Permit A CITY OF TI GARD ELECTRICAL PERMIT -
A RESTRICTED ENERGY
W DEVELOPMENT SERVICES PERMIT #: ELR2005 -00009
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/10/2005
SITE ADDRESS: 15820 SW UPPER BOONES FERRY RD BLD.B PARCEL: 2S112DD -00701
SUBDIVISION: OREGON BUSINESS PARK II ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of limited energy for data telecommunications.
Job No. J -0002
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 COMMWORLD OF PORTLAND
15350 SW SEQUOIA PKWY #300 -WMI 5711 SW ARCTIC DRIVE
PORTLAND, OR 97224 PO BOX 3675
BEAVERTON, OR 97005
Phone: Phone: 503 - 520 - 1220
Reg #: Le6a- 023303916
ELE 26- 890CLE
SUP 3541LEP
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 1/10/2005 $75.00 Elect'I Final
[TAX] 8% State Surchart 1/10/2005 $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 expi•- if work is not
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: 0 on law requires
you to folio le adopted by the Oregon Utility Notification Center. Those rules are s •t forth in • r 952 - 001 -0010
throug AR 952 -00 1 1 ! .. You may ob ain copies of these rules or direct question to OUNC -t 503) 246 -6699.
Issu d by , / Permittee Signature i / ADA"
r
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 ' " '
v •
City of Tigard Date/B /�G PernutNo & 4� .., "OW"
13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
Phone 503.639.4171 Fax 503.598 1960 ' $ ,x� I`� Date/B . Other Permit.
Inspection Line: 503.639.4175 e'I i Date Ready/By. W17. ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method P7 / Get Supplemental Information
• °•i4� :'.L�. _ .i?,;a fi '{i+�?•: -t -• - ^ . -- _ - .u- � • r +,p, `i'- .c?'i� r' i'.=! tiAS. - fl i5: ":.- Y- v.
;:•�:S:.�ri`��'' "• sit= �'^=•';; ��` �.,. it�� '°•:v *�; ":7'�YP' EOF;x.�VORK iii .•�s•;,.,�t� ��r!�.- ��.i✓it>.-�'±.t.�+-�i � { �, t _ �_ �-<, : "'�:�, _ •
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❑ New construction Addition/alteration /replacement Please check all that apply
❑ Demolition Other: ['Service over 225 amps, comm'l ['Hazardous location
OService over 320 amps - rating ❑Bulldng over 10,000 sq ft.,
- t i 4 y 5 r
:' "' ;. 'i 4 ;` - t : `" '� "�' � of 1- and 2-family dwellings residential
°; :. '' ,� CATEGORY' OFfrCONSTRUGTION'" #' a o- e i - '„ "- wellin s 4 or more new rest e
:',V.: .fS' .•,:r e• �i•✓.x' - 2..''��n•3� � -:�.,. ....:,•. t • .• '- iS +F'•...ur`' �:..ts ssSr3t<r`�- ,:�.a•
❑ 1- and 2- family dwelling Commercial/mdustrtal ❑ Accessory building ❑System over 600 volts nominal units in one structure
['Building over three stones ❑Feeders, 400 amps or more
❑ Multi - family ❑ Master builder ❑ Other:
DOccupant load over 99 persons 0 Manufactured structures or
•;rr- r 4r - T - a - - - t - .�n:�:. +.,• - ., ,..�,
'' - ,E '. 7 ' , 'JOBg FORM XND LO TIO1 i : �r �a - :' ' =L'r t RV
..,.;:i ' , A :- i;:.1 -P .., -w - ..,r - -_ .- •r, 1; - , .L..'. •_ . ❑Egress /lighungplan park
P
Upper Boones FY, ❑ Health-care
sofpiry ❑Otove
Job no.:J - 0002 Job siteaddress15820 SW U
pp Submit 2 sets of plans with any of the above
City/State /ZIPLake Oswego, OR 97035 Bldg . B The above are not applicable to temporary construction service.
