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Permit / �. ELECTRICAL ®� TIGARD RESTRICTED ENERGY CITY ICTED NERGY 1 � DEVELOPMENT H BMENT Tigard, ) 639 -4171 DATE SSU 6/2/2004 4 -00143 SITE ADDRESS: 07555 SW HERMOSO WAY PARCEL: 2S101AB -01501 SUBDIVISION: HERMOSO PARK ZONING: MUE BLOCK: LOT: 021 JURISDICTION: TIG Project Description: (2) restricted energy systems for data and security alarm. 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: X . INSTRUMENTATION: OTHER: : TOTAL # OF SYSTEMS: 2 Owner: Contractor: MINUTEMAN PRESS GUARDIAN SYSTEMS 7555 SW HERMOSO WAY 13500 SW PACIFIC HWY TIGARD, OR 97223 STE 245 PORTLAND, OR 97223 Phone: 503 - 620 -5203 Phone: 639 -3723 Reg #: LIC 53683 ELE 34 -222CL FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 6/2/2004 $150.00 Elect! Final [TAX] 8% State Surchart 6/2/2004 $12.00 Total $162.00 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 yoe9u adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 thr `I01 -0110. Y.0 may obtain copies of these rules or direct questions to OU 246 -6699. ls i / A I , ' Permittee Signature ( N " `^�' 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 Electrical Permit Application FO R :OFFICE USE ONLY - . City 0 Tigard DaDate/By: �Dq PermitNo.: g e l. j4/ 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 . , ° NiN �l� Received \ Date/B : Other Permit: Inspection Line: 503.639.4175 Y► Date Ready/By: Juris: El See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: / /� Supplemental Information b,�,{�, "" �� =•fi �<,�. u:.r >!' -:u :g'�,va ;�;3��.i�a, <` f: ' °'fi��'.. ��.� ,. ; , ; c - -� �, <� «_ fs '�. " -4.. o a " ' . y 0,&,:.. �.. TY'PE41OF WORK °i r , , 1,r ,: ; ., „ re..�;' � , , :A tT . , ,, -,, : PL R .,, .ro aa , ,` • VIEW , construction ❑ Addition/alteration/replacement Please check all that apply: El Demolition ❑Other: EService over 225 amps, comm'l ❑ Hazardous location . R��� ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., `� ) , �, GAI G ©RYQ CO]STRUTION . ^ �i� „ a of 1- and 2- family dwellings 4 or more new residential ❑ 1 and 2 family dwelling ,2'Commercial/industrial ❑ Accessory building ESystem over 600 volts nominal units in one structure ['Building over three stories ['Feeders, 400 amps or more ❑ Multi - family 0 Master builder 0 Other: �; t in .. � � �tr,��� � � 3 ,� � � , � -v '�`. s � ['Occupant load over 99 persons ['Manufactured structures or eir N , _ ' ,r :• JOBAITE„ A I OI21l : O '`11 A�I O.C x3TI0 ; V � , ❑E gress /lighting p lan RV park Job no.: Job site address: - AST c s w \ P a El Health facility ❑Other: Submit 2 sets of plans with any of the above. City /State /ZIP: 1 G 4 Q - 0 } 0 1- , The above are not applicable to temporary construction service. Suite bldg. /apt. no.: Project name: ; _- =:' `` :°, ;' *`` 'F E `SC IEDTIT E, ; , , x 7,. < , Description 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 Tax map /parcel no.: Limited energy, residential 75.00 2 Limited energy, non - residential 75.00 2 fi mm t ,. fr < aRg T1OI I . a. ,,, ' '; ' 6 , ' ` 0 , p Each manufactured or modular c_C. t. 11:1 1'./ A 1„a 1' - 1) fl T A dwelling, service and /or feeder 90.90 2 Services or feeders installation, alteration, and /or relocation 200 amps or less 80.30 2 'I,_, ;. ,;: cr tjaia "� `.