Permit CITY O TIGARD
ELECTRICAL PERMIT -
RESTRICTED ENERGY
PERMIT #: `�I�� DEVELOPMENT H BMENq Tigard, SERVICES (503) 639-4171 DATE ISSUED: 3/18/03 3 -00083
SITE ADDRESS: 14945 SW SEQUOIA PKWY 110 PARCEL: 2S112AD -01000
SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of limited energy for 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: 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
LTC 38868
MET 00004556
FEES • SUP FUiiiiiitra Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 3/18/03 $75.00 Elect! Final
[TAX] 8% State Tax 3/18/03 $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 fol w ' les adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 throuc
Issu d by 4 1.` I 11 69. Permittee Signature
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 etrical Permit Application FOR OFFICE USE ONLY
2 ` 41D Electrical f
FOR
- 2
Date/By: g ,'7 03 Permit No.: ( —6 0 0 g J
Ti Planning Approval Sign
City of igard Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other I
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 t,, Use
„ A Post-Review Laneview Land d Use
Internet: www.ci.tigard.or.us .4y e e l Contact Juris.: ® See Page 2 for
`- 2
24 -hour Inspection Request: 503 -639 -4175 J Name/Method: _ Supplemental Information.
. _ ",.:. - _r' : TYPE':OF WORK`..: _'::• ." �,' ,:-.�::
74)1;AN:ItEVIEW�(Pleas`e ctieck•a1l thatiiiiib)` °-''`": `
ew construction ❑ Demolition ❑ Service over 225 amps- ❑ Health-care facility
commercial ❑ Hazardous location
A ddition /alteration/replacement ❑ Other: 0 Service over 320 amps - rating of 0 Building over 10,000 square feet,
3'`-: i -; ';: ';':' iaCATEGORY OF CONSTRUCTION . i 5'" ' • 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder n Other: ❑ Egress/lighting plan ❑ Other:
.a Submit _ sets of plans with any of the above.
JOB,SITE INFORMATION and LOCATION " The above are not applicable to temporary construction service.
Job site address: AV9y5' S4/ 5a t4 R ..;:, .. , . ':-' 'FEE* SCHEDULE, - . ;,.;',:ls / :::;;;;(1-.. . -:: ;.
Suite #: //ej I Bldg. /Apt. #: Number of inspections per permit allowed
Description Qty Fee (ea.) Total
Project Name: 5�FI Ge New residential - single or multi - family per j
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service Included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: I Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
s ervic e and/or fee d eders er - Installation,
90.90 2
=; :51„' %�. sa \;�' I)ESCRlPTION ;OF WORK' ,•
�: Services orfe
T S7►A alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
TENANT' 601 amps to 1000 amps 240.60 2
a. ®PROPERT�C OWNER ' . ❑ r5" Over 1000 amps or volts 454.65 2 • Name: / �jti� 7' d.i Reconnect only 66.85
Address: 3.rV 5w Sc ae /7/444./ Tempora servi or fe eders - installation,
alteration, or relocatio
City/State /Zip: 66.85 I
P.4•4TG,,.�' /7i� • 200 amps or less
�` 201 a to 400 amps 100.30 '
Phone: may- ej.30'� .
ax 401 t 00 amps 133.75
.',CUATELIGANT i' ;; , f,' w ; :❑ CONTACT. PERSON ' .. • • Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of 6.65
Address: service or feeder fee, each branch circuit '
City/State/Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85
Phone: I Fax: Each additional branch circuit 6.65 :
E -mail: Misc.(Service or feeder not included):
Each pump or irrigation circle 53.40
i; + fF '�''' -i'° �; ° , ; CONTRACTOR - Each sign or outline lighting 53.40
Job No: Signal circuit(s) or a limited energy panel, /
alteration, or extensio Page 2
Business Name:1 A$6/rt• Description: ,..(1 V/
Address: .776.-g sc /7"i AL/ Each additional inspection over the allowable in an of the above:
City/State /Zip: yeve ,6 27 Per inspection per hour (min. 1 hour) 62.50
Phone: a Z33 - v .7i/ Fax:02 3 T 0) 74, 7 Investigation fee:
#: Other:
CCB Lic. 3RFs6a S Lic. #i!i'/ 06 ge Electrical'Peri .. r1E: : r _t ;'
Supervising electrician Subtotal $ 7< oa
signature required: /�� ieecat — Plan Review (25% of Permit Fee) $ (F.°
Print Name: /h ,,40e., 0,9 Lic. #: o2C•�/3 A a State Surcharge (8% of Permit Fee) $ a
TOTAL PERMIT FEE $ S j •
Authorized — / / . Notice: This permit application expires if a permit Is not obtained within
Signature: Date: / S/ C3 180 days after It has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
—, Jae < /gvAI I
(Pfease print name)
is \Dsts\Permit Forms\ElcPermitApp.doc 01/03
CITY QF.ZIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 "
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested AM PM BUP
Location / ,e7s� �f ��� Q/ P I AAP ` Suite /l! MEC
Contact Person / Ph ( ) PLM
Contractor F0 Ph ) - / SWR
BUILDING Te ant/Owner ELC
Footing
Foundation ELC Access:
�
Ftg Drain ELR 46 0nnV ^ D D d
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 ` A
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
ow'olta•e / 3 d o) d ! l o I v\ 7 L-
Fir-
ir�� Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS ART FAIL
❑ Please call for reinsp-ction RE: Unable to inspect — no access
Fire Supply Line
ADA r < - t ---�
A
E
pproach/Sidewalk Date — Inspector Q
Other:
Final DO NOT REMOVE this inspection recor from the job site.
PASS PART FAIL