Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
- Ili'j DEVELOPMENT H BMEN SERVICES 639 -4171 DATEESSU 8/22/02 2 -00163
SITE ADDRESS: 11975 SW PACIFIC HWY PARCEL: 1S135DD -05000
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Tenant Improvement - data & telecommunications
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
DREW HOFFMAN DAVID CHANDLER ELECTRIC
1281 NE 25TH #M PO BOX 80696
HILLSBORO, OR 97124 PORTLAND, OR 97280
Phone: 503 - 296 -9161 Phone: 503 - 245 -7774
Reg #: LIC 94908
ELE 26 -1081C
SUP 688S
FEES Required Inspections
Type By Date Amount Receipt Ceiling Cover
PRMT CTR 8/22/02 $75.00 2720020000 Wall Cover
Elect'I Final
5PCT CTR 8/22/02 $6.00 2720020000
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 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987. r _
Issued by Permittee Signature '� A_`
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 pp��
SIGNATURE OF SUPR. ELEC'N: ,N W C l DATE: g — 22 - c
LICENSE NO: to ggs
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
„Electrical Permit Application FOR OFFICE USE ONLY
Received Q 2 Z O Electrical
Date/By: Permit No.e/A, „ pDa OD /1e3
City of Tigard Planning Approval Sign
Y g Test F orm DatcBy: PermitNo.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
iV
+'p' 4, Date/By: Case No.:
Internet: www.ci.tigard.or.us e.� Contact Juris.: ❑ See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 W Name/Method: Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
E 11Tew construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑
111 Addition/alteration/replacement El Other: Hazardous
❑ Service over 320 amps - rating of 0 Building over er 10 10,000 square feet,
CATEGORY OF CONSTRUCTION I & 2 family dwellings four or more residential units in
❑ I & 2- Family dwelling [2tommercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
111 Accessory Building ❑ Multi- Family
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION . d LOCATION, Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site addresF % f q 7l S'L,t? ”, C , . FEE* SCHEDULE
Suite #: Bl /Apt.# Number of inspections per permit allowed
Project Name : ,/J(�^,�If 4 . 81f (/-* Description Qty Fee (ea.) Total 1
Cross street/Directions to job site: New residential - single or multi - family per
dwelling unit. Includes attached garage.
Service included:
1000 sq. R. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Subdivision: Lot #: Limited energy, residential 75.00 2
Limited energy, non residential t 75.00 7. 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF ORK service and/or feeder 90.90 2
1.. T 1)0 1 e Le` ( ' Services or feeders - Installation,
�yL � alteration or relocation:
��// 200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
13110 W I8l O " y " yl TENANT 601 amps to 1000 amps 240.60 2
Name Over 1000 amps or volts 454.65 2
Ad c 4 j �' f ` l .I Q Reconnect only 66.85 2
Address: l i qg S co 7 � 6cL�C 4 Temporary services or feeders - installation,
p 1-f a / !� � 7 / 2 2 or relocation:
Cit y /State /Zi /-c( VIA 2000 0 a amps or less 66.85 1
Phone: 9 ef$ _ ,5 T sg a Fax: /®.. 30q / 201 amps to 400 amps 100.30 2
❑ APPLICANT ONTACT PERSON 401 to 600 amps 133.75 2
Branch circuits - new, alteration, or
Name: u Fleei, 1,Le. extension per panel:
Address:,„� t 0) , /06 6 A. Fee for branch circuits with purchase of 6.65 2
service or feeder fee, each branch circuit
City /State /Zip: R) r-()L cra 9-12.5' (� V B. Fee for branch circuits without purchase of
Phone: 4.45-- 77 I r ax: Z K C' �/ O jS ry If service or feeder fee, first branch circuit 46.85 2
'I Each additional branch circuit 6.65 2
X E -mail: 60 L ,,, 1 � yl w C i ti , co 1n., Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: I A - - _ �� Signal circuit(s) or a limited energy panel,
alteration, or extension* 75.00 2
Business Name: ■ , • .i p •� : m *Description:
Address: O r *t
o k 3 0- ,
City /State /Zip: f 0 t, OA q 7 2_3 O Each additional inspection over the allowable in any of the above:
Per inspection (per hour - min. I hour) 62.50
Phone: Z qS -') 77 Y F 2 y 4 -4034 Investigation fee:
CCB Lic. #: T./go g I Lic. #: g 1p - I O' Z Other:
Electrical Permit Fees*
Supervising electricia Subtotal $
Signature re aired: .---- Plan Review (25% of Permit Fee) $
Print Name: W t ic. #: DOS State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
Authorized Si tyltz.
. lib • 4 �` - 2a. c Notice: This permit application expires if a permit is not obtained within
ate: L 180 days after it has been accepted as complete.
k)Z,-t w C ,C .1 @ e *F ee methodology set by Tri -County Building Industry Service Board.
(Please print name)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTIONpIV;SION Business Line: (503) 639 -4171 MST
• BUP
Received Date Re ue ed 4 , AM PM BUP
_
D `
Location 11 9 7 , _ 4 Suite MEC
Contact Person Ph ( ) 773 - 333 PLM
Contractor D C 7 Lk 4 CA / A f t F&Ef ritPh ( ) ‘n 5 SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR J /44
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors -
Ext Sheath/Shear
Int Sheath/Shear V
Framing
Insulation
Drywall Nailing
Firewall �
Fire Sprinkler ��C� uo�'6 " '
Fire Alarm
Susp'd Ceiling e• A
Other: 1110
�� :
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
Slab
•w Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
❑ Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date x — 02___ Inspector • — A Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL