Permit CITY TI GARO ELECTRICAL PERMIT -
# I DEVELOPMENT SERVICES PERMIT #: ELR2001 -00110
aealv
`..� RESTRICTED ENERGY
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 04/13/2001
SITE ADDRESS: 07319 SW KABLE LN 500 PARCEL: 2S112AC-01500
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -L
BLOCK: LOT: 022 JURISDICTION: TIG
Project Description: Installation of protective signaling, CCTV and Card Access.
Job #083 - 13353 - 01102103.
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: X
INSTRUMENTATION: OTHER: : X
TOTAL # OF SYSTEMS: 3
Owner: Contractor:
PACIFIC REALTY ASSOCIATES ADT SECURITY SERVICES, INC
15350 SW SEQUOIA PKWY #300 -WMI 2815 SW 153RD DR
PORTLAND, OR 97224 BEAVERTON, OR 97006
Phone: Phone: 503 - 469 -7244
Reg #: LIC 59944
ELE 26- 209CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 04/13/2001 $225.00 2720010000 Elect'l Final
5PCT CTR 04/13/2001 $18.00 2720010000
Total $243.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
Issued by ; �! / , d/. Permittee Signature /J/ • u / /
I
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale. lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Permit Application
v 'E Datereceiveda, it q Pe rmit no. � / . pQf/
._ > i( ,� ACi
Ciry� of Tigard Project/appl. no' f Expire date:
it f�Tig A ddress: 13125 SW Hall Blvd, Ti:. d OR 97223
Date issued: By: Receipt no.:
V " Ph90..$ x(503) 639 -4171
p - ax: (503) 598 -1960 / , ff Case file no.: Payment type:
�� 0 Land use approval: V' l v \ .
'''' --- TYPE 'OF PERMIT
❑ 1 & 2 family dwelling or accessory 41•6mmercial/industrial d ❑ Multi- family ❑ Tenant improvement
❑ New construction / ❑ Addition/alteration /replacement ❑ Other: Cl Partial
•
/ S S JOB SITE INFORMATION
Job address: ' 73 jc 5VV g.aby i„A,J1 R. dt Bldg. no.: Suite no.: 1 / fax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name: e- 4d e.t.th'pt -- • I Description and location of work on premises: , IO )l`oJ-v r,c1 Q '
Estimated date of completion/inspectionf
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Q�� Fee Max
Job nes 3 : ) "" O �1 V 1t:Ch - Description Qty. (ea.) Total no insp
Address:
2 815 S.W. b 3 Dr. New residential - single or multi- family per
�yt� dwelling unit Includes attached garage.
City: Be verton, (Rat / Ol.(g•IP: Service included:
Phone:[,/ j jQ- 7Di i. I Fax: go-7110 I E -mail: 1000 sq. ft. or less 4
q 41y pip _ Each additional 500 sq. ft. or portion thereof
CCB no.: i Elec bus. lic. no: ,,_....,/r_ (�(�' Limited energy, residential 2
Ci / etro lic. n•.' Limited energy, non- residential 2
✓ - A t 04 01 Each manufactured home or modular dwelling
11: -. re r p-rvisin: electrtci. ' (required) Date Service and/or feeder 2
Services or feeders — installation,
Sup. elect. name (print):. —& k (tU License no 1 Al
alteration or relocation:
PROPERTY OWNER 200 amps or less v 2
Name (print): • 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: - 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders - -
which is not intended for sale, lease, rent, or exchange according to installation ,alteration,orrelocation:
200 amps or less 2
20
ORS 447, 455, 479, 670, 701. 201 1 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
-- ENGINEER - - -_ - Branch circuits - new, alteration,
_ = or extension per panel: •
Name: A Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E-mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included): •
❑ Service over 225 amps- commercial ❑ Health -care facility Each pump or irrigation circle 2
O Service over 320 amps- rating of 1 &2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O. System over 600 volts nominal more residential units in one structure alteration, or extension* 0 o�oj 2
CI Building over three stories ❑ Feeders, 400 amps or more *Description: ,
O Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan - ❑ Other: Per inspection
Submit sets of plans with any of the above. . Investigation fee
The above are not applicable to temporary construction service. Other
• N�
Permit fee $ —
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
O Visa ❑ MasterCard expires if a permit is not obtained Plan review (at — %) $ p
Credit card number: / I within 180 days after it has been State surcharge (8 %) .... $ �j 4 1�1
Expires accepted as complete. TOTAL $ _ 2
Name of cardholder as shown on credit card
$ ,
•
Cardholder signature Amount 440 -4615 (6/00 /COM)
•
1
t •
•
Electrical Permit Fees: Limited Energy Fees:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
•
Service included: Items Cost Total ' Check Type of Work Involved:
Residential ; per unit
1000 sq. ft. or less $145.15 4 n Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ Burglar Alarm .
