Permit , A,. . . . CITY OFTIGARD
^ ^ i „,� lh � , DEVELOPMENT 6
DEVELOPMENT ELECTRICAL PERMIT —
RESTRICTED ENERGY
PERMIT #: ELR98 -0143
DATE ISSUED: 06/03/98
PARCEL: 2S112DA -00800
SITE ADDRESS.. °:15115 SW SEQUOIA PKWY #200
SUBDIVISION • ZONING:I —P
BLOCK • LOT • JURISDICTN: TIG
Project Description : Installation of limited energy panel.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO..•: AUDIO & STEREO.•: INTERCOM & PAGING..:
BURGLAR ALARM BOILER • LANDSCAPE/ IRRI GAT. °:
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: FEES
C P BREIDENBACH type amount by date recpt
17150 SW PILKINGTON ROAD PRMT $ 40.00 DEB 05 /28/98 98- 306086
LAKE OSWEGO OR 97035 SPCT $ 2.00 DEB 05/28/98 98- 306086
Phone #: 635 -3390
Contractor:
BACHOFNER DATACOM INC $ 42.00 TOTAL
55SE MAIN ST ,
REQUIRED INSPECTIONS
PORTLAND OR 97214 -3346 Ceiling Cover Low Voltage Insp
Phone #: 233 -7873 Wall Cover Elect'l Final
Reg #. ° : 011197
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. 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 rule adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001-0080. You may obtain copies of
these rules ' .irec :.estions to OUNC at (503)246 -1987. //
Issued by k , _ _�Ls� Permittee Signat�_:re�� %6/O.A .
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:
CONTR TOR 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
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ ++
c
CITY OF TIGARD Electrical Permit Application Plan Ch- - •
13125 SW HALL BLVD. Rec'd : rr ,
TIGARD OR 97223 cEIVED Date Recd - ? - 8 - -)r: �E Date to P.E. " ----7
Phone (503) 639 -4171, x304
Print or Type Date to DST
Inspection (503) 639- 4A7,5! `, 199 Incomplete or illegible will not be accepted
Permit# t.-4e, 49 - Ol Y3
Fax (503) 684 -7297 _. np PAENt Called
1. Job Addresa " � � am I) 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) NW Evaluation Service included: Items Cost Sum
I
Address 15115 SW Sequoia Parkway #200 4a. Residential - per unit
Ci City/State/Zip Ti and Oregon Each a . additional o l 5 $110.00 4
ty p g r g Each additional 500 sq. ft. or
Commercial U Residential ❑ portion thereof $25.00 1
Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all current licenses) 4b. Services or Feeders
Electrical Contractor Bachofner Datacom, Inc. Installation, alteration, or relocation
55 SE Main Street 200 amps or less $60.00 2
Address 201 amps to 400 amps $80.00 2
City Portland State OR Zip 9/214 401 amps to 600 amps $120.00 2
Phone No. 503-233-7873 601 amps to 1000 amps $180.00 2
Job No. 2303 Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No. 2 6 - 9 5 3 CLE Exp.Date 10/98 Reconnect only $50.00 2
OR State CCB Reg. No. 111978 Exp.Date 4/98 4c. Temporary Services or Feeders
COT Business Tax or Metro No. 4 382 Exp.Date 6/98 Installation, alteration, or relocation
200 amps or less $50.00 2
Signature of Supr. Elec'n 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License Nc . 2808- S Exp.Date see "b" above.
Phone Nc 503 - 233 -7873
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circuit $5.00 2
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee.
First branch circuit $35.00 2
The installation is being made on property I own which is not Each additional branch circuit $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00 2
3. Plan Review section (if required):* Signal circuit(s) or a limited energy `la , 00
panel, alteration or extension I $40.00 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units in one structure 4f. Each additional Inspection over
Service and feeder 225 amps or more the allowable In any of the above
System over 600 volts nominal Per inspection $35.00
Classified area or structure containing special occupancy Per hour $55.00
as described in N.E.C. Chapter 5 In Plant $55.00
* Submit 2 sets of plans with application where any of the above apply. S. Fees: /I D bD
Not required for temporary construction services. 5a. Enter total of above fees $ T . y V
5% Surcharge (.05 X total fees) $
NOTICE • Subtotal $ 4 7 • hi )
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑ Trust Account # $ 4/ , 0°
Total balance Due
0
■ I: \DSTS \ELC96.APP Rev 9/96
•
Page No. 1 CASE HISTORY FOR CASE NO.: ELR98 -0143
C P BREIDENBACH
15115 SW SEQUOIA PKWY Unit: 200
07/24/98
Action Description Req/ Schd/ End/ Action Notes Diep By Update Upd
Code Sent Done Done Date By
- --- --- - - - --- -- - --
ELRC001 Application Received / / / / 05/28/98 MAIL DEB 05/28/98 DRA
ELRC003 Permit Created / / / / 05/28/98 CCB expired, spoke w /Karen at Bachofner MEMO DEB 05/28/98 DRA
she is to get receipt or some type of
documentation from CCB and fax to us,
probably on 6 -2 -98. Also needs ELR
updated. Holding this permit on my desk
until this info is received.
ELRC500 (F) Issue permit / / / / 06/03/98 DONE DEB 06/03/98 DRA
ELRC725 Low Voltage Inspection / / / / 06/24/98 PASS CD 06/25/98 J *H
ELRC799 Elect'l Final / / / / 06/24/98 data & phone system PASS CD 06/24/98 CD
ELRC800 Case finaled / / / / 06/25/98 PASS CD 06/25/98 J *H
�i — 4734/
CITY OF TIGARD BUILDING INSPECTION DIVISION 044 c r 3 ` - ? �. V
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
cq 3/ 1555 Date Requested (,v 'L4 - q AM PM BLD
Location 15 15 ` Suite c)-4 MEC
Contact Person �� 0 ✓ *WC Ph 023 9, "X06 PLM
Contractor � � k. — ) � , SWR �i
BUILDING Tenant/Owner OW kt ( A�t ELC ? ?
Retaining Wall ELR 9f - 0 /
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
kit Sheath /Shear
Framing
Insulation
Drywall Nailing / 0s r , A , , L �t
Firewall A (} 41_3
Fire Sprinkler 9 a ASS
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL (**11.-d
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
P FAIL
LECTRICA
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
4111
• A_ PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date 6 • 2' - ''2 Inspector Ext
Other
Final
PASS PART FAIL . DO NOT REMOVE this inspection record from the job site.