Permit CITY OF TIGARD ERESTRICTED LECTRICAL PENERGERMIT -
Y
DEVELOPMENT H O BMENT r S o ERV SERVICES 639 -4171 DATE ISSUED: 4 -00121
- 13125 ED: 5/7/2004
SITE ADDRESS: 11365 SW TIGARD ST PARCEL: 1S134DC -00700
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
Project Description: Thermostats low voltage.
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:
BAPS TEMPLE HVAC INC
PO BOX 41160 5188 SE INTERNATIONAL WAY
SAN JOSE, CA 95160 MILWAUKIE, OR 97222
Phone: 408 - 453 -6464 Phone: 408 - 453 -6464
Reg #: L O8 -4535 1
Efit13- 4622418221 CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 5/7/2004 $75.00 Elect'I Final
[TAX] 8% State Surchart 5/7/2004 $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 � J �. - j11 Permittee Signature A , , • k • , A • ■
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 FOR OFFICE USE ONLY
u a
Cl o f T igard Date/B 5 / ' Permit No. •/ / , —e/
i 13125 Sv Hall Blvd., Tigard, OR 97223 Plan Revi.
Phone: 503 639.4171 Fax: 503.598.1960 / ,,,,,, ', '- Date/B : Other Permit
Inspection Line: 503.639.4175 i'l I, Date Ready/By fur@ Fa See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method Supplemental Information
, ' TYPE. OF-WORK - PLAN REVIEW ;,'_
'Iew 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 - of 1- and 2- family dwellings 4 or more new residential
❑ I - and 2 family dwelling 6mmercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi ❑Master builder ❑Other: ❑Building over three stories ['Feeders, 400 amps or more
['Occupant load over 99 persons DManufactured structures or
- JO B SITE INFORMATION AND LOCATION ' - . 0 Egress/lighting plan RV park
n ❑Health -care facility ['Other Job no.: Job site address: 11 3(0 5 Su) (cg4,r c!' S
! submit 2 sets of plans with any of the above.
City/State /ZIP: -Ttit tx - ISlrt The above are not applicable to temporary construction service
Suite/bldg. /apt. no.: I ProjecCname: B. A ,p, � � -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'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
LOLL) dwelling, service and /or feeder 90.90 2
l W U� CA /�- 'i -I S - S Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I . ❑ ,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
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
Qt APPLICANT • ' CI CONTACT PERSON • A Fee for branch circuits with
i v���� service or feeder fee, each 6 65 2
Business name: branch circuit
1 B Fee for branch circuits
Contact name: ....c.--c__ c(y without service or feeder fee,
each branch circuit 46.85 2
Address: Each add'l 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
Business name: I,v4- C ,,c extension Describe: Page 2 7 S ` 2
Address: s °R se ) � C Each additional inspection over allowable in any of the above
i o c t ` -` Per inspection 62.50
City /State/ZIP: (\/( " a O g7,a2,D1 Investigation per hour (I hr min) 62.50
t • ( C' �� I ndustrial plant per hour 73.75
Phone: (,,St/ ) �� - (� � Fax: x!L_J C{ 6 2 &555 - ELECTRICAL PERMIT FEES* - '•
CCB Lic.: Rq7 Electrical Lic. &_57/ Suprv. Lic.: a c.(( Subtotal 7 5, (YD
Suprv. Electrician signature, required: _ t Plan review (25% of permit fee)
Print name: T M t J 1 Io (n Date: S I 'f/ G State surcharge (8% of permit fee) 6 , ()�
/ TOTAL PERMIT FEE Si . 50
Authorized signature: to_AAAL 1 L This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Sci e_ « o: ` `d/3 San Date: 5/7 / a( • Fee methodology set by Tii- County Building Industry Service Board
Number of inspections per permit allowed.
i \Buildmg\Pennits\ELC- PermuApp doc 12/03 440 -4615T(10 /02/COM/WEB
Electrical Permit Application - City of Tigard a
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
r; RE SIDENTIALWORK,ONLY: __ : ,_ '- 1 -
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:
: oSti∎ORCI L04RK - , ^'. ;;1
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
W 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 \Buildmg\Pcmuts'ELC- PcrmitApp doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received ` � 4 Date Requested 2/( AM PM BUP
Location 1 / 3 GP c ` eL Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: EL . „o r / 90 —
/
Crawl Drain � ` � 7 I
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors -ck)
Ext Sheath/Shear l
Int Sheath/Shear
Framing
Insulation I v�j C ®l[ , g)L S ys
Drywall Nailing
Firewall ft
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
ECVIICAL
Service
Rough -In
UG/
ow Volt -•l
ire arm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Date 1 2- 1 Inspector 1 ( �i fpLqt5
Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL