Permit ELECTRICAL PERMIT -
CITY OF T I G A R D RESTRICTED ENERGY
. DEVELOPMENT SERVICES PERMIT #: ELR2004 -00243
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/30/2004
SITE ADDRESS: 15575 SW SEQUOIA PKWY 160 PARCEL: 2S112DD -01600
SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: Low voltage for cabling.
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: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: CABLING X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC REALTY ASSOCIATES CUPERTINO ELECTRIC INC
15350 SW SEQUOIA PKWY #300 -WMI DBA: CEITRONICS, INC
PORTLAND, OR 97224 27350 SW 95TH AVE# 3032
WILSONVILLE, OR 97070
Phone: Phone:
Reg #:
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 7/30/2004 $75.00 Elect I Final
[TAX] 8% State Surcharl 7/30/2004 $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 OUNC at (503) 246 -6699.
Issued by Permittee Signature 3, (
1\
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 ApplickE
h FOR OFFICE USE ONLY
City of • T JUL 30 21 i4 Dat ( �J 30 7 [, A Peru&No.:e0L,_�O Oa
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 CITY OF TI o 46 "" M tiiA Other Permit:
( D ate /B y:
Inspection Line: 503.639.4175
BUILDING 1 - - , 0 1u ' : Date Ready/By: ® See Page 2 for
Internet: www.ci.tigard.or.us - - J Notified/Method: ( Supplemental Information
TYPE OF WORK PLAN REVIEW
21Iew construction El <ddition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ❑Hazardous location
OService over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I- 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
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi- family 0 Master builder ❑Other:
JOB SITE INFORMATION AND LOCATION ['Occupant load over 99 persons ['Manufactured structures or
❑Egress/lighting plan P
Job no.: Job site address: J5 Su ❑Health -care facility DOther:
S 7� S w dl) o/� /6b Submit 2 sets of plans with any of the above.
City/State /ZIP: '1' /(.yQ�j�� / OZ q7 0 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: �(�Q7�/� r FEE* SCHEDULE
`-'� ' e' ��""'�_c 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 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
40/0 f� /`'�LJ [S
r /�L (/ /JdJ� ,�` dwelling, service and /or feeder 90.90 2
!� 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: 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
Phone: ( ) Fax: ( ) relocation
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
Business name: C4/ S branch circuit 6.65 2
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address: / 5575 ��`( .. jt /4 5/0 /(' Each add'I branch circuit 6.65 2
T-j 42/
City /State/ZIP: -. , c 7z. 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
Wk. extension. Describe: Page 2 r/67 2
i
Business name: eiz 0 C48 — , 4k. 6- ) l
Address: Z - T ss-� q C 4vE 7 - E � Each additional inspection over allowable in any of the above
/ J Per inspection 62.50
City /State /ZIP: tOIL40A,(/ /1 J,E ! D2, 4 Investigation per hour (I hr min) 62.50
Phone: (5 03 ) 570-- 85o Fax: ( 503 ) 570 -851 Industrial plant per hour - - 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 77 50 Z E:ctrical Lic.: 7 ZJ LA Supry ' . _ -
Subtotal
Suprv. Electrician signature, required. f Plan review (25% of permit fee)
Print name: kJ • • 1 I Da • 7 Z - 7. State surcharge (8% of permit fee) f
TOTAL PERMIT FEE S� 5.,),... Authorized signature%/" i -# \ • a ./ This permit application expires If a permit is not obtalne 180
1 ll days after it has been accepted as complete
Print name: i Date: • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Building \Pemuts \ELC- PcrmitApp.doc 12/03 440.4615T(IO /02/COM/WEB /°//
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line. (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested — I'7 AM PM BUP
Location _ _ • 0 _ _. _ Suite / 6 O MEC
Contact Person _ Ph ( ) 'JOB Cog z j PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR DUL{r yOS��
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation (4 L._ ��,p/1.. E
Drywall Nailing /
Fire wall
Fire Sprinkler
Fire Alarm (■ t
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
41LIRY,■ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
'ASS PART FAIL
S 0 Please call for reinspection RE: ❑ Unable to inspect – no access
Fire Supply Line
ADA 8 — /7 _
Approach/Sidewalk Date ` Inspector w� ✓ Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL