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Permit
CITY OF TIGARD ELECTRICAL PERMIT - RESTRICTED ENERGY ss� DEVELOPMENT SERVICES PERMIT #: ELR2004 -00232 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/27/2004 SITE ADDRESS: 13815 SW PACIFIC HWY 60 PARCEL: 2S103DD -00800 SUBDIVISION: ZONING: C -G BLOCK: LOT: JURISDICTION: TIG Project Description: Voice and Data. 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: D.W. SIVERS COMPANY HENKELS & MCCOY INC 4730 SW MACADAM AVE PO BOX 20009 #101 PORTLAND, OR 97220 PORTLAND„ OR 97201 Phone: 503- 223 -2680 Phone: 255 -5125 Reg #: ELE 26- 895CLE LIC 63699 FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 7/27/2004 $75.00 Elect! Final [TAX] 8% State Surchar€ 7/27/2004 $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 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699. Issued by 4 . iI / � � 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 SIGNATURE OF SUPR. ELEC'N DATE: LICENSE NO: Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day Ele trical Permit A licati l FOR OFFICE USE ONLY Fr 6 City of Tigard ,�.. �� Date/B : © g As I6 Permit No " : ODaf — r O -_ 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revi w Phone: 503.639.4171 Fax: 503.598.1960' 7UP,4 / / ",w v,1 +' DateB : Other Permit: Inspection Line: 503.639.4175 _AI, e' I i Date Ready/By: MN El See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information T Y P E OF •WORK' • . : . .- . . R E V I E W - ' ❑ New construction 'Q Addition/alteration/replacement Please check all that apply: ❑ Demolition ❑Other: ❑Service over 225 amps, comm'I ❑Hazardous location ❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft., . CATEGORY OF CONSTRUCTION, 7 . of 1- and 2- family dwellings 4 or more new residential ❑ 1- and 2- family dwelling al Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi - family ❑Master builder ❑Other: ❑Building over three stories ❑Feeders, 400 amps or more ❑Occupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park ,//+ ❑Health -care facility ❑Other: Job no.: Job site address: / 3 8 S S Gt1 Pa C IA C Submit 2 sets of plans with any of the above. City/State /ZIP: 77 y , d O R 9 a 3 The above are not applicable to temporary construction service. FEE * - SCHEDULE Suite/bldg. /apt. no.: 60 Project n r w 1 e y 4 C. j ! •• Description Qty. Fee. Total Cross street/directions to job site: MI A) tell? /..2-/(C New residential single - or multi - family dwelling unit. Includes attached garage. • _ 1,000 sq. ft. or less 145.15 4 Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: • Limited energy, residential 75.00 2 Limited energy, non - residential 75.00 2 . DESCRIPTION OF WORK - Each manufactured or modular • //o1 4. t D A 1'1 - re R kM v dwelling, service and /or feeder 90.90 _ 2 Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER ❑ TENANT. 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/State/ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2 Owner signature: Date: Branch circuits — new, alteration, or extension, per panel ❑ APPLICANT : . I " ❑ CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each 6.65 2 Business name: branch circuit B. Fee for branch circuits Contact name: without service or feeder fee, each branch circuit 46.85 2 Address: - Each add'l branch circuit 6.65 2 City/State/ZIP: Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 2 Phone: ( ) Fax:: ( ) Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited- CONTRACTOR energy panel, alteration, or extension. Describe: Page 2 2 Business name: He N k e / 4 4. me G e, s Address: y. _ Each additional inspection over allowable in any of the above S Gpo 04 / A vL Per inspection 62.50 City/State /ZIP: �� ,..71/4 ,..a d o n ,, Investigation per hour (I hr min) 62.50 Phone: (56 3) 2 S s - s) Z f Fax: ( ) g - v 7 Industrial plant per hour 73.75 • ELECTRICAL PERMIT FEES* CCB Lic.:Z6_ 6 - Electrical Lic.: 636 9 9 — Suprv. Lic.: 5 6 3 LEIS Subtotal 7 — - Suprv. Electr si gna�tufe, required: Plan review (25% of permit fee) Print name: ( ^ / Aj de is o I,/ Date: -7 -.27 — a . , State surcharge (8% of permit fee) TOTAL PERMIT FEE g , 00 Authorized signature: /47 �&...----_ This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: L / i1 hi d e's vv.) Date: 7- a ) - a y • Fee methodology set by Tri- County Building Industry Service Board h •• Number of inspections per permit allowed. is Buiiding \Permits\BLC- PermitApp.doc 12/03 440- 4615T(10 /02/COht/WBB Electrical Permit Application - City of Tigard -� Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: �: RESIDENTIAL WORK ONLY:' Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial system $75.00 • (SEE OAR 918 - 260 - 260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems Zr Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling El Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations is BuildingTemtitskELC- PemtitApp.doe 04/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP 1 2 Received Date Requested - °Z AM PM BUP Location ) Suite 4 MEC Contact Person Ph ( ) 57.2- PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR ( 206 - 0 6 0?-3.. < Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation DD ,e� /° f) FOIL- F N 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 arm PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. Please call for reinspection RE: Unable to inspect - no access Fire Supply Line ADA �j q / Net,E6Em4 Approach/Sidewalk Date 1 2 + _07 Inspect ( - / Est Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL