Permit `w
CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
4 111 1 1‘6 DEVELOPMENT SERVICES PERMIT #: ELR2005 -00306
�� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/26/2005
PARCEL: 2S1 12 D D -00701
SITE ADDRESS: 15822 SW UPPER BOONES FERRY RD BLD.0 ZONING: I -P
SUBDIVISION: OREGON BUSINESS PARK II LOT: JURISDICTION: TIG
Project Description: Phone /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
ELE 3- 538CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[TAX] 8% State Surcharl 9/26/2005 $6.00
[ELPRMT] ELR Permit 9/26/2005 $75.00
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 g it will expire if work is not
started within 180 days of issuance, or if work is suspended for more than 180 days. A�TTEITION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules a / set f rth in O■R 952 - 001 -0010
through OAR 9524 -0100. You may obtain copies of these rules or direct quest ns to UN fat 503 - 246 -6699.
x
Issued By: ,j2 A 7.1, ' Permittee Signature: /- v, ,-
OWNER INSTALLATION ONLY J
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 503 -639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
. Approved plans are required on the job site at the time of each inspection.
. Electrical Permit Real !Il \I ___ l OR OFFICE USE - ONLY
City of Tigard �e/B ' i —�,, -0 Permit No. 6( ►, ,;'. (,a 76,6
13125 SW Hall Blvd., Tigard, OR 972 Plan Review
Phone: 503.639.4171 Fax: 503.598. e P S 2005 ''' " t' f7 ' 1 p�r/B Other Permit lin Inspection Line: 503.639.4175 .__r - ' _ � _ L J Date Ready/By. . ® See Page 2 for
Internet: www.ci.tigard.or.us Cr -, Nonfied/Method. Supplemental Information
l• OF f • • //
R d ttio ti '������ PLAN REVIEW
❑ New construction - .1a�hftent Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'I ❑Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq ft.,
CATEGORY OF CONSTRUCTION oft- and 2- family dwellings 4 or more new residential
❑ I- and 2- family dwelling aCommercial /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
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION 0 Egress/lighting plan RV park
Job no.: Job site address: 1 6 - $ 22 S'Li UQPrt.a C.00 1J�S F Lay ❑Health -care facility ❑der:
T 3 D G Submit 2 sets of plans with any of the above.
City /State/ZIP: l \ , , 0 ( . The above are not applicable to temporary construction service
FEE' SCHEDULE
Suite/bldg./apt. no.: Project name: l) I S Do
o2 4. 0 A,R_ALI Description I Qty. Fee. T Ial 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 I
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential (75.00 2
DESCRIPTION OF WORK 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 OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: P/4 Cl r — . _ r 2-rc.A- ( k � c s o c ... ■ ,-r ` 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/Z1P: 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
❑ APPLICANT I ❑ 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, 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 -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: Keg , T1JG b e 1 f}C ?NO tJ.2 M S,.J -LLIC.
Address: � - ? as ,_ `� L SS C T - . Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: (_A-KC 0 S'w r G 0 D2 C -? O 3 Investigation per hour (I hr min) 62.50
Phone: (7 3 ) gee (.f if Fax: (SV_S )69 9 q & Industrial plant per hour 73.75 _
ELECTRICAL PERMIT FEES"
CCB Lic.: i t 3 S 9 ( Electrical Lic.:3 -S3 B etc. Suprv. Lic.: Z g89 CZ A
Subtotal •
Suprv. Electrician signature, required: Plan review (25% of permit fee)
il.tA
State surcharge (8% of permit fee)
Print name: \Q . -I P' t M '1 a . /k Date: e (2_ ( , ,f
TOTAL PERMIT FEE
Authorized signature: p r This permit application expires if a permit is not obtained within 180
J days after it has been accepted as complete
Print name: 3p s c ?; , c. t 0, Date / L ( 70 J • Fee methodology set by Tri- County Building Industry Service Board
l
•• Number of inspections per permit allowed.
i.\ Building 'Pennits\ELC- PemitAppdoe 12/03 - 440-4615T(10/02/COM/WEB
R� 1
Electrical Permit Application - City of Tigard, ti
11
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 J •
• System* J •
❑ Vacuum Systems*
•
❑ Other:
•
COMMERCIAL WORK ONLY: • 1
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 Systems
❑ Landscape Irrigation Control* '
•
❑ Medical
❑ Nurse Calls - - _J , 9 •
❑ Outdoor Landscape Lighting* ,
Protective Signaling . • - -, , IA,Other f- P1-t0 ►
Total number of commercial systems: • • •
*No licenses are required. Licenses are required
for all other
-
i:\ Buildineennits\ELC- PamitAppdoe 04/03 -
CITY OF TIGARD `
BUILDING DIVISION PERMIT #: ELR2005 -00306
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/26/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 s' "'I � ..
INSPECTION WORKSHEET FOR DATE: 10/14/2005 TIME: 7:02AM PAGE: 63
SITE ADDRESS: 15822 SW UPPER BOONES FERRY RD BLD.0 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK II LOT #: TYPE OF USE:
PROJECT NAME: US DOOR & HARDWARE G P
DESCRIPTION: Phone/Data.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: KB INC PHONE #: 503 - 788 - 1444
Inspection Request Scheduled For: Date: 10/14/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 018381 -01 503-788-1444 Y
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 1
Date: /D ` l i t " OS Phone #: (503) 718-