Permit ELECTRICAL PERMIT CITYOFTIGARD RESTRICTED ENERGY
A � � , DEVELOPMENT SERVICES PERMIT #: ELR2004 -00255
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/12/2004
SITE ADDRESS: 15495 SW SEQUOIA PKWY 150 PARCEL: 2S112DD -01600
SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: Low voltage: voice and 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 ESP TECHNOLOGIES
15350 SW SEQUOIA PKWY #300 -WMI 7929 SW BURNS WAY STE. F
PORTLAND, OR 97224 WILSONVILLE, OR 97070
Phone: Phone: 503 628 - 4195
Reg #: LIC 73872
ELE 34- 269CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 8/12/2004 $75.00 Elect'I Final
[TAX] 8% State Surcharl 8/12/2004 $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
through OAR 952 -011 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246-66 .
Issued by ADP ' / .. i Permittee Signatures
OWNER INSTALLATION ONLY J
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 Receive d j / 0 4/ 6 Permit No. / ' >, "'' 0
13125 SW Fall Blvd., Tigard, OR 97223 Plan Revie
Phone: 503.639.4171 Fax: 503.598.1960 dr „i ;.�; +\ Other Permit:
Fr.�'� �� I Date/B
Inspection Line: 503.639.4175
..it 1.1 - "I Date Ready/By: FM ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
,
z aj •^ "; ` , ' F,'',:fi ,,6 _ . »T WO RTt . �1. ` ..1i � �,.:.��y;,.. ; ._ ' :,.�+ r,�r ; £. �� � d , �" � pP. -. . ..
. .. �.-- . . � � �... � .T r` '`SY^ � �r , z� _e ms 1?�ww5A . 'wIRO`s!... -., �- <`�' ` '
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Service over 225 amps, comm'l 0 Hazardous location
❑ Other:
d , r , , , t F , ❑Service over 320 amps — rating ❑Bulking over 10,000 sq. ft.,
.a ';:."‘",,../.y`',::4 'CA GDRY; OF r k ,: , ;% � ,i )s'.,'
. ~
;; � •- COl!(S`•C,RTtCm,IQN •µ`-�• „L': ,,�,��,,, x (� >• of I- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling gCommercial/industrial ❑ Accessory building OSystem over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑ Other: ❑Building over three stories [Weeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
:. s. _ s , •.�JO$`'JS)ti i1I FOEMATION AND Zdd,'ATION ` -': ` ” °''s RV park
,�- ;: ,. ❑ Egess/lighting plan P
Job no.:. I Z 13 N 7.0 1 Job site address: I S 1 ei s Se ❑Health care facility ❑Other:
Sln� l� u O[Q h K w y Submit 2 sets of plans with any of the above.
City/State/ZIP: 'r .- q a ,,--9( , o if_ 1 3- ZZ N The above are not applicable to temporary construction service.
Suite/bldg./apt. no.: S " Project name: (( ''''1.:..i. _ : ` -T�F *„S 'Di)LE , IE :
O J VP✓Vi2o ry Wtl'� `eS$ 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'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
3 i
>ta o w �`�
"i, r " s ;IlE�CHIPT � � )F �� '"; - i';' Each manufactured or modular
( � �.�._,, dwelling, service and /or feeder 90.90 2
V 9 l -' C�- O tA rl - Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
' "`" �d "PROPERTY OWNER l - Iel TENANT ' , r' ' 201 amps to 400 amps 106.85 2
� �° _. - fir' � `�'' 401 amps to 600 amps 160.60 2
Name: I / ' N ( ( y1, /" 601 amps to 1,000 amps 240.60 2
Address: l S 401 S- S w S .e. (4. oi-e, ( 0, w ti Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: - ra pt, g _ 6 ( l 0 ' 1 2 Z Li Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) J 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
°, x °;' ^ - , 0 -- l'Pi.'IC ; 3 ,• ° ,j .' • ,. _OI'
CTACT PERROIY 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,
Address:
each branch circuit 46.85 2
Each add'I 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 Signal circuit(s) or limited-
4 :°. :' ',, ` W , , energy pane, alteration, or
; 1 r. CgJtACT�OR ° _ . _ ... -,... _. .e:is_ panel, i op
extension. Describe: I Page 2
/ ¶5 - -- 2
Business name: 5 p 'C,c- G(/�,h ln 1es
Address: - c S LAD S LA-v- \i S ` St' -e • - C • Each additional inspection over allowable in any of the above
_ ` Per inspection 62.50
City/ State/ZIP: l/J t. \ S 0 VA_,-, I Lk 1 O K- c "1 }tri- b Investigation per hour (I hr min) 62.50
Phone: ( 515 (p t7_,- "( (q 5 - Fax: (so 3) 602,- 2 �-g ( Industrial plant per hour 73.75
z ftr*'S
,� .. . , .. ELEC`[ T, I3L' �AT�= �R' 11LI'I'`,_FE7ES_!..`i:. ; =:c,'; S ' ,,t�.' ,,;,
CCB Lic.: " - ' 2 2 812 Electrical Lic.: 3 L i — et,: Suprv. Lie.: Z.Z I ( f Subtotal '-c , sv
Suprv. Electrician signature, required: 07.-,e ...,s; . Plan review (25% of permit fee)
Print name: 4 1 FF e. Date: g I. t (o v( State surcharge (8% of permit fee)
cro
TOTAL PERMIT FEE $ \ ,
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Buiiding \Penmts\ELC- PemutApp.doc 12/03 440- 4615T(10/02/COM/WBB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
,., ^ � r +[f 7 TENTatV W 1■11 ^x, ._?�^v' i �,-;M1 Z 7
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:
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 \Permits\ELC- PemritApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Lute: (53) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Reques ed 9 AM PM BUP
Location / 5 44 9 5 P r .6 i Suite /---S MEC
Contact Person Ph ( ) 4/C41— 7 31 3 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing U
Foundation ELC
Ftg Drain Access: ELR 7 ,`
' d d 25.5
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation ® 7C _ F/ N4'�
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 e Alarm
- ASS PART FAIL
0 Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd.
S t t ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire
ADA�upply Line I G
Ap roach/Sidewalk Date Inspector Ext
P
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL