Permit CITY OF TIGARD ELECTR ERG
RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT #: ELR2000 -00263
-! 13125 SW Hall Blvd., Tigard, OR 97223 (5031639 -4171 DATE ISSUED: 11/6/00
SITE ADDRESS: 12394 SW SCHOLLS FERRY RD PARCEL: 1S134BC -00900
SUBDIVISION: PP1993 -058 ZONING: C -G
BLOCK: LOT: 003 JURISDICTION: TIG
Project Description: Tenant Improvement
• 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:
Owner: Contractor:
DENNIS THOMPSON G G TELECOMMUNICATION CO
12475 SW MAIN 121 SW SALMON ST
TIGARD, OR 97223 STE F -1
PORTLAND, OR 97204
Phone: 503 - 781 -0124 Phone: 295 -2922
Reg #: LAC 59692
ELE 34- 248CLE
FEES Required Inspections
Type By Date Amount Receipt Elect'l Final
PRMT CTR 11/6/00 $75.00 2720000000
5PCT CTR 11/6/00 $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 thes - • •'rect que +': • ■UNC at (503)
246 -1987.
Issued by Permittee Signatu = ,4f ,;_jr
I V
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
s
t
Electrical Permit Application
Date received: (k to k b c> Permit noliA gtsb -OD 2.4 3
l ,•1 1, City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: l 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 Jif Commercial/industrial O Multi - family O Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: 12394 S. to.). SGtou.s regal ",p,0 Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Su id' i i• :
Project name: - t •s% a J I • • 1 i escription and location of work on premises: — DATA tdiej.4146
Estimated date of completion/inspection: .
CONTRACTOR APPLICATION FEE SCIIEDLILE
Job no: Fee Max
Business name: G6 ELaeJa1 m re 417o1J Description Qty. (ea) Total no. imp
New residential - single or multi - family per
Address:
12.1 S. u). S44.,4oAl ST'S ?I dwelling unit. Includes attached garage.
City: Poi?.,, Lqµ D I State:0 2 I ZIP: q-1 204 Service included:
Phonea3. 2q8. 292.2 I Fax:503.245•68861 E -mail: G(,f t£ceaApt., 1000 sq. ft. or less • 4
CCB no.: 59/29'2,_ Elec. bus. lic. no: 3
I 34 .. 248 CL E Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
Cit, ctro lic. no 541C) Limited energy, non- residential 2
1 _ „ -- - ' 1 1 - to .00 Each manufactured home or modular dwelling
'Signature of supe ism e Date 1I - 6 - 00 Service and/or feeder 2
Sup. elect. name (print): , a J_ ��,� Licenseno:l20p JLr
Services or feeders- installation,
alteration or relocation:
PROPERTY OWNER .
200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only i
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
20
ORS 447, 455, 479, 670, 701. 201 1 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
O Service over 320 amps- rating of 1&2 ❑ 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,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* / 2
O Building over three stories 0 Feeders, 400 amps or more *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable In any of the above:
O Egress/lightingplan ❑ Other. Per inspection I I I i
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other t
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee $ Os • .3
0 Visa ❑ 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 $ g r. O b
Name of cardholder as shown on credit card
Cardholder signature Amount 440 -4615 (6100/COM)
•
Electrical Permit Fees: Limited Energy Permit Fees:
Number of Inspections per permit allowed
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Service included: Items Cost Total
4a. Residential - per unit Restricted Energy Fee $75.00
1000 sq. ft. or less • • $147.15 4 (FOR ALL SYSTEMS)
Each additional 500 sq. ft. or
portion thereof $33.40 1 Check Type of Work Involved:
Limited Energy $75.00 ❑
Each Manufd Home or Modular Audio and Stereo Systems
Dwelling Service or Feeder $90.90 2
4b. Services or Feeders ❑ Burglar Alarm
Installation, alteration, or relocation ❑ Garage Door Opener'
200 amps or less $80.30 2
201 amps to 400 amps $106.85 2 -
401 amps to 600 amps $160.60 2 ❑ Heating, Ventilation and Air Conditioning System'
601 amps to 1000 amps $240.60 2 .
Over 1000 amps or volts $454.65 2 ❑ Vacuum Systems'
Reconnect only $66.85 2 ,
4c. Temporary Services or Feeders ❑ Other
Installation.
amp a or relocation T YPE OF WORK INVOLVED - COMMERCIAL ONLY
200 amps or less .. $66.85 2
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Fee for each system $75.00
Over 600 amps to 1000 volts.. (SEE OAR 918 - 260 -260)
see "b" above. .
4d. Branch Circuits Check Type of Work Involved:
New. alteration or extension per panel Audio and Stereo Systems
a) The fee for branch circuits • •
with purchase of service or ❑
feeder fee. Boiler Controls •
Each branch circuit $6.65 2
b) The fee for branch circuits ❑ Clock Systems -
without purchase of service .. _
or feeder fee. Data Telecommunication Installation
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ Fire Alarm Installation
4e. Miscellaneous
(Service or feeder not included) ❑ HVAC
Each pump or Irrigation circle $53.40
Each sign or outline lighting $53.40 ❑ Instrumentation •
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 Intercom and Paging Systems
Minor Labels (10) $125.00
4f. Each additional inspection over ❑ Landscape Irrigation Control'
the allowable Many of the above
Per Inspection $62.50 0 Medical
Per hour . $62.50
In plant - $73.7 ❑ Nurse Calls
5. Fees: ❑
6a. Enter total of above fees $ Outdoor Landscape Lighting'
8% Surcharge (.08 X total fees) $ ❑
Subtotal Protective Signaling •
6b. Enter 25% of line 6a for _ ❑
Plan Review if required (Sec. 3) $ Other
Subtotal • $
• Number of Systems
❑ Trust Account # • No licenses are required. Licenses are required for all other installations
Total balance Due $
FEES:
ENTER'FEES $ •
8% SURCHARGE (.08 X TOTAL ABOVE) $
TOTAL $
r
•
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24=Hour Line: 639 -4175 Business Line: 639 -4171
BUP
Datb Requested /�— 7 AM PM BLD
Location /Z) ff V 54/ _ eA4/ j ✓r Suite MEC
Contact Person Ph PLM
Contractor G G- C.6 wk,lit4 v ry t_c_49- Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR 7Fw tie) Z 3
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 . i
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
CLECT
Service
Rough In
UG /Slab
Fir
F'
ASS ART FAIL
SITE
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 Date / / (� 9 c511° ec
Inspector t
Other p
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24- HouAnspection Line: 639 -4175 Business Line: 639 -4171
l BUP
Date Requested - " d v AM PM BLD
Location / _l3 c ! e/ 3W. Sc% OGGS 4f Suite MEC
Contact Person J Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR ,69O — C7Q2 G 3
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
Susp'd Ceiling -
Roof � hj
Misc: �C
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
` ASS PART FAIL
1 �L ` E'CTRICA>
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
• PART FAIL
SITE
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: J Unable to inspect - no access
ADA
Approach /Sidewalk 1
Other Date Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.