Permit I
CITY O F T I G A R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
—AI- c ,�l�� DEVELOPMENT SERVICES PERMIT #: ELR2004 -00098
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/13/04
SITE ADDRESS: 06650 SW REDWOOD LN 180 PARCEL: 2S112DA -01400
SUBDIVISION: PP1996 -048 ZONING: I -P
BLOCK: LOT: 002 JURISDICTION: TIG
Project Description: Limited energy for data telecommunications system.
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:
PACIFIC REALTY ASSOCIATES STEELHEAD ELECTRIC INC
15350 SW SEQUOIA PKWY #300 -WMI 207 JERSEY ST
PORTLAND, OR 97224 SILVERTON, OR 97381
•
Phone: Phone: 503 873 - 4496
Reg #: LIC 135010
ELE 24 -419C
SUP 4821S
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 4/13/04 $75.00 Elect' Final
[TAX] 8% State Surchari 4/13/04 $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 = • . = . dopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 throuc
- sued by j „i�j[� / �' , �, i ; Permittee Signaturek
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
E�1 ctric.al Permit Application FOR OFFICE USE ONLY
City of Tigard Received '/
13125 SW Hall Blvd., Tigard, OR 97223 Plan R /1 DY Review
'"
Phone: 503.639.4171 Fax: 503.598.1960 � i�na A y M D : Other Permit.
Inspection Line: 503.639.4175 F' Date ReadyBy: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TY OF WORK . . - ..:,,,' PLAN REVIEW. :.-
❑ New construction ( Addition /alteration/replacement l Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l 0 Hazardous location
i20 mpg ,,
CATEGORY OF CONSTRUCTION ❑Servof 1 -and ce over 2- fa a dwellings s — rating ❑Bullrin 4 or more over new 10 residential 000 sq. ft.
❑ 1 and 2 family dwelling [ ' 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/lightingplan RV park
�S'c3 /�,C AGO 8 ` . I ❑Health -care facility ❑Other:
Job no.: Job site address: o / ` oV tCJ /V
Submit 2 sets of plans with any of the above.
City/State/ZIP: r �c4bu 0k ! /.,-Z/ The above are not applicable to temporary construction service.
ga
OD •ldg. /apt. no.: J 8"0 I Project namtr,V 6l Fr ko iT ' Oti in I D FEE* SCHEDULE • i. 'i.`,
`^ Description I Qty. I Fee. I Total I •
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
/ Includes attached garage.
S i) I 0 / /tI P k'u) V 1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'1500 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
dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
I , / PROPERTY OWNER I f❑ TENANT. . 201 amps to 400 amps 106.85 2
/ / �I M 401 amps to 600 amps 160.60 2
Name: PA G / F� C /' , /yC1 4 S [ 601 amps to 1,000 amps 240.60 2
Address: / 5 S� �` (N \ �y ( /0 / 4p Pl y S f / f/: \j A, Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: ib//c' A/t/DQ (/° " 7z; 9' Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) uu 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 .. ❑ CONTACT PERSON A. Fee for branch circuits with
6.65 2
�,`; ♦
service or feeder fee, each
Business name: • 1. � , . •.:; "+r <� /�`� / 7,, branch circuit
B. Fee for branch circuits
Contact name: s' without service or feeder fee, 46.85 2
Address: each branch circuit
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:
( ) I Fax: : ( )
. Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR Xenerpy panel, alteration, or
Business name: S I rvC/�Q�
�e/d r /�� � `"
G � /„ S � �
C extension Dec r [ Page 2 2
Address: 1 S"�Q A)h z I/1� 6 , 0 J Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: � /VM ( ) G e Investigation per hour (1 hr min) 62.50
Phone: , / 99 _ l / Q Fax: ( ' O � ) y 9 622 Cs Industrial plant per hour 73.75
v / I + ELECTRICAL PERMIT FEES*
CCB Lic.: ) ..S1.3 1 Electrical Lic.: i OS I Suprv. Lic.: � �'t tad ego Su 75 . v
Suprv. Electrician signature, required: _a Plan review (25% of permit fee)
Print name: / N / U4/1/s Date: y --- g -0 y State surcharge (8% of permit fee) 0. 0 t)
TOTAL PERMIT FEE D/ • CO
Authorized signature: This permit application expires if a permit is not obtained within 180
days after It has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
• • Number of inspections per permit allowed.
i:\ Building \Perrnits\ELC- PerrnitApp.doc 12/03 440.4615r(10/02/COM/WEB
Electrical Permit Application - City of Tigard - T
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*
El Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY j
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
El Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
El Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i: Bui lding\Permits\ELC- PertnitApp.dot 04/03
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 c' (t .c? ' ` Suite /Z MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ..4/1 ELC
Footing ELC
Foundation Access: Drain ELR —
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
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
Fi e Alarm
,40111-% 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
*A - PART FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA pp ^ 1(�(� Ext
Approach/Sidewalk Date �� Inspector �" , "�
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL