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Permit • �>w CITY OF TIGARD ELECTRICALPERMIT - RESTRICTED ENERGY 1 ;' DEVELOPMENT SERVICES PERMIT #: ELR2004 -00277 13125 SW Hall Blvd., Tigard, OR 97223 ( 639 -4171 DATE ISSUED: 9/1/2004 SITE ADDRESS: 15575 SW SEQUOIA PKWY 100 PARCEL: 2S112DD -01600 SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P BLOCK: LOT: JURISDICTION: TIG Project Description: Voice /Data install. 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 AZIMUTH COMMUNICATIONS INC 15350 SW SEQUOIA PKWY #300 -WMI P.O. BOX 508 PORTLAND, OR 97224 WILSONVILLE, OR 97070 Phone: Phone: 503 639 - 0110 Reg #: ELE 36 -94CLE SUP 2312LEA LIC 145828 FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 9/1/2004 $75.00 Elect'I Final [TAX] 8% State Surchart 9/1/2004 $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 - 001 -0100. You may obtain copies of these rules or direct questions to UNC at /( (503) 246 -6699. Issued by ��� V Permittee Signatuv�l, 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 Elcxtrical Permit : i blitIttuu IVED FOR OFFICE USE ONLY City of Tigard SEP ©_ 2004 DaReceive teB v 06 Pemilt �f4R.aQ7 - ooa77 • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie Phone: 503.639.4171 Fax: 503.59 / /acdiia- 411,,, K Other Permit: Q 33 G I Y OF TIGARD t � �l 11 Date Re Inspection Line: 503.639.4175 t Date Ready/By: Juris: ® See Page 2 for Internet: www.ci.tigard.or.us BUILDING DIVISION Notified/Method: T7 Ca Supplemental Information .. - TYPE tOF. WORk . a. . , ,- . REVIEW , ','.;',.^:..;::.!,,..:. ❑ New construction :/ Addition/alteration/replacement Please check all that appry: ❑ Demolition ❑Other: ❑Service over 225 amps, comm'l EHazardous 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 0 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 INFORMAT16N AND LOCATION - ° ., RV park ❑Egress /lightingp1an P Job no.: Job site address: / 55-15 ❑Health -care facility ❑Other: �� au o t A P KuJ Y Submit 2 sets of plans with any of the above. Ci /State /ZIP: 11 ( The above are not applicable to temporary constructio service. ervice. ty (t(oA�, O I` PP P rY - � ` FEE * - SCHEDULE = .. : �: • Suite/bldg. /apt. no.: Project name: �Ea -e5 (c7 Description I Qty. I Fee. l Total 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 - dwelling, service and /or feeder 90.90 2 U 0 t / DATA 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: 601 amps to 1,000 amps 240.60 2 Address: I 54ci 5 S',U), S6G2t �otH f Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/State /ZIP: `T(GG) , we_ 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 . ❑ 'APPLICANT _ CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each 6.65 2 Business name: Ail Mu. (o tv.it ui%1(CA ri 0A) S branch circuit Contact B. Fee for branch circuits ontact name: �Og (jJ ��G without service or feeder fee, 46.85 2 Address: P te) ` 2 by, s g each branch circuit Each add'l branch circuit 6.65 2 City/State/ZIP: (!-) (LSDIO V I L LE r c o. C '70 t7 Miscellaneous (service or feeder not included) 3 ) (, 3q _ 01 16 (5 t3/ t c Pump or irrigation re ig lighting 53.40 2 Phone: (50 Fax: ) 6T1- L � Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited- . 'CONTRACTOR energy panel, alteration, or extension. Describe: 1 Page 2 2 Business name: t2t/bll.. CbWLt'rt LA../ J tCA-r( S Address: �� , co k Sob Each additional inspection over allowable in any of the above Per inspection 62.50 City/State/ZIP: w k t_S'ON t)1 u 6-1 C) K Ct 7 07 0 Investigation per hour (I hr min) 62.50 Phone: (5b3 639 - D i l 0 Fax: (5a 3) 6 34- 0//s" Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES *_ . CCB Lic.: 14 5gz3' Electrical Lic.: 3(o c%. Suprv. Lic.:a31,2 £ E Subtotal --z< r Suprv. Electrician signature, required: 8,„,„ Plan review (25% of permit fee) Print name: 93 eC Lk (--8 ea- C Date: et i + ' d T State surcharge (8% of permit fee) .6 TOTAL PERMIT FEE ' f 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:\ Building \Permits\ELC- PermitApp.doc 12/03 440- 4615r(10 /02/COM/WEB Electrical Permit Application - City of Tigard t Page 2' - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY:" • • 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 DI 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 is Building\PemutaLC- PermitApp.doc 04/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line:' (503) 539 -4175 INSPECTION DIVISION Business Line: (503) 639 - 4171 MST J BUP Received Date Requested \ <\ v AM PM BUP Location ( S '7 5 S5 '*!,(I Pi Suite / 6t) MEC Contact Person 'T" R Ph ( ) -JV - { R PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR �p _� ), 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 Service Rough -In UG/Slab Low Voltage Fire Alarm i‘f.) PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. . SITE Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ( i ADA Approach/Sidewalk Date / " /C- C Inspector 4/EL� ; I �� Ext PP I Other: Final DO NOT REMOVE this inspection record from th ob site. PASS PART FAIL