -
:`:a;:.�����"�n:zu,.AN�. �:�,.::.n ..a..+s�'i..:- . aaa. t£:. �a�,,. ,.- ,..s- �,.....�r.::,- ..':�>..r .,... .... . �.« .. -,. ,.
El New construction IN Addition/alteration /replacement Please check all that apply:
['Service over 225 amps, comm'I ['Hazardous location
❑ Demolition ❑Other:
_ Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
: F,479-, , r,„ , -3k �s; ; ,-.-- lr :✓,.,:,. - w .r .., :c±.:?x,:�;a. -, y.crrur,.: aces.. -3::;,•t-�,.- :_:;ara,..��r , ;.; r a. -`T. , `s,`.:; . -, ,
- 'CATEGOR ' OF CONSTRUCTION'' '' ��' �`-` "':!=''; of 1- and 2-family dwellings 4 or more new residential
.w,�,...r� -� �.�'' `�s-t ...�.�.... c�. ,.. a.?`�a..e.�:c.�:,ea.. -a.:.. a .� saa .,., k_..�..,. ra..er.�... a 3�5.:�„+._,:z��',r;,,;�, Y
❑ 1- and 2- family dwelling jg Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
El Multi family ID Master builder ❑Other:
EBuilding over three stories ['Feeders, 400 amps or more
['Occupant load over 99 persons ['Manufactured structures or
.;,. ,; „; : ; r r* i„ li ..l w ' °` hr A`.,"_ t ` -1 =�; ° °.' ;Fc.. o
' : &: .,,, z '' _ JOSSIT IL ,, V'1~,ORIYI A TIO N '. 'D I .: s:' .
. �:�:�: t'�: ��;... O CATIO \ ;�: ><� ;, �,,.. . ;, 4.: ❑Egress /lighti plan RV park
!.:�.�_. ;�s<�iEIr'..s=+� -, . . �_.:. cs�< k� sx�vab':, .,�.at?h..:�;.���,- _:..n: c� >,.�,r��:- '��4�.t°' .�. aea -� � �s
Job no.:3agk -Y 1 1 Job site address: n 1 a5 Su. k Cly° -\ p k-On ❑Health -care facility ['Other:
Submit 2 sets of plans with any of the above.
• City /State /ZIP: �l ,t } ,(jj oy- 91 a,3 , The above are not applicable to temporary construction service.
-2 , • tO ■ S� Y \ CA e Description gn °•' k' FEET .§:6 i - ; ;'':a' ; • Suite/bldg. /apt. no.: Project name: G ��4 �s L J` - Qty. Fee. Total .
�
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 75.00 2
,{3y - Yi . F `3: y , yTrvrr Each manufactured or modular
;`
;, ; ;'s ,r, l . ,y �'.. '. t. ,',s-:, ; , fi r, £ . K
%�,F �t '`', "�`�,;1"DE5CRI'ETIOIV;'OF�tiV .� "�:;j °�, -.,
: �.4e�.°:- `„��'u�= �'";""a``. %;;s r: is;' ;t: • r�'�<, .., .,. w�-. �u<-«.:. a.,• ��-. b. �'. s_.:, �n�. ��i�`;...:':,". �'$ �' .,�- ��''.,'�i;� ^ � ::s�>n „a.,...�,
n dwelling, service and /or feeder 90.90 2
[ (29 `VA0Yl( f I Services or feeders installation, alteration, and /or relocation
,, 200 amps or less 80.30 2
.,; ro=ii::�- � ;"': r :� ,- ;�`,?. ax ;x:x•: •.i,201 amps to 400 amps 106.85 2
°= a '� PROP.ERTY` YNERa °21, . � Y u.� ® :;:TEN > ,,a v :, ;, , . , ,,, , ,, t i,,, , , , ,, , , , : , ::. -' ...
