Permit A, - CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
L ° fi1iti DEVELOPMENT SERVICES PERMIT #: ELR2004 -00159
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/14/2004
SITE ADDRESS: 11365 SW TIGARD ST PARCEL: 1 S134DC -00700
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
Project Description: Low voltage for security system.
Job No. BAPS
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: SECURITY. X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
BAPS TEMPLE A & E SAFE & ALARM CO
PO BOX 41160 PO BOX 179
SAN JOSE, CA 95160 MCMINNVILLE, OR 97128
Phone: 408 - 453 -6464 Phone: 408 - 453 -6464
Reg #: E4 - 453315234CLE
L $C3- 4726549A
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 6/14/2004 $75.00 Elea! Final
[TAX] 8% State Surchart 6/14/2004 $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
througla-CIAR 952-16 -0100. You,:k o • ain copies of these rules or direct questions to OUNC at (503) 246 -6699.
Issued by l i x_71a♦ t i 4 _41, Permittee Signature ,
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 Application nA FOR OFF USE ONLY ,
City of Tigard
Date/B eved 4170 A $ � p / I • •
13125 SW Hall Blvd., Tigard, OR 97223 1.zsr P lan Review
Phone 503.639 4171 Fax 503 598.1960 m P0'1I � �;\ Date/B Other Permit
Inspection Line 503.639 4175 r j Date Ready/By El See Page 2 for
Internet: www ci tigard or us Notified/Method i Supplemental Information
',, { - �. 41 aPL•ANREVIEW-�r.:
� - ' � `TYPE' OF WOR � � �� , - . .s_ .. -•� �" Ft
� ..: .
I hNew construction ❑ Addition/alteration/replacement Please check all that apply
❑ Demolition ❑Other: ['Service over 225 amps, comm'l ['Hazardous location
Service over 320 amps — rating ❑ Buildng over 10,000 sq ft ,
- - ' CATEGORY OF?CONSTRUCT ION;" -:-...•'''. ''_ _ ` of 1 - and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling E iCommerciaUtndustrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
['Building over three stones ['Feeders, 400 amps or more
❑ Multi 0 Master builder 0 Other:
' - ' 5 . - . - lr ;' •JOB'SITE INFORMATION AND ;LOCATION '`° • ❑E /li plan ['Occupant load over 99 persons ['Manufactured structures or
RV park
�"�• - P
Job no.: A S Job site address: / � [ 3 S h'r t / ' 1 ❑He -care facility above
City /State /ZIP• r / „' g Q 0 d A The above are not applicable to temporary construction service
Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE > T ;' •
Description I Qty I Fee 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'l 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. •WO , i i` ' • �,; 'y'' _ _ . - , Each manufactured or modular
dwelling, service and /or feeder 90 90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80 30 2
• PROPERTY 1OWNE ' '
12 H' ❑ - TENANT ' ,.' _c �.,. ;, , 7: .; 201 amps to 400 amps 106 85 2
401 amps to 600 amps 160 60 2
Name: -- t_ a ,.. l PeAJ 601 amps to 1,000 amps 240 60 2
Address: 0 jb (.4 1 i 1./5 Over 1,000 amps or volts 454 65 2
'�J r �N Reconnect only 66 85 2
� City/State/ZIP: S 4Ss, e J,k 95— Temporary services or feeders installation, alteration, and/or
( ) L. -� c44, ( ) relocation
Phone: 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 -
, � ..- . _ , 4 E CONTACT;PERSON ; :-:'• I -
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'1 branch circuit 6 65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax:: ( )
Sign or outline lighting 53 40 2
E -mail: Signal circuit(s) or limited-
. •'M1 • ` S , ,. , energy panel, alteration, or
1
,� CONTILACTOR : - _
extension. Descnbe Page 2 2
Business name A - &- C t c VA. ,,,,,/ ! y (► u L i -Pi
Address: t' 0 B 0 7 1 7 Each additional inspection over allowable in any of the above
Per inspection 62 50
City /State /ZIP: / - i L m , /V AI L , / ' / tr. O 9 7 / 2 t9 Investigation per hour (I hr min) 62.50
Phone: (S 4 4 e/ 7L , ( [ /3 I 1 Fax: ( ) If 72_ —3 5 G Industrial plant per hour 73 75
ELECTRICAT r PERMIT.'FEES* ;' +: ? .p,;,-'i
CCB Lic.: 6'5 11 i Electrical Lic 3 z clz Lic / - /c/1 5 Subtotal 74
Suprv. Electrician signature, required p / ri/�„ r Plan review (25% of permit fee) ((
/ _ / �¢� ` State surcharge (8% of permit fee) r 00
Print name: }n l / e 4' /S h ee ,,,� ate: / t - /
U
TOTAL PERMIT FEE S ' • Ov
Authonzed signature: ?/k. c/0 7 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 Tn- County Building Industry Service Board
•• Number of inspections per permit allowed
i \BuddingiPermits\ELC- PemutApp doc 12/03 440.4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
• Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
. Wi777-77.t1
RESIDENTIAL. WORK.7ONIYY:
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:
"COMM E E:At *ORI{ ONL ::;.� > :�._ . .; ° t ; ,
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
•
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i \BuiIdmeemuu\ELC- PemutApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested 8 — ( AM PM BUP
Location 1/3 GS T7 CAA Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 734P$ ELC
Footing ELC
Foundation Access:
Ftg Drain ELR — 00 X57
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
rik Ext Sheath/Shear Int Sheath/Shear
Framing n ,� 1
Insulation SEr• 2, t f IL0
Drywall Nailing �V 1� r
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof I
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
F' . larm
AS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line /61 ADA 8 - 7 ► ( / fr 3 2 /1 (J Ext
Approach/Sidewalk Date ( Inspector C.>r�/�C.
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL