Permit CA
CITY OF T I G A R D E L E C T R I C A L PERMIT -
RESTRICTED ENERGY
DEVELOPMENT H BMENT Tigard. � 639 -4171 DATE ISSUED: 4 -00075
13125 ED: 3/23/04
SITE ADDRESS: 15780 SW UPPER BOONES FERRY RD BLDG D PARCEL: 2S112DD -00700
SUBDIVISION: ZONING: IP
BLOCK: LOT: JURISDICTION: TIG
Project Description: Install limited energy for voice /data.
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 KJB INC
15350 SW SEQUOIA PKWY #300 -WMI 14 PEAKNESS CT
PORTLAND, OR 97224 LAKE OSWEGO, OR 97035
Phone: Phone: 503 - 788 - 1444
Reg #: LIC 113596
ELF. 3 538CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 3/23/04 $75.00 Elect'I Final
[TAX] 8% State Surchart 3/23/04 $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 ill expire if work is not
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTEN 0 : Oregon law requires
you o ow rue : , . •ted by the Oregon Utility Notification Center. Those rules are set f.rth in •AR 952 - 001 -0010 throuc
- -��� I /
�II�
I sued by i I ,.;�� ' / ed 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
Electrijal Permit Application - FOR O FFICE USE.ONLY •`'
City of Tigard Date /B . ., • ,J D i R�=
13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
Phone 503.639.4171 Fax 503.598 1960 - -iP ` i +'� Date/B Other Permit
Inspection Line 503.639 4175 II Date Ready/By 0 See Page 2 for
Internet www ci tigard.or.us Notified/Method En Supplemental Information
'4K -i^ >h .- 4 i .•,,.T`'; °7 .T.YPE rWOR .,.y,• : il, ? .u,:�y;:u ,;•r'''; .:�K':,- " "
-- .. ': � ,. '�PL
' _AN � REVLEW�'
r' -''
❑ New construction K Addition/alteration/replacement c 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 ,
- ' _ , r ° ' ' , CATEGORY' OF 1 CONSTRUCTION '' r"`{•'" ' i41 " , ' � '
•(' 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
Building over three stones ['Feeders, 400 amps or more
❑ Multi - family 0 Master builder 0 Other:
Occupant load over 99 persons ❑Manufactured structures or
!.'- ' ;: ce,; ,.-;q ?_ -F 1,JOB''SITE Pi iFORMATIONi D - tLO CATION °_ ' C ' ❑ Egress /lighting plan RV park
Job no.• Job site address: ❑Health -care facility ['Other c� S W' U Q P e 'Z .e()0 t S F t2Ry Submit 2 sets of plans with any of the above
City/State /ZIP: O The above are not applicable to temporary construction service •
Suite/bldg. /apt. no.: / Project name (� ! . ir''''or.-`4,,3".
r 't; ` .4-.SCHEDULES •.
tJ J 6 - 1 Ls' P u i 'L R. -S Description I Qty. I Fee Total 1
Cross street/directions to job site: I 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 fl or portion 33 40 1
Tax map /parcel no.: Limited energy, residential 75 00 2
"rr^aK, ✓t � Limited energy, non - residential 75.00 / 2
:' �DESCRI�PTION,.OFF,WORK; ;': :<<• '•f''v
. -:`;it •:. � . �_, •,, ; • „ ^�;��.`;., : .1. �,;, -... _ ,r•. ` - • r'• • ; :.':: ", ._.. . _ Each manufactured or modular
J /
6 (�� -� N— n 1 -0 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'"'•.∎; a ',..• •r;,' -' = ❑, TENANT r ,-.,•:.•', $a•r, :-- 201 amps to 400 amps 106 85 2 • 401 amps to 600 amps 160 60 2
Name: PAC -r-R V S` 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
-' ' 1-- - ' - A. Fee for branch circuits with
' , ■ 'APPIICANT� • ,:;+ : •t - - � , '� :• C
service or feeder fee, each 6 65 2
Business name: branch circuit
Contact name: B. Fee for branch circuits
without service or feeder fee, 46 85 2
Address: each branch circuit
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-
', - ''"-.:t*:', ,- .r. energy :.�'� ? � , � CONTRi1GTOR,` - ' *''• `1 r � - gY P anel, alteration, or
extension. Describe Page 2 2
Business name:
K 3 B ENC. Dg A Twe I (4orJEMAN NC.
Address: I �2 /� K N S S C. Each additional inspection over allowable in any of the above
n Per inspection 62 50
City/State /ZIP: L A K E 0 S W G CJ , o R, ' 7 0 3 S Investigation per hour (I hr run) 62 50
Phone: 60 3 ) 1 S 8 ( /4_ 4 Fax (SQ3 ) G Q 9 1-f- ci ((1o2. Industrial plant per hour 73.75
•. ,, r, :.-. i:f ECTRICAL PERMIT: • FEES• , _: .
CCB Lic. I + 3 5 ( Electrical Lic. 3' 3c� C �Suprv. Lic.:, 4 8( L Subtotal
Suprv. ElPstVrtature, required: � /b/ / If Plan review (25% of permit fee) 7570
0U
Date l /' State surcharge (8% of permit fee) ,00
Print name.
J p 5 G l M 1 A 0 3,� /ot TOTAL PERMIT FEE 8 t t m0
Authorized signature: rpm - - / 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 ‘Bmlding\Pemuis'ELC.PerinnApp doc 12/03 440 4615T(10 /02/COM/WEB
Electrical Permit Application - City of'Tigard
Page,2,- ,Supplemental Information •
LIMITED ENERGY PERMIT FEES:
ESIDtisla' WORK O__17 �Y ,4- fg7773.
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* , - - t - - • - - -
❑ Vacuum Systems*
❑ Other: .
r-- f
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
- Check Type of Work Involved: V •
❑ Audio and Stereo Systems ` ,
❑ Boiler Controls' ,
❑ Clock Systems .
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC -
❑ Instrumentation .
❑ 'Intercom and Paging Systems
❑- Landscape Irrigation Control* V
❑ Medical
❑ Nurse Calls V
❑ Outdoor Landscape Lighting* •
❑ Protective Signaling _
❑ Other
Total number of commercial systems: •
*No licenses are required. Licenses are required ,
• for all other' installations -
i \Bui ding\Permjts\ELC- PcmutApp doc 04/03 - _
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received . 3 : Z 2. Date Requested 3/36 ‘° VAM PM BUP
Location 5 i'D / ' ,, / ._ . Dv - ite MEC
I
Contact Person ,. re Ph ( c - 4. 320 — <C PLM
Contractor /&J7.� -e__ • / r l �D, ?FP- 7�e/V SWR
BUILDING Tenant/Owner /27A/1 / j t rJti%-. Dal ELC
Footing
Foundation ELC
Access:
Ftg Drain , �-rl— UO U 75
Crawl Drain
Slab Inspection Notes: SIT -Aa Post & Beam p `( 40 `-.-
Shear Anchors
Ext Sheath/Shear ---.6--1.-.--
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
ELECTRICAL L'
y 5ervice
Rough -In
- .w Vo a• -
F' -
`i Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SI 111 Please call for reinspection RE: El Unable to inspect - no access
Fire Supply Line \
ADA 3 " 3 � - (:)‘"\ L - 1 `� ) L�
Approach/Sidewalk Date Inspector L . Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL