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Permit r W CITY OF TIGARD ELECTRICAL PERMIT - RESTRICTED ENERGY � y,� DEVELOPMENT SERVICES PERMIT #: ELR2003 -00302 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/2/03 SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 100 PARCEL: 1S134BC -00401 SUBDIVISION: ZONING: C -N BLOCK: LOT: JURISDICTION: TIG Project Description: Limited energy for fire alarm alteration. 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: X OUTDOOR LANDSC LITE: OTHER: : HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: TOTAL # OF SYSTEMS: 1 Owner: Contractor: SISTERS OF PROVIDENCE IN OR OREGON ELECTRIC CONST /GROUP BY STEVE FOSTER 1010 SE 11 TH AVE_ PO BOX 13993 PORTLAND, OR 97214 PORTLAND, OR 97213 Phone: _ Phone: 503 234 - 1001 Reg #: L.933-23424/200 SUP 4460S ELE 26 -95C FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 10/2/03 $75.00 Elect Final [TAX] 8% State Tax 10/2/03 $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 throuc Iss ed by L _ � �� % At • � ' Permittee Signature X • 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 i r . _ • a ,) � _ on (Electrical Pe � � 1 , � � i , ra._� A ra w OFFICE USE ONLY A h l■ City of Tigard OCT ate received: /' ' vg Permit no.: tcR ,�- Lb3D9. 1 . 13125 SW Hall Blvd OCT 2 2003 Project/appl. no.: Expire date: s 1..L. Phone: (503) 639-4171, FAX: (503) 598 -1960 Date issued: By: 'Receipt no.: Internet address: www.cl.tig Case file no.: _Payment type: 24 -Hour Inspection Re ;` . . a pp! LJ 182 family dwelling or accessory pal U Multi- family • ❑ Tenant improvement ❑ New construction CI additioNalteration/replacement ❑ Other: . ❑ Partial JOB SITE INFORMATION Job Address: 12442 SW Scholls ferry RD Bldg. No.: Suite no.: Tax map /tax lot/account no.: Lot: Block: Subdivision Project Name: PMG Scholls Ferry Description and location of work on premises: LE panel for fire alarm Estimated Date of completion /inspection: Will ou call for ins • ection within 24 hours? Yes ❑ No ❑ Pro Contact Ga Hatch (503) 546 -6083 Phone CONTRACTOR APPLICATION FEE SCHEDULE • ax no. Job No.: 58025 Description Qty Fee (ea.) Total imp New resldentlal•sIngle or - multi- family per dwelling unit Business name: Oregon Electric Group Includes attached garage. Service Included: Address: 1010 SE 11th Ave. 1000 sq. ft. or less $ 145.15 $ - 4 City: Portland State: OR Zip: 97214 Ea Addl 500 SF or Portion $ 33.40 $ - 1 Phone: (503) 234 -9900 Fax: 503) 234 -1001 1E-mail: Umlted Energy. 1 & 2 Family $ 75.00 $ - 2 CCB • : - . bus. lic. no.: 26 -95C Limited Energy, Multi- Family $ 75.00 $ - 2 •Ci .' w • s ' . :., i • . �� - — Each manufactured home or modular dwelling. Service Sigma of supervising eke #mmrrt9uo-ad) 1. 10/1/2003 and /or feeder. $ 90.90 $ - 2 Service or Feeders - Su•. Elect. Name •rint :Mark Kenne License no: 4460S Installation, Alteration or Relocation: PROPERTY OWNER 200am'sorless $ 80.30 $ - 2 Name (print): 201amps - 400amps $ 106.85_ $ - 2 Mailing Address: 4olamps - 600amps $ 160.60 $ - 2 City State: (Zip: 601amps - 1000amps $ 240.60 $ - 2 Phone: Fax: 1E-mail Over 1000A or Volts $ 454.65 $ - 2 Owner Installation: The installation is being made on property I own which is Reconnect Only $ 66.85 $ - 1 or not intended for sale, lease, rent, or exchange according to ORS 447, 455, Femporaers •I Serv ices nstallation , , 479, 670, 701. Alteration or Relocation: Owner's signature: Date: . 200 am.s or less $ 66.85 $ - 2 ENGINEER 201amps - 400amps $ 100.30 $ - 2 Name: Over 401amps- 600amps $ 133.75 $ - 2 Branch Circuits - New, Address: Alteration or Extension Per Panel: A. Fee for branch City: State: Zip: circuits with purchase of service or feeder fee, each branch Phone: Fax: E -mail: drcult $ 6.65 $ - 2 B. Fee for branch circuits W /Out Purchase of Service or Feeder. PLAN REVIEW 1st Branch Ckt $ 46.85 $ - 2 ❑ Service over 225 amps -comrr ❑ Health -care facility Each additional branch circuit $ 6.65 $ - CI Service over 320 amps - rating of ❑ Hazardous location Miscellaneous • (service or feeder not Included) 1 &2 family dwellings ❑ Building over 10,000 square feet four or Each pump or initiation circle $ 53.40 $ - 2 ❑ System over 600 volts nominal more residential units in one structure Each Sign or Outline Lighting $ 53.40 $ - 2 ❑ Building over three stories ❑ Feeders, 400 amps or more Signal Circuit(s) or Limited Energy Panel Alteration or Extension' ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park 1 $ 75.00 $ 75.00 2 ❑ Egress /lighting plan ❑ Other: 'Description: Submit 2 sets of plans with any of the above. The above are not applicable to temporary construction service. Each AdditonalInspection over the Allowable In any of the Notice: This penult application Above Per Inspecti $ 62.50 $ expires If a permit Is not obtained within 180 days after It Investigation fee: has been accepted as complete. (Other Permit Fee $75.00 Plan review 25% $0.00 i State Surcharge 8% $6.00 0 Total $81.00 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received l 2 - ( 2 :3 6 ate Requested /211 v /03 AM PM BUP Location l • 4 / Z 21 % Suite ( ® MEC Contact Person -- A.. A ii .. • i _��. Ph (.00 � � 7� 4 S53LM Contractor Ph ( ) SWR BUILDING Tenant/Owner /,(//21,1 O i • ELC Footing ELC Foundation Access: 0 �'1 a Ftg Drain 3 v (J Crawl Drain Slab Inspection Notes: SIT Post & Beam C J Al .l r y T 1) <AJ1 CC UTf& Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof the �/ Other: �` Final PASS PART FAIL j 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 • • RT FAIL I Service • U a �PASS�� PART • FAIL fl Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. � � ❑ Please call for reinspecl•n RE: ❑ Unable to inspect — no access Fire Supply Line / / ADA Approach/Sidewalk Date Inspe /� Ext Other: Final DO NOT REMOVE this Inspection rec rd fro the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line; (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested /t / a'' AM PM BUP Location l ° c / / L � " / —:7Saite /6n MEC Contact Person � r✓ �) Ph ( ) y 9 3�5 PLM Contractor C EZ- • Se Ph ( ) — a (9 ! SWR BUILDING Tenant/Owner ELC 3- 6 6 D Footing ELC Foundation Access: 3- o 3o �. Ftg Drain ELR Crawl Drain Slab Inspection Ns� /e/ %ez-Q c _ SIT Post & Beam • Shear Anchors P Ext Sheath/Shear Int Sheath/Shear Framing Insulation . Drywall Nailing Firewall �� 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 ,I 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 Volt • !e Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall 4WD) PART FAIL Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date ZI/ � 03 Inspector ? • ' << Other: — �� / •p, Final DO NOT REMOVE this Inspection recor ; fro ob site. PASS PART FAIL