«a; ii-Wi , , , :: °'t A;c.:, .If i s y` t : 201 amps to 400 amps 106.85 2 ,: , PRQPERTXIER :' '. ` _ . ' w; � o t'PE _.. s. F <, H ' `' 401 amps to 600 amps 160.60 2 Name: 1 A IA) \J l Al V 12 F .5 S 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 Phone: (55 ) 1sSO -524 Fax: ( ) relocation 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 9„ , ; fit, C sN ,n.• ? i A. Fee for branch circuits with APPLICCAN1 : � O NTAC7PERSON < s `�'"``'` "�` ""��° ""��° ` service or feeder fee, each Business name: G U 6 R'Q tRN Sy ;1 1. til t' t") branch circuit 6.65 2 B Fee for branch circuits Contact name: RR ,. L Y t ( L without service or feeder fee, 1{ each branch circuit 46.85 2 Address: )35' SW A 1F-tL., 1 A-wy 2 Each add'I branch circuit 6.65 2 City /State /ZIP: 70 D 1. - P-Ar) d ' ('"122-5 Miscellaneous (service or feeder not included) Phone: (Sol ) (0 3I 3-12_3 Fax: : (SO) ) ( y (62,51 Pump or irrigation circle 53.40 2 Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited - r s an $, g . s m:;rn : , ;y S dxi:, a„ - 15. w S o.KI ACT012 . ,p EK i .w SR > energy panel, alteration, or extension. Describe: Page 2 2 Business name: CO u AIL 7►.dnl S`i S 7F,I11S 1 1 '' 1 Address: r 5 - (1 0 C W ?A L t w t,. 1 - a w`/ 1i . t.{ S Each additional inspection over allowable in any of the above Per inspection 62.50 City /State /ZIP: . O 1 1-/4 "r0 0 11- • C '1 - 1 2-23 Investigation per hour (I hr nun) 62.50 \ � Phone: (S O j ) ( o ' Z j S --1 2-3 Fax: (SJ j) (or L/ 53 Z Si Industrial plant per hour 73.75 Mit :..7fnEG' I; RICaIPE1t1Vl'IT)I�?EWN..;: <Wg ,n <Y 0 CCB Lic.: 5 3 631 Electrical Lic.: 3 1 221 c.LE- Suprv. Lic.: ' 4: 1 1.1- 1 L'rA �� (� � F Subtotal \c0 . e 3 Suprv. Electrician signature, required: C�! " `ek ,)j vl y (a / /' `� Plan review (25% of permit fee) Print name: A 1 `.. 1-L, 5, ? ■ .L 1; t- Date: (pl -) L Li State surcharge (8% of permit fee) II- , c 1 TOTAL PERMIT FEE 1 6 2- • a 0 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. i:\ Building \Permits\ELC- PermitApp.doe 12/03 440- 4615T(10/02 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* n Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: `''`�C4JN IVIFRC w WORK Ol L r , " 1 •1 Fee for each commercial system $75.00 (SEE OAR 918- 260 -260) b 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* Z / Protective Signaling ❑ Other _ Total number of commercial systems: 2 ' *No licenses are required. Licenses are required for all other installations i:\ Building \Permits\ELC- PermitApp.doc 04/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST c� BUP Received Date Requested d �� d AM PM BUP • Location 7 s s i)/t Suite MEC Contact Person Ph ( ) ' C — 7 I PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner a/'LJ ELC Footing ELC Foundation Access: . lI� Ftg Drain ELR o'c - V r T3 Crawl Drain Slab Inspection Notes: SIT Post & Beam Sr Anchors Ext Ext Sheath/Shear Int Sheath/Shear Framing Insulation A4 PKZ Drywall Nailing Firewall Fire Sprinkler / Fire Alarm V l ft 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 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. ‘41112t PART FAIL Please call for reinspection RE: ❑ Unable to inspect — no access Fire ADASupply Line 1 7 Approach/Sidewalk Date 0 (,� t Inspector ' Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL