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Permit fr, ` CITY OF T I G A R D E L E C T R I C A L PERMIT - RESTRICTED ENERGY r'lll DEVELOPMENT SERVICES PERMIT #: ELR2003 -00340 `-" 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/4/03 SITE ADDRESS: 07007 SW CARDINAL LN 185 PARCEL: 2S112AD 01000 SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P BLOCK: LOT: JURISDICTION: TIG Project Description: Installation of limited energy for HVAC wiring. 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: X PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: : TOTAL # OF SYSTEMS: 1 Owner: Contractor: PACIFIC REALTY ASSOCIATES PROTEMP ASSOCIATES INC 15350 SW SEQUOIA PKWY #300 -WMI 807 NE COUCH PORTLAND, OR 97224 PORTLAND, OR 97232 Phone: • Phone: 233 - 691 1 Reg #: ELE 26- 1063CRE LIC 38868 SUP 2613LEP FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 11/4/03 $75.00 Elect'I Final [TAX] 8% State Surcharl 11/4/03 $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 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 f .11 ° .dopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throuc - , / Issu d by ,L . f le J ,r /,/tv.,6% 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 Electr'ictal Permit Application FOR OFFICE USE ONLY " Application lyilfi i ,/ Electrical Date /By: If 3 / 1 3 Permit NoE- e h , _ c-,0 n City of Tigard s® Planning Apv Sign ��`� Date /By: Permit No.: 13125 SW Hall '1 0 Plan Review Other Tigard, Oregon ° " Date/By: Permit No.: • / / 2 ' 7 , - 9 O 3 - cZ f3 1 Post- Review Land Use Phone: 503- 639 -4171 �ax: -O 1960 Date /By: Case No.: Internet: www.ci.tigWar.us a I Contact Juris.: ® See Page 2 for ect 24 -hour Ins ion R q t g 5 . €0 � S ' " Inspection q , Name /Method: Supplemental Information. GV & j .. WORK . < . , ` '. . .;PLANrREVIEW`(Elease``ch'e kaall tliati'a i `'°`° ; ` } ❑ New construction Demolition amps- ❑ facility IY) _ ❑ Service over 225 am s Health -care facili commercial ❑ Hazardous location ❑ Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet, l r. /.` >'; ,.`;' 1 CATEGORY, OF.jCONSTRUCTIUN... *: ".;," , 1 & 2 family dwellings four or more residential units in ❑ 1 & 2- Family dwelling ❑ Commercial/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 ❑ Other: ❑ Egress /lighting plan ❑ Other: :: `-. - ; :: 4:0WSITE INFORMATION and4LOCATION 'g.'-'''- -'' ' - Submit sets of plans with any of the above. The above are not applicable to temporary construction service. Job site address: 7 . C.7 .s %c'O'- z... 4./v, r . : ;.: : 4 : ; � . , ., , . � °� - .. u� � . �= . ` �;��.�fFEE;��SCHE"DULE.� .�� . �; �:' ° � >,` "AWg Suite #: /W3 W3 Bldg. /Apt. #: Number of inspections per permit allowed Project Name:<'" 1,7 O„ t4l, LPL. Description Qty Fee (ea.) Total New residential- single or multi - family per it Cross street/Directions to job site: 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 - 4. " - z service and/or feeder 90.90 2 y`�� > - ... , „ . rn,.. , �U ,:OF�WORIC:;:�: ::� - ,.. ,° �- ..... Services or feeders - installation, 7-. 5'7 6 7 alteration or relocation: 200 amps or less 80.30 2 201 amps to 400 amps 106.85 2 PROPERTY-O 401 amps to 600 amps 160.60 2 J 4 <^ ®= TENANT „z��, �, ; :r �: ��;, ,` , . '- =_ . 601 amps to 1000 amps 240.60 2 NER rF.$ �.; � � ,�� f Reconnect amps or volts 454.65 2 Name: � Reconnect nett only 66.85 2 Address: Temporary services or feeders - installation, City/State/Zip: alteration, or relocation: y p 200 amps or less 66.85 1 Phone: Fax: 201 amps to 400 amps 100.30 2 4 1 to amps 133.75 2 ® AP,EI WANT ;”. ®*CONTACT' PERSON° : ^,4.' Branch circuits - new, alteration, or Name: extension per panel: Address: A Fee for branch circuits with purchase of service or feeder fee, each branch circuit 6.65 2 City /State /Zip: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit 46.85 2 Phone: Fax: Each additional branch circuit 6.65 2 E -mail: Misc.(Service or feeder not included): };• !, a 1 x '� ;;.. ' �t � :.�t� � „ �� ;�� ., CON,TRAC-�'I'OR,.� � , .. a. �i' -� ., Each pump or irrigation circle 53.40 2 " Each sign or outline lighting 53.40 2 Job No: Signal circuit(s) or a limited energy panel, Business Name: % Ti p alteration, or extension / Page 2 2 Description: #1/4--e--- . Address: 97 ; .. /7 1' rt `) City /State/Zip: Each additional inspection over the allowable in any of the above: Y p Per inspection per hour (min. I hour) 62.50 Phone: ,. 3 - - j J f Fax: a - q 7(�, 7 Investigation fee: CCB Lic. #: Lic. other �c.� �9� # •oZl� -I �� ` ';. 'aNdA4k + •V4M3.rEleci"riial Perinit;Fees* m..s.,' _ 4axveRaarz. Supervising electrician Subtotal $ signature required: Plan Review (25% of Permit Fee) S ' / ✓ .z'© Print Name: Lic. #: State Surcharge (8% of Permit Fee) $ ( . G TOTAL PERMIT FEE $ l� t — o Authorized t�� ./ Notice: This permit application expires if a permit is noned within Signature: `•'l7'—t' Date: 7, y 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. J i t // /A../ (Please •nt name) • is \Dsts \Permit Fomis \ElcPermitApp.doc 01/03 • 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: Audio and Stereo Systems Burglar Alarm n Garage Door Opener n Heating, Ventilation and Air Conditioning System Vacuum Systems El Other COMMERCIAL WORK ONLY: Fee for each system $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: n Audio and Stereo Systems n Boiler Controls n Clock Systems n Data Telecommunication Installation El Fire Alarm Installation n HVAC n Instrumentation ❑ Intercom and Paging Systems n Landscape Irrigation Control ❑ Medical n Nurse Calls n Outdoor Landscape Lighting n Protective Signaling n Other Number of Systems * No licenses are required. Licenses are required for all other installations r \Dsts \Permit Forms\ElcPermitAppPg2.doc 01/03 CITY OF TIGARD 24 -Hour • BUILDING Insp, ctiort Line: (503) 639 -4175 MST INSPECTION DIVISION Business Line: (503) 639 -4171 BUP • Received � L ��� Date � Requested / Z /` SA AM PM BUP Location 770 C'- a c Suite / 7 5 MEC Contact Person Ph ( ) 97/ - Z9J ELM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ' 3 Foundation Access: 3 3? Ftg Drain ELR () 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 4 J rl 3 — c J // S PASS PART FAIL ELECTRICAL _ Service Ro Rough -In �' - - owVo FF arm `� • RT FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. 0 Please call for reinspectiog RE: ' Unable to inspect – no access Fire Supply Line J j ADA t Approach/Sidewalk Date / Inspect L1Lti Other: Final DO NOT REMOVE this inspection record from the Jo site. PASS PART FAIL