�� '° 401 amps to 600 amps 160.60 2
Name: 0 • ` i 601 amps to 1,000 amps 240.60 2
Address: C �� ,^c-�� Over nett amps or volts 454.65 2
,_1. .�Q 3 9 �'J Reconnect only 66.85 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
y - relocation
Phone: ( 6.-) (. l a -� - 1 U...e LA 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
s ,.,. ; ,.,.: cif r : 1 a- ; , s;:fiffr = '.a` , ed z. ; 7 1 :. A. Fee for branch circuits with
, , ` "x ®l >APPLICANT .4�.; , ,r: p , : " 1. : =° ® COi\IFAGT PERSOtY ;t. A x +
„""� ?33;- sa„,.,.,7^'.... -..,. <_,..,,,..,. ?u`;..«' z.-." ?` , - ;, i:,< a:?:` ra.: ,.5�- .e�a e . «��:- �sa.:__.���, ,.,,- ...�F,.- , -esr.S
service or feeder fee, each 6.65 2
Business name: branch circuit
. B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address: Each add'l 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 -
S ii :. ae F;: s•„ - -c'° i = *s' -: ?w i.w i r ..� i energy panel, alteration, or Cy-
...� , >GO' TI�C7:012'� ;.t u- � >;` �;�`�� <:. ._s�:::;'; " �- x.;�`� „. energy P
. R ^:; ,: :" ' :: ; .. ... _. -" ..max . : :_. _e .._. > .... - ° ;,;.., 5, /
'� >:. ,,., extension. Describe: 1 Page
2 .
Business name: `(1-�`(� \ P `� tk (,
Address: D -D...0 N , �, -��' ��.Q Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: ‘c?c•Ny \. CN c5„--- ` ) 1 -1 Investigation per hour (1 hr nun) 62.50
Industrial plant per hour I 73.75
Phone: 5 3) p�T 3 ° 572-2_ Fax: ( 3'���� - . .- : ,:, - -- :
`' r- ��,,:'..�- 7 :VITT ;FEES: . .
CCB Lic.: 5y:535 Electrical Lic.: p._3 0 Suprv. Lic. 1 5 . Subtotal 95 (�
Suprv. Electrician signature, required: t Plan review (25% of permit fee) /
n v ; �e�/} 641� I
Da / / / ,� �� /�� /� / / State surcharge (8% of permit fee) `p ;
Print name: V4 /` i 1
TOTAL PERMIT FEE B („�
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
" Number of inspections per permit allowed. ^ c
i.\ Building \PermitslELC- Penn3iApp doc 1703 440- 4615T(10 /02 /COM/WEB ,i�JJ.�
Electrical Permit Application - City of Tigard - Or
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
ESViff t it:O]RW;.Ot` 1I IEpt ,., .;°°: ': to ..:
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*
- ❑ Vacuum Systems*
❑ Other:
'.�.. :W Cam S� _.O AS'Y ,
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
Fr Audio and Stereo Systems
• Boiler Controls
Clock Systems
[] Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
Other GC k ILT ( ill) •
Total number of commercial systems: t
*No licenses are required. Licenses are required
for all other installations
\ Bui ldingU'ermits 'ELC- PennitApp.doc 04/03
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2004-00378
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12
Phone: (503) 639- 4171 �+
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/15/2005 TIME: 7:i3AM PAGE: 83
•
SITE ADDRESS: 07125 SW HAMPTON ST CLASS OF WORK:
SUBDIVISION: BEVELAND NO. 2 LOT #: 020 TYPE OF USE:
PROJECT NAME: SPECIAL DISTRICTS ASSOCIATION
DESCRIPTION: Additional access.
OWNER: SPECIAL DISTRICTS ASSOCIATION OF OR, PHONE #: 503 -371 "8667
CONTRACTOR: SONITROL PACIFIC PHONE #: 223-5822
Inspection Request Scheduled For: Date: 3/15/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 001646-01 603 -223 -5822 V
Corrections /Comments /Instructions:
i✓
() PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 9/o°'1—"' Date: — D.5
Phone #: (503) 718- �� "/