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Permit > • ` CIT� OF TI��RD ELECTRICAL PERMIT - . RESTRICTED ENERGY ;tN DEVELOPMENT SERVICES PERMIT #: ELR2002 -00239 - �� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/7/02 SITE ADDRESS: 11530 SW PACIFIC HWY PARCEL: 1S136DA -00700 SUBDIVISION: ZONING: C -G BLOCK: LOT: JURISDICTION: TIG Project Description: Low voltage for HVAC T- stats. 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: HI HAT INC ARROW MECHANICAL 11530 SW BARBUR BLVD 10330 SW TUALATIN RD PORTLAND, OR 97219 TUALATIN, OR 97062 Phone: Phone: Reg #: MET 00002476 LIC 00005193 ELE 34 -47CEP FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 11/7/02 $75.00 Elect'I Final [TAX] 8% State Tax 11/7/02 $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 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699. Issued by 1..( �� 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 (�'flt , C.pA 4Th— DATE: LICENSE NO: Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day • I Electrical Permit Application Date received: / / -7 -D Z Permit no. dG --t:20 9 do } � ` 1 I =, ,14. I I City of Tigard Project/appl.no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By:' 4 Receipt no.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement ❑ New construction *ddition/alteration/replacement ❑ Other: ❑ Partial JOB SITE INFORMATION Job address: , j :40 Std "?ai� _rrr.�. B(j) Bldg. no.: Suite no.: Tax map /tax lot/account no.: . Lot: Block: 'Subdivision: \-) f • Project name: 1 .-j4. Description and location of work on premises: f - 63)N't 214V Lv ) Estimated date of completion/inspection: j` _4p ,1 ;, La1�� . ItiJI 12 CONTRACTOR APPLICATION \-------- FEE SCHEDULE Job no: 4.t-1 Aer— Fee Max Business name: ,8t) patea..w 1 Litz_ co Description New residential - sit Qty. (ea.) Total no. insp I -single or multi - family per Address: a 0 4 s(..,), T1 iA L dwelling unit. Includes attached garage. City: Statj(� � �` ZIP: ) 2 Service included: Phon . [ e I Fa J-) Y / / I E -mail: 1000 sq. ft. or less 4 '` Each additional 500 sq. ft. or portion thereof CCB no.: 57 3 Elec. bus. lie. no-] �.1 Cc� Limited energy, residential 2 City /metro lie. no.: 7 b Limited energy, non-residential 2 1 -1a-02- Each manufactured home or modular dwelling Signatur o s pervi electrician (required) Date Service and/or feeder 2 ` l – I L t License no Services or feeders – installation, Sup. elect. name (print): • ('�'R� Z r �� alteration or relocation: PROPERTY OWNER 200 amps or less 2 Name (print): r ,i, lU 1_04A4,e, 201 amps to 400 amps 2 401 amps to 600 amps 2 Mailing address: I I 3 C 5,,.)1 r Wo 601 amps to 1000 amps 2 City: M g-era° Star I ZIP. 2.2, Over 1000 amps or volts 2 Phonl --i-Qcc I Fax: 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, or relocation: 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 Phone: Fax: E -mail: of service or feeder fee, first branch circuit: 2 Each additional branch circuit: • PLAN REVIEW (Please check all that apply) Misc.(Service or feeder not included): O Service over 225 amps- commercial O Health -care facility Each pump or irrigation circle 2 O Service over 320 amps- rating of 1 &2 0 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* 2 O Building over three stories ❑ Feeders, 400 amps or more *Description: 0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above: O Egress/lightingplan Other. T ri Per inspection Submit _ sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ -7 -d0 Cl Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $ Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ (o .00 Expires accepted as complete. TOTAL $ I . 00) Name of cardholder as shown on credit card $ Cardholder signature Amount 440-4615 (6/00/COM) • • ELECTRICAL PERMIT FEES: - LIMITED ENERGY PERMIT 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 ❑ _ Audio and Stereo Systems Each additional 500 sq. ft. or portion thereof $33.40 1 I I Burglar Alarm Limited Energy $75.00 Each Manufd Home or Modular Dwelling Service or Feeder $90.90 2 n Garage Door Opener Services or Feeders ❑ 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 2 601 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 WORK INVOLVED - COMMERCIAL ONLY Installation, alteration, or relocation Fee for each system $75.00 200 amps or less $66.85 2 (SEE OAR 918 -260 -260) - 201 amps to 400 amps $100.30 2 401 amps to 600 amps $133.75 2 Check Type of Work Involved: Over 600 amps to 1000 volts. see "b" above. n Audio and Stereo Systems Branch Circuits ❑ New, alteration or extension per panel Boiler Controls a) The fee for branch circuits with purchase of service or ❑ Clock Systems • feeder fee. Each branch circuit $6.65 2 ❑ Data Telecommunication Installation b) The fee for branch circuits without purchase of service or feeder fee. ❑ Fire Alarm Installation First branch circuit $46.85 Each additional branch circuit $6.65 HV • Miscellaneous ❑ Instrumentation (Service or feeder not included) Each pump or irrigation circle $53.40 Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems Signal circuit(s) or a limited energy panel, alteration or extension $75.00 ❑ Landscape Irrigation Control Minor Labels (10) $125.00 • Each additional inspection over ❑ Medical the allowable in any of the above - • Per inspection $62.50 • ❑ Nurse Calls Per hour $62.50 In Plant $73.75 ❑ Outdoor Landscape Lighting Fees: - ❑ Protective Signaling Enter total of above fees $ n Other . • 8% State Surcharge $ . I. Number of Systems 25% Plan Review Fee See "Plan Review" section on $ No licenses are required. Licenses are required for all other installations front of application. Fees: Total Balance Due $ Enter total of above fees $ ❑ Trust Account # 8% State Surcharge $ • Total Balance Due $ • i:\dsts\forms \elc- fees.doc 0 6/07/01 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Reques ed ,°"" ' AM PM BUP Location 1 t 5 Suite MEC Contact Person Ph ( ) 7 q S7)X-- PLM Contractor 11 ��Ph ( ) SWR BUILDING Tenant/Owner /` C; ELC Footing ELC Foundation Access: Ftg Drain / ELR 0 2 — dam a- 3 y Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation ii4C)6r 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 fl Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL 0 Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line / ADA ^ Approach/Sidewalk Date 6 • _ Inspecter'IV Ext Other: Final DO NOT REMOVE this inspection record from th job site. PASS PART FAIL