Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
44 DEVELOPMENT SERVICES PERMIT #: ELR2004 -00190
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 6/29/2004
SITE ADDRESS: 15575 SW SEQUOIA PKWY 160 PARCEL: 2S112DD -01600
SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: Limited energy for HVAC
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
15350 SW SEQUOIA PKWY #300 -WMI
PORTLAND, OR 97224
Phone: Phone:
Reg #:
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 6/29/2004 $75.00 Elect Final
[TAX] 8% State Surchari 6/29/2004 $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 • = • -:: -0100 Yo may obtain copies of these rules or direct questions to OUNC at (50 6 -6699.
Issu by = - � i +F-dA1-4 Permittee Signature
OWNER INSTALLATION ONLY
The installation is being made on property 1 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
tricl Permit Application FOR OFFICE USE ONLY
City of Tigard Received ��� t .
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review / �, //� �(��( T
Phone: 503.639.4171 Fax 503.598.1960 Alk .ih,, y Date/B : Other Permit:
Inspection Line: 503.639.4175 W Date Ready/By: ',�� /' ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Mil Supplemental Information
TYPE OF WORK , PLAN REVIEW,
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ['Service over 225 amps, comm'l 0 Hazardous 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 ❑ 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
DOccupant load over 99 persons OManufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
: �p ❑Health -care facility ❑Other:
Job no.: Job site address
y5 5.,...., S fiva/i Pk Submit 2 sets of plans with any of the above.
City/State /ZIP: f' / The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: le,t7 Project name: !/QCA7� 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'! 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
• v L dwelling, service and/or feeder 90.90 2
,
�t7 Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
'PROPERTY OWNER I 0 TENANT. 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: Ai. e U 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: (s ) Gad ,c3 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: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address:
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 -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension.,Dgsc ' : �, / Page 2 2
Business name: Rze, /14P ` pfd / ry�-
Address: G)7gG
se' i i tL� AZ- Each additional inspection over allowable in any of the above
Ll ,i Per inspection 62.50
City/State /ZIP: 1 r" T2�/,D� a 47=-72 47=-72 Investigation per hour (1 hr min) 62.50
Industrial plant per hour 73.75
Phone: c63 )0 3'VQ!/ Fax: r°5 2figaolge 41/7-7
ELECTRICAL PERMIT FEES* .
CCB Lic.: Electrical Lic.:
6� x,txxl Suprv. Lic. r3417 Subtotal 75.co
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: l Wadi 7 ��bL� Date: Stat p ermit fee) , D
TOTAL PERM FE g /, Ov
Authorized signature Thi s permit ication surcharge expires if (8% a pe rmit i no obtained wi thin 180
day appl after it has been acc ted as c
Print name: ,..)/zem /).�1 Date�l A U • 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- 4615T(10 /02/COM/WEB
Electrical Permit Application - City of Tigard ,r _
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: - I
•
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
is\ Building \Permits\ELC- PemtitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested 5i' — 1 7 AM PM BUP
Location f 5 A .e-c J Suite / MEC
Contact Person ( y/1 .a—y - Ph ( ) S7 9 — ( D (C1 t PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR 6D4f- (t a
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear cv,
Int Sheath/Shear
Framing
Insulation H J , / - w n , i4 f � p n ,r ,rte�+1
Drywall Nailing n V ,1 �-- lu J i 1 ADC-- �(/G,( C�
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In � � Aevr T�� t \i rJ a /C)
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
d apr
e PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE 1 Please call for reinspection RE: El Unable to inspect - no access
Fire Supply Line
ADA 8- i? -O /
Approach /Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL