Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
A DEVELOPMENT BM SO R 9 OR 97223 -00297
(503) 639 -4171 'DATE ISSUED: E %20/00
- 13125
SW
SITE ADDRESS: 06825 SW SANDBURG ST PARCEL: 2S101 DD -00400
SUBDIVISION: SALEM FREEWAY SUBDIVISION ZONING: C -P
BLOCK: LOT: 001 JURISDICTION: TIG
Project Description: Tenant Improvement - HVAC
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:
TOTAL # OF SYSTEMS:
Owner: Contractor:
TOC MANAGEMENT SERVICES AMERICAN HEATING
6825 SW SANDBURG STREET 1339 SW GIDEON ST
TIGARD, OR 97223 PORTLAND, OR 97202
Phone: 620 -1710 Phone: 239 -4600
Reg #: LIC 00033135
ELE 26- 683CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 12/20/00 $75.00 2720000000 Elect'l Final
5PCT CTR 12/20/00 $6.00 2720000000
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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
Issued by / �Q /rn Permittee Signature
INSTALLATION 0 '
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 Permit Application
Datereceived: 1 $ Permit no.: ADD � DD 2 l
u,Fr�. .' � ti ` 1
,.� I City of Tigard Project/appl. no.: Expire date: .
City ofTigard 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 XCommercial/industrial ❑ Multi - family ❑ Tenant improvement
1$(New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: �.S 5&.&) i i bi t ...pl_ s+ Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: � I Block: I Subdivision: U
Project name: -n .C. ma, & n '.t44-Description and location of work on premises:
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: 2 - 00 Fee Max
Business name: r 1 ,-, �� V Description Qty. (en.) Total no. insp
" x New residential - single or multi- family per
Address: 133'1 S.... 6 la Q tM
dwellingunit. Includes attached garage. '
City: 1>'-4 I State MI Z1P:g1202 Sersiceincluded:
Phone QN -4t0 I Faxt3 -'A 381 E -mail: 1000 sq. ft. or less 4
CCB no.: 33 I3G I Elec. bus. lic. no: Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
Cit me tic. no.: iD Limited energy, non- residential 2
��(�� 0---'49 Each manufactured home or modular dwelling
a fore of supervising electr inn ( Date Service and/or feeder 2
Sup. elect. name (print) a,ra t1 i ,,, & License no: , 1'i2v( Services or Feeders — installation,
" t' O \1'NER alteration or relocation:
PRVPER7
200 amps or less 2
Name (print): 201 amps to 400 amps 2
Mailing address: 401 amps to 600 amps 2
601 amps to 1000 amps 2
City: I State: 1 ZIP: 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
201 amps to 400 amps 2
Owner's signature: Date: 401 to600am.s 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: . 1 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 included):
O Service over 225 amps- commercial O Health -care facility Each pump or irrigation circle 2
U Service over 320 amps- rating of 1&2 Cl Hazardous location Each sign or outline lighting 2
family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure - alteration, or extension* I 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/lighting plan O 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 $
O Visa 0 MasterCard expires if a permit is not obtained' Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (6/00/COM)
Electrical Permit Fees: Limited Energy Fees:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
P Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 4
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
portion thereof $33.40. • 1
Limited Energy $75.00 ❑ Burglar Alarm
Each Manufd Home or Modular ❑
Dwelling Service or Feeder $90.90 2 Garage Door Opener*
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation
200 amps or less $80.30 2
201 amps to 400 amps $106.85 2 ❑ Vacuum Systems
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 ❑
New, alteration or extension per panel Boiler Controls
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 ❑
or feeder fee. Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6.65 HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems
•
Signal circuit(s) or a limited energy
•
panel, alteration or extension $75.00 ❑ Landscape. Irrigation Control
•
Minor Labels (10) $125.00
Each additional inspection over ❑ Medical
the allowable In any of the above
Per inspection $62.50 ❑ Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting*
Fees: ❑ Protective Signaling
Enter total of above fees $ r7 Other
8% State Surcharge $ Number of Systems
•
25% Plan Review Fee
See `Plan Review" section on $ * No licenses are required. Licenses are required for all other installations
front of application.
Fees:•
•
Total Balance Due $
Enter total of above fees $ 9 5
❑ Trust Account # 8% State Surcharge $ 4 .• �7
Total Balance Due $ I . Ot
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 � AM PM BLD
Location 6g Zc 5 -' -54 d 64 3T Suite MEC
Contact Person 647 Ph Z 3 y 7/ PLM
Contractor ' / Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR ZUe U 3 9 7
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm V P Susp'd Ceiling C _ G1 � s —
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
p lf(
Post & Beam f
Rough In
Gas Line
Smoke Dampers '
Final
PASS PART FAIL /
Service
Rough In
UG /Slab
_ CAN.MEW
Fire Alarm
PART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Othe oach /Sidewalk
Date a L" - v - 0 / Inspector � Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
3,14P
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 - ham I:, spection Line: 639 - 4175 Business Line: 639 - 4171
2 BUS " -
Qate Requested .. ' / AM PM BLD
Location 33 .SL✓ SG-,- d Suite MEC
Contact Person / Ph 572-5 PLM
Contractor 7/ -e-ri 'i-7 ' /fir- Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR 7�ivv —GO 2 jF 7
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: ,[_j I /
Slab / 1 V �"� SIT
Post & Beam
Ext Sheath /Shear
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
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
Rough In
UG /Slab
ire Alarm
Fi
SS PART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk D 3 // c9 / I _L - — Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
/ zyZP
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 7' 7. G AM PM BLD
Location pe. £OJ'Z s Suite MEC
Contact Person Ph 70/ Z/ PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC oo�
Retaining Wall ELR c!/! >G -6O Z97
Footing Access:
Foundation F'PS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear �� �j
Ina Sheath /Shear
Framing C. , 7_00
Insulation ^ ,.,
Drywall Nailing CC) / —0C) 0
Fire wall i% — O / a l
Fire Sprinkler
Fire Alarm
Susp'd Ceiling / /� G /
d [.(i v — a1/45-
Roof
Misc:
Final
PASS PART FAIL
PLUMBING � P G7 1 [ 11
- Post & Beam
Under Slab
Top Out
Water Service � e
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
- Service
Rough In
UG /Slab
roVC
Fire Alarm
F•
'ART FAIL
S
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date ' - �6 — o / Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.