Limited Energy $75.00
• Each Manufd Home or Modular Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders n Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less " $80.30 2 ,
201 amps to 400 amps $106:85 2 Vacuum Systems* •
401 amps to 600 amps $160.60 2 s
• 601 amps to 1000 amps $240.60 2 Other
Over 1000 amps or volts $454.65 2
•
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORKdNVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation
200 amps or less $66.85 2 Fee for each system : - :. _ $75.00
201 amps to 400 amps • $100.30 2 (SEE OAR 918 -260 -260)
401 amps to 600 amps $133.75 2
Over 600 amps to 1000 volts, Check Type of Work Involved:
see "b" above.
Branch Circuits n Audio and Stereo Systems
New, alteration or extension per panel
a) The fee for branch circuits Boiler Controls
with purchase of service or
feeder fee. ' n .' Clock Systems
•
Each branch circuit $6.65 2
b) The fee for branch circuits pi Data Telecommunication Installation
without purchase of service
or feeder fee. n Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6.65
•
ri HVAC
Miscellaneous
(Service or feeder not included) 0 Instrumentation
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 ri Intercom and Paging Systems
Signal circuit(s) or a limited energy .
panel, alteration or extension $75.00
Minor Labels (10) $125.00 n Landscape Irrigation Control
Each additional inspection over I Medical •
the allowable in any of the above
Per inspection $62.50 ❑
Per hour $62.50 Nurse Calls
•
•
In Plant $73.75
Outdoor Landscape Lighting
Fees: �---�/
,tom Protective Signaling
Enter total of above fees $ .lJ 1j at ,r(
Other '
8% State Surcharge $
25% Plan Review. Fee ' Number of Systems
See "Plan Review" section on $
front of application. * No licenses are required. Licenses are required for all other installations
Total Balance Due $ Fees:
00
Enter total of above fees ..
❑ Trust Account # ,u 60
• •
8% State Surcharge $ re?' Total Balance Due ia'
is \dsts \forms \elc- fees.doc 10/09/00
OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Busfl ess Line: 639 -4171
BUP
Date Requested q - ( AM PM BLD
Location 7 3 / Suite 5 0 MEC
Contact Person Ph 4 `, • _ T PLM
Contractor 1- DT Ph SWR
BUILDING : Tenant/Owner PQ c.. /°I CC, I ELC
Retaining Wall ELR ��� , 7 d //b
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation 1 / % �
Drywall Nailing Cc f V C 1 � QC �— - 19 2
Firewall
Fire Sprinkler
Fire Alarm
Susp'd•Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING "° '°
Post & Beam
Under Slab F./ q 1 y /�
Top Out ��
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
(11.11111:1F
MECHANICAL „':.• W:y'' <'
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
A T FAIL
ELECTRICA.`
Rough In
UG /Slab
Low Voltage
. Fire Alarm
•.
2116: RT FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspectio Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date - 2 l 'o Inspect /L__ Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.. .