Permit RESTRICTED E
CITY OF T I G A R D ERG
RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT #: ELR2004 -00253
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/11/2004
SITE ADDRESS: 15230 SW SEQUOIA PKWY 100 PARCEL: 2S112DA -00300
SUBDIVISION: ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: Install data wiring.
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 KJB INC
15350 SW SEQUOIA PKWY #300 -WMI 14 PEAKNESS CT
PORTLAND, OR 97224 LAKE OSWEGO, OR 97035
Phone: Phone: 503 788 - 1444
Reg #: LIC 113596
ELE 3- 538CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 8/11/2004 $75.00 Elect'I Final
[TAX] 8% State Surchari 8/11/2004 $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. ATTE I ON: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth i OAR 952 - 001 -0010
through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questio t• OU C at (50 ) 246 -6699.
Issued by Permittee Signature 0,14
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
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received / (/ 1,0
V
Date/By: permit No.: /! _ / 6 L-pfv / /'L� �
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 . o ' ' dl ltpgj;1 � + ia DateBy: Other Permit:
Inspection Line: 503.639.4175 E'I I� Date Ready/By: Jw ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: 7 ) L Supplemental Information
TYPE OF WORK, • . ,-. . - -. PLAN REVIEW ,- ,
❑ New construction 0 Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ['Hazardous location
['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION `: " `: ` . _ of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling igi 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 " . DEgress/lighting plan RV park , - w o / I
G r
Job no.: Job site address: (Si 3 0 S t"...) S C QLI 0 ( A RA/ Y DHealth-care facility gOr:
Submit 2 sets of plans with any of the abtheove. (-D
City /State /ZIP: tl Cc A /2... C 02 , The above are not applicable to temporary construction service.
•
Suite/bldg. /apt. no.: I Q p Project name: ISM 1 S 14 IL YZ i To 2F G A 1 remy FEE* SCHEDULE Fe **
/ 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.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'! 500 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
ti f s (1 P _u n t p ,� i ,t (� dwelling, service and /or feeder 90.90 2
-`r W I R.-I Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
0, PROPERTY - OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) 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
service or feeder fee, each 6.65 2
Business name: l.< 13, T N C c ' A + t(. E. p t l.p tv t M A 1,./C branch circuit
B. Fee for branch circuits
Contact name:
J Q S 2. pi WI L 1 1- ti without service or feeder fee,
each branch circuit 46.85 2
Address: ` If P G.J=_A- I( N 2 fs C r.
Each add'! branch circuit 6.65 2
City/State /ZIP: LA (<L. OR..) t 6 o 0 2 cc 0 ? S- Miscellaneous (service or feeder not included)
Phone: (93'3 fl g ( y I Fax: : (92 3)(09 9 9 (, Z Pump or irrigation ci 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
' CONTRACTOR energy panel, alteration, or _
Business name: ^� extension. Describe: / Page 2 /I� 2
-5B lNG° De A ¶t 4E 14O NL HAti) I NJC
Address: ( 4. A 1{. S Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: LA- (C p S L G o , D 2 . 7 0 1 5 Investigation per hour (1 hr nun) 62.50
Phone: (973 )78 8 ,c�� Fax: (gtz 611f C (tea Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES* .
CCB Lic.: I( 3 5 q 6 Electrical Lic.: 3— ,g, Cc. C Suprv. Lic.: 2 g09 LEA Subtotal
Suprv. Electrician signature, required: � Plan review (25% of permit fee) �,
/1.1.4.4 ,.P. State surcharge (8% of permit fee) —
Print name: 5'o s ` 1 Al I i✓ T A. Date: i�/ (( /9 (,
TOTAL PERMIT FEE �l O il
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: J O S c? t Al r N T A Date: ('((( /07- • Fee methodology set by Tri- County Building Industry Service Board
no Number of inspections per permit allowed.
is'. Building \Pennits\ELC-PemitApp.doc 12/03 440- 4615T(10 /02/COM/WEB
•
Electrical Permit Application - City of Tigard r
Page.2 - Supplemental. Information
•
•
LIMITED ENERGY PERMIT FEES: •
S-71 i.t:: AI; WOR K b` Yit7 = _ ° ° ' : ' ==
;e ONLY: -yx �;� �- ',�r�° _ -���.� -.� a��
Fee for all residential systems combined : , $75.00
Check Type of Work Involved: _
•
❑ Audio and Systems*
❑ Burglar Alarm -
❑ :Garage Door Opener* . . ,_ ,
❑ Heating, Ventilation. and Air Conditioning ' . '' -
System* '
.
❑ Vacuum Systems*
❑ Other:. •
CO 6 RCIAI `V ORK N ;2Ys `;" ,s ' ?> r 7 .
Fee for each commercial syste , ' $75.00 . . •
. (SEE OAR.918- 260 -260) .
Check Type,of Work,Involved:
❑,. Audio and StereoSystems .
D. Boiler Controls
❑ Clock Systems • :
[]Data Telecommunication Installation,
❑ Fire Alarm Installation
❑ HVAC , • . .
❑ Instrumentation ,. - •
❑ Intercom.and Paging Systems • - ' - ' ' ' •
• ❑ Landscape Irrigation Control*
' '❑ Medical • -
❑ Nurse Calls ' -
•
❑ Outdoor Landscape-Lighting*
Protective Signaling
Total number of commercial systems:
. *No licenses are required. Licenses are required ' • • .
for all other installations
L Building \Pemits\ELC- PermitApp.doc 04/03 .
CITY OF TIGARD 24 -Hour
BUILDING Inspection Linc`(503) 639 -4175 MST
INSPECTION DIVISION - Business Line: (503) 639 - 4171
BUP
Received Date Requested C T — r AM PM BUP
Location l5=-S-31=2___56
Suite /00 MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner Awl 1.511 ELC
•
Footing
Foundation ELC
Ftg Drain Access: ELR 200y
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors - -
Ext Sheath/Shear /,t
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
F' - ; larm
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S , E Please call for reinspection RE: 0 Unable to inspect — no access
A ire Supply Line o Y / 4,/tze6-m -co
Inspector Approach/Sidewalk D I /// / � Ext
Other:
Final • DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL