Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
I , DEVELOPMENT SERVICES PERMIT #: ELR2004 -00225
FBI II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/26/2004
SITE ADDRESS: 15230 SW SEQUOIA PKWY 100 PARCEL: 2S112DA -00300
SUBDIVISION: ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Proiect Description: Low voltage for T- stats.
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 PROTEC INC
15350 SW SEQUOIA PKWY #300 -WMI 720 NE FLANDERS
PORTLAND, OR 97224 PORTLAND, OR 97232
Phone: Phone: 235 - 4000
Reg #: LIC 55414
ELE 34 -215C
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 7/26/2004 $75.00 Elect'I Final
[TAX] 8% State Surchari 7/26/2004 $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. 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
throu. - OAR 952-co 1 -0100. lot y obtain copies of these rules or direct questions OUNC at (503) 246 -6699.
�.� Issu d by _� , i _ Permittee Signature r
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
- ',- " - Received ayzr�
City of Tigard i c � . � r/
S _ ? I L Date : / . _ L :�� r � i Ato it
13125 SW Hall Blvd., Tigard, OR 97223 ' ' ` r 1 J Plan Review —
Phone: 503.639.4171 Fax: 503.598.1960 kfnpti 4 '' l ' Date/B : Other Permit:
Inspection Line: 503.639.4175 ' -.r� A Date Ready/By: BM ® See Page 2 for
Internet: www.ci.tigard.or.us -- ' (5�� . Notified/Method: Supplemental Information
-., . TYPE t9F )WQRK , , -. ,, - . • '. 'PLAN REVIEW. ; -
❑ New construction ❑ Additidn7Altkikdatftmlacergent Please check all that apply:
❑ Demolition ❑ Other: ['Service over 225 amps, com'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 ❑ 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 ❑Egress /lighting plan RV park
Job no.: Job site address: �y ❑Health -care facility ['Other: �5...?3 , S M - ' ,R Submit 2 sets of plans with any of the above.
City/ State/Z1P: 72- 9 , 4502b at The above are not applicable to temporary construction service.
Q Project name /6j , l / �'`� - a FEE* SCHEDULE .'
name/6)46,4 ! r�l v�C �i Description I Qty. I Fee. l
Suite/bldg. /apt. no.: iv 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'l 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
• STS i dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT, .. . 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: i e` , v S) 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
Phone: ( 33 - 6 Fax: ( ) - a 2
3�9/�7 200 00 c am 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 I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address: -
Each add'l branch circuit 6.65 2
City / State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited-
CONTRACTOR . energy panel, alteration, or
extension. Describe: / Page 2 2
Business name:
Address: 97irsz. ., 17 vC Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: ) re 54.,..D f ek, Investigation per hour (1 hr min) 62.50
Phone: ( )3-',// Fa ( )?-75. _ 976 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.3 ' G. Electrical Lic , i e p� Suprv. Lic Subtotal
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) L!J
Print name: Date: a �. Ov
TOTAL PERMIT FEE a
Authorized signa e' This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: �� N ! Date: /a-3 Fee methodology set by Tri- County Building Industry Service Board
I Number of inspections per permit allowed.
i:\ Building 'PermitslELC- PemitApp.doe 12/03 440- 46151(10 /02/COM/WEB
Electrical Permit Application - City of Tigard or
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:' 77
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY: _ •
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ 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
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Pemtits\ELC- PemutApp.doc 04/03
CITY OF TIGARD 24 -Hour
Inspection L1�tie 503) 639 -4175
BUILDING MST
INSPECTION DIVISION Business Line: (503) 639 - 4171
BUP
Received Date Requested T-/ / AM PM BUP
Location 1,'23 ® 56 .Roo (Jo / + Suite /00 MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner A r' 5W ELC
Footing
•
Foundation ELC
Access:
Ftg Drain ELR 1-00V
Crawl Drain
Slab Inspection Notes: 7 5 77 - 73' SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
1
Int Sheath/Shear
Framing
Insulation —
Drywall Nailing
Firewall
Fire Sprinkler 0
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 (Mi7 5T7G/C&& Herr v' y .J D 0
PASS PART FAIL
MECHANICAL
Post& Beam
Rough -In
Gas Line
Smoke Dampers -
Final
PASS PART FAIL
ELECTRICAL
Service •
Rough -In
UG/Slab
. Low Voltage
,� arm
� i r.ar • • ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
❑ Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line GIB( /6
ADA Date ` l [ �-�v 7(t
Approach/Sidewalk Inspector E
Y
Other:
Final DO NOT REMOVE this inspection record from the Job site..
PASS PART FAIL