Permit RESTRICTEDE
CITY OF TIGARD ERG
RESTRICTED ENERGY
•ll Aity DEVELOPMENT SERVICES PERMIT #: ELR2002 -00221
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: . 10/15/02
SITE ADDRESS: 11636 SW PACIFIC HWY PARCEL: 1S136DB -02500
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of security cabling.
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: SECURITY X
TOTAL .# OF SYSTEMS: 1
Owner: Contractor:
NACHTIGAL, FRED C SUC PERS REP CAPITOL DATA & COMMUNICATIONS
KESSLER, JULES E 12810 NE AIRPORT WAY
101 SW WASHINGTON ST PORTLAND, OR 97230 -1029
HILLSBORO, OR 97123
Phone: 503- 255 -9488 Phone: 503- 255 -9488
Reg #: LIC 142457
ELE 26- 1054CLE
SUP 3132S
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 10/15/02 $75.00 Elect'I Final
[TAX] 8% State Tax 10/15/02 $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 throuc
Issued by �f� Permittee Signature o- / r',L /C 9770N
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
IC
- � a Electrical Permit Applicatio ' E USE ONLY
D received: /� t 'emit no.:. _do
Pro'ectla no.. Ex 'ire date:
.rAlii Q ir C ity of Tigard iV t F Date issued: � �
� ,
� Recei s t no.:
CITY e7 TIGARD Address: 13125 SW HALL BLVD, TIGARD Case file no.: Pa ent 1. e:
t 1 / Phone: (503) 639 -4171 Fax (503) 598-1960 t VII)
1 � `V Land use approval: 0(',I r A ��� a _0O24 O
TYPE OF PERMIT
❑ 1 & 2 family dewlling or accessory ❑ Commercial/ndiistrial -- ' ` ❑ Multi- family ❑ Tenant improvement
0 New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
.10B SITE INFORMATION
Job address: 11636 SW PACIFIC HIGHWAY City: TIGARD Bldg. No.: Suite no.: Tax map /tax lot/account no.:
Lot: 'Block: N/A (Subdivision:
Project name: STARBUCKS (Description and location of work on premises: SECURITY CABLING
Estimated date of completion/ins.ection: 10/15/02
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: C22 -215 Fee Max.
Business Name: CAPITOL DATA /COMMUNICATIONS Description Qty. (ea.) Total no. insp
Address: 12810 NE Airport Way New residential - single or multi - family per
City: Portland State: OR ZIP: 97230 - 1029 dwelling unit. Includes attached garage.
Phone: 503 - 255 - 9488 'Fax: 257 -7121 1E-mail: ray @cepdx.com Service included:
CCB no.: 142457 !Elec. bus. lic.no: 26- 1054CLE 1000 sq, ft, or less $ 145.15 4
City/metro lic.no • ' " /0 /3 /0' Each additional 500 sq. ft. or portion thereof $ 33.40
10/1/02 Limited energy residential $ 75.00 2
Signature of supervising electrician (required) Date /O /Vey Limited energy, non - residential $ 45.00 2
Sup. elect. name (print): Richard Martin License no.: 2865 - Each manufactured home or modular dwelling
PROPERTY OWNER Service and/or feeder $ 90.90 2
Name (print): Services or feeders - installation,
Mailing address: alteration or relocation:
City: State: 'ZIP: 200 amps or less $ 80.30 2
Phone: Fax: 1E-mail: 201 amps to 400 amps $ 106.85 2
Owner installation: The installation is being made on property I own 401 amps to 600 amps $ 160.60 2
which is not intended for sale, lease, rent, or exchange according to 601 amps to 1000 amps $ 240.60 2
ORS 447, 455, 479, 670, 701. Over 1000 amps or volts $ 454.65 2
Owner's signature: Date: Reconnect only $ 66.85 1
ENGINEER Temporary services or feeders -
Name: installation, alterations, or relocation: •
Address: 200 amps or less $ 66.85 2
City: State: ZIP: 201 amps to 400 amps $ 100.30 2
Phone: Fax: E -mail: 401 amps to 600 amps $ 133.75 2
PLAN REVIEW (Please check all that apply) Branch circuits - new, alteration,
❑ Service over 225 amps - commercial ❑ Health -care facility or extension per panel:
❑ Service over 320 amps - rating of l &2 ❑ Hazardous location A. Fee for branch circuits with purchase of
family dwellings ❑ Building over 10,000 square ft. four or service or feeder fee, each branch circuit $ 6.65 2
❑ System over 600 volts nominal more residential units in one structure B. Fee for branch circuits without purchase
❑ Building over three stories ❑ Feeders, 400 amps or more of service or feeder fee, first branch circuit: $ 46.85 2
❑ Occupant load over 99 persons ❑ Manufactures structures or RV Park Each additional branch circuit: $ 6.65
❑ Egress/lighting plan ❑ Other: Misc. (Service or feeder not included):
Submit sets of plans with any of the above. Each pump or irrigation circle $ 53.40 2
The above are not a i livable to temnorary construction service. Each sign or outline lighting $ 53.40 2
Signal circuit(s) or a limited energy panel,
alteration, or extension' 1 $ 75.00 _ 75.00 2
*Description:
Each additional inspectionover th allowable in any of the above:
Per inspection I I $ 62.50 I I
Investigation fee
Other
❑ Visa ❑ MasterCard Permit fee $ 75.00
Credit card number: / / Notice: this permit application Plan review ( ) $
Expires expires if a permit is not obtained State Surcharge( 8% ) $ 6.00
Name of cardholder as shown on credit card
$ withing 180 days after it has been TOTAL $ 81.00
Cardholder signature Amount accepted as complete.
CITY OF TIGARD 24 -Hour
• v BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested I ( I /2 AM PM BUP
Location 1) 40 34 P4'(4-4-;' Suite MEC
Contact Person K — Ph ( ) G.c. 3 - //3, PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ,.[■tj) ELC a - 0 °SY3
Footing ELC Q - 5
' Foundation Access:
Ftg Drain ELR O) - ex, A'A V
Crawl Drain
C. Slab Inspection Notes: SITe��/ ►
Post & Beam O'd Co yr, rv"fri / c ° con
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
PASS PART FAIL
ELECTRICAL
Service
Rough -In -t�µ
UG /Slab
Low Voltage
Fir Alarm
PART FAIL ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SI Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA Date /IUD(, 11
Approach/Sidewalk /OA Inspector ^ o _ . _ o. Ext
•
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL