Permit • - CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
I DEVELOPMENT SERVICES PERMIT #: ELR2001 -00168
A II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/20/01
SITE ADDRESS: 15660 SW PACIFIC HWY A -2 PARCEL: 2S110DC -02200
SUBDIVISION: WILLOW BROOK FARM ZONING: C -G
BLOCK: LOT: 011 JURISDICTION: TIG
Proiect Description: Installation of burglar alarm system. Job No. 10610113
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:
TIGARD, CENTER LP PROTECTION ONE ALARM MONITORIN
9777 WILSHIRE BLVD #609 15500 SW 72ND AVE
BEVERLY HILL, CA 90212 PORTLAND, OR 97224
Phone: Phone: 624 -0244
Reg #: ELE 34- 428CCLE
LIC 116325
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 6/20/01 $75.00 2720010000 Elect'l Final
5PCT CTR 6/20/01 $6.00 2720010000
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
requ' you to o w rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 - 001 -0010 throu OAR 952 -0 0080. You may obtain copies of these rules or direct ueslions to OUNC at (503)
2 6 -1987.
Iss ed by Permittee Signature
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 Permit Application
Date received: Permit a4'f - ''7 l,
rrr+p � � • Tigard ;..i I City of Til Proj ect/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory "at'ommercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration /replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address:/ la_< r • w y Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: 'Subdivision:
Project name: I Description and location of work on premises: 4,„ f f„,,,Q 0 _ €. ,.. yr (� & ,, r .syl
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: /O 676 f ij Fee Max
� / Description Qty. (ea.) Total no. insp
Business name: ]
-G �.-�7T o l�n New residential - single or multi- family per
Address: pd 2 42 5Z, /O"d dwelling unit. Includes attached garage.
City:l��y� /, ,7,4 I State I ZIP: 4/?2, .Z '7 Service included
Phone: - -07 5<5 I Fax: ?/D 8r I E -mail: 1000 sq. ft. or less 4
3 � P :- Each additional 500 sq. ft. or portion thereof
CCB o.: IL5 L5 I Elec. bus. lie. no: Limited energy, residential 2
t m" c. no • Limited energy, non- residential 2
/ t Each manufactured home or modular dwelling
: ign. re of supe ising electrician (required) Date 4 �ae2 —!>/ Service and/or feeder 2
S •. elect.nam =.61 a License no: r�7��Servicesorfeeders — installation,
alteration or relocation:
PROPERTY OWNER 200 - amps or less 2
Mir t): ,. dt0� -, -.OT d 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: / 6( ,5).‘1 7,--c,. /-145rry 601 amps to 1000 amps 2
City: F/ d ,-- I Stateep I ZIP: 9 ?p_ �� Over 1000 amps or volts 2
Phone :4_ _/ �/J I Fax: I E-mail:
Reconnect only t
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:
200 amps or less 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 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
0 Service over 320 amps - rating of 1&2 O Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O o� System over 600 volts nominal more residential units in one structure alteration, or extension* / / 2
O Building over three stories O Feeders, 400 amps or more *Description:
O Occupant load over 99 persons O Manufactured structures or RV park Each additional inspection over the allowable In any of the above:
O Egress/lightingplan 0 Other. Per inspection I
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee $ '75; 0-69
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: I / within 180 days after it has been State surcharge (8 %) .... $ • vr7
Name of cardholder as shown on credit card Expires accepted as complete. TOTAL $ . d v
$
Cardholder signature Amount 440 -4615 (6100/COM)
I
Electrical Permit Fees: Limited Energy Fees: .
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total y Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or El portion thereof $33.40 1 I I Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular Door Opener'
Dwelling Service or Feeder $90.90 2
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2 Vacuum Systems
201 amps to 400 amps $106.85 2
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 TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918 - 260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts, ❑
see "b" above. Audio and Stereo Systems
Branch Circuits ❑ Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85 HVAC
Each additional branch circuit $6.65 ❑
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 ❑ Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal panel� alteration or extension $75.00 D Landscape Irrigation Control
Minor Labels (10) $125.00
Medical
Each additional inspection over
the allowable in any of the above Calls
Per inspection $62.50
Per hour $62.50 , ❑
In Plant $73.75 Outdoor Landscape Lighting
Fees: ❑ Protective Signaling
Enter total of above fees $ El Other
8% State Surcharge $ Number of Systems
25% Plan Review Fee * No licenses are required. Licenses are required for all other installations
See "Plan Review" section on $
front of application.
Fees:
Total Balance Due $
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
i:\dsts\forms \elc- fees.doc 10/09/00
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested Z Z- AM PM BLD
Location / S ( S4 ff¢ Cl / L ' tr , Z Suite MEC
Contact Perso427Ve / Ph z'' 0 �J~f 14 Z l 4LM
Contractor GO'/ D rl D`! Ph SWR
BUILDING Tenant/Owner ,6ly 9 /h. rD ELC
Retaining Wall ELR ZC/u
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear C CJ ri y hiler r m
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab )Q /
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas
Smoke e Dampers
Final
PASS PART FAIL
Rough In
UG /Slab
Low Voltage
Fire Alarm
4 PART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ I Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk
Other � Date � 2 - 3 / Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.