Permit rp4 CITY OF TIGARD ELECTRICAL -
ENER
RESTRICTED ENERGY
1/I14 DEVE ICES 639 -4171 DATE PERMIT 4 -00050
ISSUED: 2/27 04
SITE ADDRESS: 11643 SW PACIFIC HWY B PARCEL: 1S136CA -01800
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of limited energy for burglar alarm.
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: BURG ALARM X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
MILNE REAL PROPERTIES, INC PHILLIPS ELECTRONICS
P 0 BOX 2740 (DBA FOR MASTER ALARM L.L.C.)
PORTLAND, OR 97208 1110 NW FLANDERS
PORTLAND, OR 97209
Phone: Phone: (ROBERT)
Reg #: LYC2- 508325364
ELE 26- 213CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 2/27/04 $75.00 Elect'I Final
[TAX] 8% State Surchart 2/27/04 $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
starte • in :1 • - . of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
yo o follow rules adopte• • the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 throuc
sued by . . � p& Permittee Signature e.
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
.4 _ Electrical Permit Application
n Datereceived:�) -,27 Permit no.:
.14.1 ji City of .
Tigard g R ECEIVE p Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd Tigard,
Phone: (503) 639 - 4171 FEB Date issued: By: Receipt no.:
Fax: (503) 598 -1960 200 Case file no.: Payment type:
Land use approval: CITY OF TIGARD AftuillooAkvAg
IA ii :1'.' PERMIT
O 1 & 2 family dwelling or accessory 'Commercial/industrial 0 Multi - family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other: 0 Partial
JOB SITE INFORMATION
Job address: //( j .G.9.. icte ' `c 1 (J-: y Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: Subdivision: _J
Project name: ('2ravesr pe &4' I Description and location of work on premises: eceti,lcc �ca. --
Estimated date of completion/inspection:
,.._— - - - C O . I V T R A C Olt.- APPLMAT.LO,N _ __ -_ _ _ . _ . : .: FI, L: S,CREQU LC
Job no: • Fee M ._.
Business name:PG) c G ,,,•, Description Qty. (ea) Total no. insp
New residential - single or multi- family per
Address: 0 pv ,,,,,, ?-Tce.,A..,,&—, f dwelling unit. Includes attached garage.
City fib �Q I State ZIP: F ?2c9w Servicelncluded:
�423.'(.22i`9�3 I 2� c 2 I 100 sq. ft. or less • 4
Phone• F E - mail: q•
Each additional 500 sq. ft. or portion thereof
CCB no.: 62.s: G 4/1/ I Elec. bus. lic. no: 7(..3.0 Limited energy, residential 2
City /metro lic. no.: ,j'(,p3 i�/1/ y Limited energy, non - residential 2 •
Z /Z1 joy Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date ` 1 Service and/or feeder 2
Sup. elect. name (print): ' , j . 4, License no: 2.4 LE Services orfeeders - installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
Mailing address: 401 amps to 600 amps 2
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:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to600am.s 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):
O Service over 225 amps- commercial 0 Health -care facility Each pump or irrigation circle 2
O Service over 320 amps- rating of 1 &2 ❑ Hazardous location Each signor outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, f
O System over 600 volts nominal more residential units in one structure alteration, or extensions ZS 7 /s 2
O Building over three stories 0 Feeders, 400 amps or more +Description:
ii . 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/lighting plan 0 Other. Per inspection
Submit _ sets of plans with any. of the above._ Investi - -- - �- •
The above not applicable to temporary con struction se'r'vice. • ;Other - _ ' '' . ' . ;
Not all jurisdictions accept credit cards, please call jurisdiction for m information. ore infoation. - N otied:- This permit-application Permit fee t $ - 7, ,1,10
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ 4. U
Expires accepted as complete. TOTAL $ / . 0
. Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (M)0/COM)
Electrical Permit Fees: - Limited Energy Fees: r. `
Com lete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 4, Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less , 4
., : T ---- -. • ❑ 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
Dwelling Service or Feeder $90.90 2 ❑ 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
Installation, alteration, or relocation TYPE OF WORK INVOLVED - COMMERCIAL ONLY
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
❑ Audio and Stereo Systems
New, alteration or extension per panel Boiler Controls
a) The fee for branch circuits
with purchase of service or ' ' '
feeder fee. ❑ Clock Systems
Each branch circuit $6.65 2
b) The fee for branch circuits • ❑ Data Telecommunication Installation
without purchase of service
or feeder fee.
First branch circuit $46.85 ❑ Fire Alarm Installation
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous
(Service or feeder not included) • ❑ Instrumentation
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 ...
Signal circuit(s) or a limited energy ❑ Intercom and Paging Systems
panel, alteration or extension $75.00
Minor Labels (10) $125.00 ❑ Landscape Irrigation Control
Each additional inspection over ❑ Medical
the allowable in any of the above
Per inspection $62.50 I �
Per hour $62.50 1 1 Nurse Calls
In Plant $73.75
Fees: ❑ Outdoor Landscape Lighting'
gi Enter total of above fees Protective Signaling
8% State Surcharge $ ❑ Other
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:
❑ Trust Account # Enter total of above fees $ 7
1
8% State Surcharge $ C
Total Balance Due $ �l
i:\dsts \forms \elc- fees.doc 10/09/00
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
2 BUP
Received 9 9e Z 7 Date Re uested 3/f 7 ' AM PM BUP
Location /16 Sea Suite B MEC
Contact Person Ph ( ) PLM
Contractor .t- — - Ph ( 3) Z Z Z — SO ? SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access: ( 5-0
Ftg Drain Crawl Drain
Slab Inspection Notes: Q SIT
Post & Beam p ant.l �.� , ��� '(/ �L.c /LQLd ��/1PJZ/Y�
Shear Anchors o
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
)4 7
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 G a
("Low Vol
Alarm
❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
AS PART FAIL
SITE Please call for reinspection RE Unable to inspect — no access
Fire Supply Line
ADA _ O� %� ���
f
Approach/Sidewalk Date 3 2 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL