Permit CITY OF TIGARD ELECTRICAL PERMIT_
RESTRICTED ENERGY
y;� DEVELOPMENT SERVICES PERMIT #: ELR2004 -00293
AA
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 9/15/2004
SITE ADDRESS: 15575 SW SEQUOIA PKWY 100 PARCEL: 2S112DD -01600
SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: 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 PROTEMP ASSOCIATES INC
15350 SW SEQUOIA PKWY #300 -WMI 807 NE COUCH
PORTLAND, OR 97224 PORTLAND, OR 97232
Phone: Phone: 233 -6911
Reg #: ELE 26- 1063CRE
LIC 38868
SUP 2613LEP
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 9/15/2004 $75.00
[TAX] 8% State Surchart 9/15/2004 $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 -0 1 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
Issued by CK G,L�� Permittee Signature
b
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 AuREGE IVED FOR OFFICE USE ONLY
Cl of "ligard Received Permit No. ' D — " D���O��3
13125 SW Hall Blvd., Tigard, OR 97223 SEP 15 2004 DateBy /� / /)�� H�otU
Phone: 503.639.4171 Fax: 503.598.1960 Plan Revie
p CITY OF TIGAR _ •j,L I �I1� Date Re Other Permit:
Inspection Line 503.639.4175 / e' Date Ready/By:ids : ®See Page 2 for
Internet: ww.ci.tigard.or.us BUILDING DIVISION Notified/Method: ( ICA Supplemental Information
on
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition /alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ❑Hazardous location
❑Service over 320 amps - rating DBuildng over 10,000 sq. ft.,
. . ' . ; CATEGORY OF CONSTRUCTION `, ' ' "1" of 1- and 2- family dwellings 4 or more new residential
❑ I- 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.: c( Job site address: /375- facility ❑Other:
�� � +�v 0/» ��W`� Submit 2 sets of plans with any of the above.
City /State /ZIP: 71 OA— The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.:/ea �
Project name: o t S fN FEE* SCHEDULE
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'I 500 sq. ft. or portion 3 .40 1
Tax map /parcel no.: Limited energy, residential 75.0 2
DESCRIPTION OF WORK Limited energy, non - residential 75.0 t QD 2
Each manufactured or modular
j - - dwelling, service and /or feeder 90.90
_f I I'i_ 41- _ :00A, G47/!t -c • Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
PROPERTY OWNER.. 201 amps to 400 amps 106.85 2
. ' '❑ ..TENANT. .
_ 401 amps to 600 amps 160.60 2
Name:
P/} t_ 'Ras 7---
• 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
❑ CONTACT PERSON A. Fee for branch circuits with
r
service or feeder fee, each 6.65 2
Business name: PA / ,/... ,4sstx , , branch circuit
B. Fee for branch circuits
Contact name: IIgR, C e _ - AL ) � without service or feeder fee, 46.85 2
Address: g g g s s / / 7 / I each branch circuit
Each add'I branch circuit 6.65 2
City /State /ZIP: �a42 /lam. Miscellaneous (service or feeder not included)
Phone: (6-43 ) Z33 --e/` if I ue Fax: : (s ) 2c38 --p76 • 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
Business name: extension. Describe: Page 2 2
S'
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
3gg I � I � t �� ` p ' n ELECTRICAL PERMIT FEES*
CCB Lic.: 6 Electrical Lic.: V u rv. Lic.: [lam 7 /
Subtotal
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: R 4 e-- c
/t+- y State surcharge (8% of permit fee) 6
e.,- _hre A--- Date: { _) p
TOTAL PERMIT FEE O
Authorized signatttr 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:\ Building \Permits\ELC- PermitApp.doc 12/03 440- 46IST(10 /02/COM/wEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
/ BUP
Received Date Requested ` v l 4/ AM PM BUP
Location ( S 5 7 , ..12 r.c_A.uc� Suite /60 MEC
Contact Person ��c -c-- (J Ph ( ) , ' � O L ` � 9 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
,Ftg Drain ELR aDD - 40 a93
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
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
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
ia PART FAIL
S Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date o / ° Inspector Ext
Other:
Final DO N • T REMOVE this inspection record fro the jo te.
PASS PART FAIL