Permit ELECTRICAL PERMIT CITY O T I GA R D RESTRICTED ENERGY
r DEVELOPMENT SERVICES PERMIT #: ELR2004 -00110
��, I - ' 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 4/28/2004
SITE ADDRESS: 13545 SW PACIFIC HY PARCEL: 2S102CC -00600
W
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Low voltage. Voice and data wiring.
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:
DDHK VENTURES, LLC PAVELCOMM INC
12604 SW 60TH CT 1640 NW 14TH AVE
PORTLAND, OR 97219 PORTLAND, OR 97209
Phone: 503- 977 -0578 Phone: 503- 223 -5008
Reg #: ELE 26- 559CEP
LIC 00063963
MET 00003259
FEES SUP pakitiped Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 4/28/2004 $75.00 Elect! Final
[TAX] 8% State Surchari 4/28/2004 $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 952-1-0100. You may o tain copies of these rules or direct questions to OUNC at (503) 246 -6699
Issued by 0 4; / i Permittee Signature 0)1 C?
•
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
,
i Electrical P . - tL , f D 'cation
. Datereccivcd: ' D Pcrmitno ' -0O //I)
,•,�rtl,'�t City cep A,�
, ,{, �.� � City of Tigard APR 2 7 ?fin Project/appl. n •.: Expire date:
City of Tigard Address: 13125 SWHalak�lvd.Tigard,E)./47223 Date issued: B Recei tno.:
Phone: (503) 639.41 T 1' P
Fax: (503) 598 - 1960- ILp /NG h Q AR Case fik no.: -n () Payment type: —
Land use approval: /e , oN
TYPE OF PERMIT 1
0 1 & 2 family dwelling or accessory )(Commercial/industrial 0 Multi - family 0 Tenant improvement
0 New construction 0 Addition /alteration/replacement ❑ Other. ❑ Partial
JOB SITE INFORMATION 1
Job address: L7.r- um Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot: Block: Subdivisio
Project name: Description and location of work on premises. ) Wiliffiri�
Estimated datc of completion/inspection: 1 C. RD. rairMIN1 4 .e —
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Tee • Max
. Business name: f r 4 rAr`.lr( Description Qty. (ea.) Total no. Ir p
. Ad, f . fariViffr L / I 0 4_./ New residential - single or ttutMdstrttly per
dwelling unit Includes attached garage.
Cit Sa1iiJ Mr171111MMIEMMAERRomela Ser+lcektehtded:
- "(fit .. ,� A O WY/X. 0 o! 1325111=Mill 1000 sq. fi. or less 4
i j 1 Each additional 500 sq. ft. or portion thereof
CCi3no.: . ' ,I Elec. bus. llc. ..i �y�v/
Limitcd energy. residential 2
0 C y/rnetm lie. n - : /7 //r1 _ � ,�
t / • • � g Limi ted energy, non-residential 2
to a ��f J m,� Each manufactured home or modular dwelling
r ' i ;nature of su • _ .Self.. • �� Service and/or feeder 2
u el ect nam nn / �� $ �� rI / 5cnicesorfeeders- Installation,
p -- Z ��
alteration or rctocution:
PROPERTY OWNER 200 amps or less 2
me
Na (print); /0 _ / _ex; 201 amps to 400 amps - 2
401 amps to 600 amps • 2
Mailing address: 601 amps to 1000 amps 2
• City: I State: (ZIP: Over 1000 amps or volts 2
Phone: I Fax: (E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary sericesor feeders - • -
which is not intended for sale, lease, rent, or exchange according to Installation, alteration,orrelocatlon:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: • _ 401 to two amps 2
ENGINEER Branch circuits - new, alteration,
or extenslon per panel; •
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee. each branch circuit 2
City: State: ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E-mail: or 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);
0 Service over 225 amps-commercial 0 Health -care facility Each pump or irrigation circle 2
0 Service over 320 amps - rating of Iet2 0 Hazardous location Each sign or outline lighting 2
family dwellings O Building over 10.000 square feet four or Signal circuit(s) ora limited energy panel.
0 System over 600 volts nominal more residential units in one stntctute alteration. or extension* 2
0 Building over three stories 0 Feeders. 400 amps or more •Desctiption:
0 Occupant toad over 99 person 0 Manufactured structures or RV park Each additional Inspection over the allowable In any of the above:
0 Egress/lightingplan 0 Other
Per inspection I I
Submit _ sets of plans with any oftlte above. Investigation fee
The above are not applicable to temporary construction service. Other l O o
'Not all jurisdicdoht accept credit cards. pteate call jurisdiction far more infommtion Notice: This permit application Permit fee $ ., /7 •
0 Visa 0 MasterCard cxpircs if a permit is not obtained Plan review (at %) $
Credit card number: — _L _L__ within 180 days after it has bccn State surcharge (8%) $
1e ' accepted as complete. TOTAL $
Name of cardholder as shown on credit card
Cardholder signature - Amount 4404615 (6100/COM)
LPS -d E00/200'd S82 -1 1/0108i;i;80S+ 3NI V1O313AVd -word we89:80 P00Z -2 -JdV
CITY OF TIGARD 24 -Hour
BUILDING Inspection Luiti'!* 503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested t' ` I I � • AM PM BUP
Location I35 -1 (5 PA-c- c--- Hui l / Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR 2401/ 00 I /0
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam 674/74-E-1)
Shear Anchors • l
Ext Sheath/Shear
Int Sheath/Shear
Framing
Inlati
Ds wall on D _ /� 4 7//y
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
F Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
- AS PART FAIL
SITE D Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 6 -a— / Inspector - /`� / , ' p aAT Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL