Permit CITY OF TI GA R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
��i DEVELOPMENT SERVICES PERMIT #: ELR2003 -00243
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/10/03
SITE ADDRESS: 17135 SW PACIFIC HWY PARCEL: 2S115C6 -04200
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION: KIN
Proiect Description: Limited energy for HVAC wiring.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATAITELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
TUALATIN VALLEY FIRE & RESCUE STAATS MECHANICAL & MAINTENANCE
20665 SW BLANTON 1910 E MILL PLAIN
ALOHA, OR 97007 • VANCOUVER, WA 98661
Phone: Phone: 360 - 694 - 7596
Reg #: LIC 132591
SUP 426LEP
ELE 742LHR
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 11/10/03 $75.00 Elect'l Final
[TAX] 8% State Tax 11/10/03 $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 _ _ _ Permittee Signature 4'l'\. a..40 / 0_`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
. .
Electrical Permits �plicaio�n • OFFICE USE ONLY
2003 Date received: ia, d ' Permit no.: i / , .00, " •
T •f �ji City of Tigard Al �j 0 Project/appl. no.: Ex•ire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard,.�� T :�� R 97-22 ` �D ' "
h' f S J Date issued: y; Receipt no.:
Phone: (503) 639 -4171 C�� ■
Fax: (503) 598 -1960 BU%LOINC nIVlS10N Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory XiCommercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: /7 / 35 S W pAcIFIC Wy Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: 'Block: I Subdivision:
Project name: 7 i /F'4 !Description and location of work on premises: / ✓r4 C X E/4oiA.T0N S
Estimated date of completion/inspection: - pp -'
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Fee Max
Description Qty. (ea.) Total no.insp
Business name: STAAI'S �EL/,li4NlU�1. /�AIN'Tr�tICE New residential - single or multi - family per
Address: (j4,/ dweIDngutdt .mchsdesattachedgarage.
City: V4#kou VAC I State: IN( ZIP ZIP:4266f Se vicehtcmded:
Phone: Fax: .- ] E -mail: 1000 sq. ft. or less 4
CCB no.: 3z S9 1 'Elec. bus. lic. no: 7421.x(4 • Each additional 500 sq. it or portion thereof
Limited energy, residential > 2
Ci metro lic. - — Limited energy, non - residential 2
Zpo Each manufactured home or modular dwelling
• supervising electrician (required) Date Service and/or feeder 2
Sup. elect name (print): FF' sr. , T License no: ' z(j p Services or feeders- Installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): - 11/c c a 1 e , 1 - J 201 amps to 400 amps 2
Mailing address: 1001 4
Oa) ,41.-) 401 amps to 600 amps 2
601 amps to 1000 amps 2
City: 4-1-0 4-1-0 rf 'L & I State:a.- I ZIP: 7 7 7 Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
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:
ORS 447, 455, 479, 670, 701. 200 amps or less 2 N
201 amps to 400 amps 2 IN
Owner's signature: Date: 401 to 600 amps 2 ``
ENGINEER Branch circuits - new, alteration, 1
Name' or extension per panel:
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
Phone: Fax E -mail' of service or feeder fee, first branch circuit 2
Each additional branch circuit
PLAN REVIEW (Please check all that apply) misc. (Service or feeder not incladed):
❑ Service over 225 amps - commercial 0 Health-care facility Each pump or irrigation circle 2
O Service over 320 amps- rating of 1&2 0 Hazardous location Each sign or outline lighting family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
0 System over 600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over three stories ❑ Feeders, 400 amps or more *Description:
O Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable In any of the above:
O Egress/lighting plan ❑ Other: Per inspection
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 DO
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it bas been State surcharge (8 %) $ •
Expires TOTAL $ , 0
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440 -4615 (6/00 /COM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / / — / AM PM BUP
Location 1 7 13 S ' Suite MEC
Contact Person Ph (. ?c C)) 6, " 3 — 737 1 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner TV a -1 ELC
Footing
ELC
Foundation
Ftg Drain Access: ELR 3- Do a ( it3
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear � S j
Framing f� (�
Insulation 69-‘75 rw/
Drywall Nailing
Firewall Zv /&e
Fire Sprinkler _ V
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 l
Low Voltage
Fire Alarm
PASS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SI El Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date 4 t/ D✓ a Q Inspector , - Ext
_, r Ada— Ada—
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL