Permit CITY OF TIGARD ELECTR ERG
R RESTRICTED ENERGY
1 �� ; ► DEVELOPMENT SERVICES PERMIT #: ELR2004 -00154
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/10/2004
SITE ADDRESS: 06650 SW REDWOOD LN 290 PARCEL: 2S112DA -01400
SUBDIVISION: PP1996 -048 ZONING: I -P
BLOCK: LOT: 002 JURISDICTION: TIG
Project Description: T- stats.
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: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: .
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC REALTY ASSOCIATES PROTEMP ASSOCIATES INC
15350 SW SEQUOIA PKWY #300 -WMI 807 NE COUCH
PORTLAND, OR 97224 PORTLAND, OR 97232
Phone: Phone: 233 - 6911
Reg #: ELE 26- 1063CRE
LIC 38868
SUP 2613LEP
FEES Required Inspections
Description Date Amount Elect'I Final �.A./ VC) LT"C361E
[ELPRMT] ELR Permit 6/10/2004 $75.00
[TAX] 8% State Surcharl 6/10/2004 $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 • UNC at (50 ) 246 -6699.
Issued by Permittee Signature __��
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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
9
1C�il FOR OFFICE USE ONLY
Electrical Permit A pp °�
City of Tigard JUN 0 600 Received Z. /03/ Permit No.: :6 V ., CO/6y
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie `/ r1 /
Phone: 503.639.4171 Fax: 503.598.1 O TIGARD 1, �a ;k�I' Date/By: Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: rums: ® See Page 2 for
Internet: www.ci.tigard.or.us BUILDING DIVISIO Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW " . " -,` . -
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ❑Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF 'CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1 - and 2 family dwellingmmercial/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
Job no.: Job site addres ❑Health -care facility ❑Other:
O s� I� t 'or t� Submit 2 sets of plans with any of the above.
City /State /ZIP: / l 041A2 f .. Z The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name: ��ri twAy�. /_,r' 'j
Description I Qty. I Fee. - I Total I ,.
l �."
Cross street/directions to job site: 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
Limited energy, residential 75.00 2
Tax map /parcel no.:
. Limited energy, non - residential 75.00 2
' DESCRIPTION OF WOR K Each manufactured or modular
• dwelling, service and /or feeder 90.90 2
. s - - 4-S Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
0 PROPERTY OWNER • ' I ❑ 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 l
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)
Phone: ( ) Fax: : ( ) Pump or irrigation circle 53.40 2
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: £
447 Each additional inspection over allowable in any of the above
Address:
9� 5 /7744\ Per inspection 62.50
City/State /ZIP: 72.o.M.› / t ? ;I ^r : Investigation per hour (1 hr min) 62.50
Phone: ( Fax: ) 974.1 Industrial plant per hour 73.75
`091) — ELECTRICAL PERMIT FEES* .
CCB Lic.: s . Electrical Lis ..... /o4 Suprv. Lic..... , 3 4...› Subtotal
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee)
cLIA4--. TOTAL PERMIT FEE
Authorized signatur
This permit application expires if a permit is not obtained within 180
days after It has been accepted as complete
Print name: c i �� Date :,/i0/ • Fee methodology set by Tri -County Building Industry Service Board
V'�
•• Number of inspections per permit allowed.
i:\ Building \Pennits'nLC- PennitApp.doc 12/03 440 4615x(10 /02/COM/WEB
Electrical Permit Application - City of Tigard - -
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: 1
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
El Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
El Vacuum Systems*
El Other:
_ COMMERCIAL WORK • 1
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
❑ Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
•
El 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
i: Building \Prnnits\ELC- PemtitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
7 BUP
Received 1 (co Date Requ sted �� AM PM BUP
Location jl`D� S � ICX c Suite c 71- R 0 MEC
Contact Person 9t/Lo.ry1-4.2 Ph ( ) 5 La - r9 1 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ' Y1 ELC
Footing
Foundation ELC
Access: 4, -tit
Ftg Drain � ELR oZ�
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Drywall on ; CO `i . ,; , � /1/ iL
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
Rough -In
UG/Slab
ow Voltag
- • arm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
El Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA AlfIXTEM-r / Approach/Sidewalk Date? I � " � Y Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL