Permit -- - CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
,Ii DEVELOPMENT SERVICES PERMIT #: ELR2002 -00281
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/6/02
SITE ADDRESS: 15353 SW SEQUOIA PKWY PARCEL: 2S112DA -00700
SUBDIVISION: PACIFIC CORPORATE CENTER ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: Low voltage for installation of new page speakers.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: X 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: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: .
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC REALTY ASSOCIATES BACHOFNER DATACOM INC
15350 SW SEQUOIA PKWY #300 -WMI 55 SE MAIN ST
PORTLAND, OR 97224 PORTLAND, OR 97214 -3346
Phone: Phone: 233 - 7873
Reg #: LIC 111978
ELE 26- 953CEP
SUP 2808S
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 12/6/02 $75.00 Elect'l Final
[TAX] 8% State Tax 12/6/02 $6.00
Total $81.00 EXPIR
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
Issued by _ L " �� , , _! - � Permiftee Signature 1 ,--C k :
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
Datereceived:(n - (a -0)- Permit no.: / jbopr� ,Q0?- /
a.rr )1 i� � . City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: bal 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 ❑ Commercial/industrial ❑ Multi- family O Tenant improvement
❑ New construction ❑ Addition/alteration /replacement ❑ Other: ❑ Partial
JOB SITE 1NFORNIATION
Job address: 15353 SW SEQUOIA PKWY Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: Subdivision:
Project name: BALLY TOTAL FITNESS' Description and location of work on premises: INSTALL NEW PAGE SPEAKERS
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCIIEDLLE •
Job no: 5989 Fee Max
Description Qty. (ea.) Total no. insp
Business name:
B ACHnFNFR DWiW C)M r TN(-7_ New residential - single or multi -family per
Address: 55 SE MAIN dwelling unit. Includes attached garage.
City: PORTLAND I StateOR I ZIP: 97214 Serviccincluded:
Phone: 503- 233 -2006 I Fax: 233_2 I E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
1 11978
CCB no.: I Elec. bus. lie. no: 26_953a Limited energy, residential 2
City /metro lie. no.: / Limited energy, non- residential 2
,• ELI/, , _ _.// . l' -O4' U Z Each manufactured home or modular dwelling
Signature of supervising electricia ,eequired) Date Service and/or feeder 2
Sup. elect. name (print): '•B H. EPCHTNER License no: 17695 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
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:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
• 201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am s 2
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 O Health -care facility Each pump or irrigation circle 2
O Service over 320 amps - rating of 1 &2 O Hazardous location Each sign or outline lighting 2
family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, 1 75
O System over600 volts nominal mom 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 O Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lighting plan 0 Other. Per inspection I I I
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards. please call jurisdiction for more information. Notice: This permit application
Permit fee $ 75 DU
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ To) $ •
,
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ (o .W
Expires accepted as complete. TOTAL $ r .
Name of cardholder as shown on credit card
$ EXP!RE� /
Cardholder signature Amount X 15 (6t00/COM)
Electrical Permit Fees: Limited Energy Fees:
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total NI, Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular Garage Door Opener'
Dwelling Service or Feeder $90.90 2
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2 Vacuum Systems'
201 amps to 400 amps $106.85 2
401 amps to 600 amps $160.60 2 El amps to 1000 amps . $240.60 2 Other
Over 1000 amps or volts $454.65 2 .
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00 .
200 amps or less $66.85 2 (SEE OAR 918 - 260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts, ❑
see "b" above. Audio and Stereo Systems
Branch Circuits El Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 2. ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included) •
Each pump or irrigation circle $53.40 ❑ Intercom and Paging Systems
Each sign or outline lighting • $53.40
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control"
Minor Labels (10) $125.00 •
Each additional inspection over
❑ Medical
the allowable In any of the above ❑ Nurse Calls
Per inspection $62.50
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting*
• Fees: [ 1 Protective Signaling
Enter total of above fees $ T1 Other
8% State Surcharge $ Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ ' No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $ •
Enter total of above fees • $
❑ Trust Account # • 8% State Surcharge $ •
•
Total Balance Due $
i:\dsts\forms\elc- fees.doc 10/09/00 •
r
CITY OF TI GARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
� DEVELOPMENT SERVICES PERMIT #: ELR2002 -00281
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/6/02
SITE ADDRESS: 15353 SW SEQUOIA PKWY PARCEL: 2S112DA -00700
SUBDIVISION: PACIFIC CORPORATE CENTER ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: Low voltage for installation of new page speakers.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: X 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: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC REALTY ASSOCIATES BACHOFNER DATACOM INC
15350 SW SEQUOIA PKWY #300 -WMI 55 SE MAIN ST
PORTLAND, OR 97224 PORTLAND, OR 97214 -3346
Phone: Phone: 233 - 7873
Reg #: LIC 111978
ELE 26- 953CEP
SUP 2808S
FEES Required Inspections
Description Date Amount Low Voltage Inspection
ED
[ELPRMT] ELR Permit 12/6/02 $75.00 Elect'I Fin ' �j
[TAX] 8% State Tax 12/6/02 $6.00 R
12_ a Y 1G 3
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes a
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 require
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 thro c
Issued by 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
BUP - Building Permit EL C - Electrical Permit
Inspection Description Date Passed By ,f Inspection Description Date Passed By
Footing /Setback Underground cover
Foundation walls Wall cover
Footing drain Ceiling cover
Waterproof bsmt walls Electrical rough -in
Slab Electrical service
Crawl drain Electrical final
Underfloor insulation
Post/beam structural
Shear walls /anchors ELR - Restricted Energy Permit
Roof nailing -4 Inspection Description Date Passed By
Firewall Low voltage
Tilt -up panel Electrical final
Masonry/Reinforcement
Framing
MFG - Structure set -up MEC - Mechanical Permit
Insulation
Drywall nailing It Inspection Description Date Passed By
Post/beam mechanical
Suspended ceiling Gas line
Engineered soils
Welding Lab Final Mechanical rough -in
Concrete Lab Final Fire damper
Bolting Lab Final Duct work
Structural observation Smoke detector
Mechanical final
Fireproofing Lab Final
Final inspection
PLM - Plumbing Permit
BUP — Fire Protection System Permit Inspection Description Date Passed By
Plumbing underslab
Al Inspection Description Date Passed By Crawl drain
Sprinkler underfloor /slab Post/beam plumbing
Sprinkler rough -in Plumbing top -out
Sprinkler final RP/backflow preventer
Fire alarm final Rain drain
Storm drain
Water service
SIT - Site Permit Sanitary sewer
Inspection Description Date Passed By Culvert/catch basin
Footings _ Pump /fill septic tank
Foundation walls Plumbing final
Sprinkler supply lines -
Sprinkler underfloor /slab
Catch basin/Manhole SWR - Sewer Permit
Engineered soils I Inspection Description Date Passed _ By
Engineering acceptance Sanitary sewer
Final inspection Final inspection
Inspection Record - BUP, PLM, SWR, ELC, ELR, MEC, SIT Permits
is \dsts \forms \InspRecordBUP.doc 04 /17/01