,•,''; :,�, _;; ; _. , FEE *�SCHVLE :•E~ ..` ' -
Suite/bldg. /apt.no.: #172 Project name: Joslin Sales Description t ? = •:r � -� r
scription I Qty. I Fee f Total 1
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.:
- r •.. °;6 n,t_ i`,1 v' fr , ,.. ,.,- D,ESCRIPTIO1 OF WORK c 1 .
Limited energy, non - residential 75.00 2
;,, � � +,. , -c `�,r, ., 3 ,_�, F - . - - . - c ..,. r_ ,.. ='��� _ •:_, ,..:•l'1 ' .. ; Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Data Telecommunications Cabling Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
' ,. : � `� F ` ,, " ® . ' : PROEER7 ° Y, OW . ' , ';' 14_ . `y'�` ` . . ," .. N =i TENANT ' . ' 'r "�" 201 amps to 400 amps 106.85 2
:'�r. <u'�- t +..._..,(�.o , €.� . _,� _�.t � 1 :i}(-, y ,- ..c:- .,�.�._. _ _ . �•'' 'Y 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
)� 7 ._- t "-'� '' • -' "";N t ' A Fee for branch circuits with
service or feeder fee, each
; • -1 - TY. - . ❑- A:PPLICe1N . .. a'
.. ` ... ;) _ . ACT PERSON "
�., , . ^a :. �v "'` : < •.i ?
_ 6 65 2
Business nam -. Commworld of Port - nd branch circuit
B. Fee for branch circuits
Contact name: Bo • Olsen without service or feeder fee,
each branch circuit 46 85 2
Address: 5711 SW • . is Drive Eachadd'lbranchcircuit 6.65 2
City /State /ZIP: 13= , ve r t on , • R 97005 Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: (5 •' 520-1220 Fax: : ( 50 3) 646-0235 Sign or outline lighting 53.40 2
E -m. . Signal circuit(s) or limited- '
;, }; 9' , y : 4E;: j "ra' 4• ti a�% �'�• P energy panel, alteration, or � 75:09 75,00
;: � '=1, s H _r-,' �s- _ a:: ' ,, CON TRACTOR.''' �"'e "" T , lt,r By P
extension Describe. Page 2 2
Business name:
Commworld of P ortland l7f11
Address: Each additional inspection over allowable in any of the above
5711 SW Arctic Drive Per inspection 6250
City/State /ZIP: Beaverton, OR, 97005 Investigation per hour (i hr min) 62.50
Phone: ( Fax: ( / Industrial plant per hour 73 75
5 03 5 2 0 -1 2 2 0 5 i /646-0235 4 6 - 0 2 3 5 ._. . ti -9;� ELECTiuc'A%,;AP_EigkiriFtFS* t: ;` ; .':�-' -')
CCB Lic.: 103916 Electrical Lic 6 - 8 • • , ; Sup rv. Lie. 3 Oi-1 LEA
Subtotal 7`J� QQ
Suprv. Electrician signature, required: , Plan review (25% of permit fee)
// / Date V - U S State surcharge (8% of permit fee) 6, C)
Print name:
�// / / // 6.047 e., / - / 6/ " TOTAL PERMIT FEE # V,QO
Authorized signature. / 0- This permit application expires if a permit is not obtained within 1R0
days after it has been accepted as complete
Print name: Bob Olsen Date.1 /10/05 • Fee methodology set by Tn- County Building Industry Service Board
•• Number of inspections per permit allowed.
i.\ Building \Pemuts\ELC- PennitAppdot 12/03 440- 4615T(10 /02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information `
LIMITED ENERGY PERMIT FEES:
Fla! "§WgtratNgOW07.FttT:M-WR-WfVggrgng
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:
DCO ' e ' a itelAI WORK ONI*.: P • f A'' r s
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
1 \ButIdmg\Pemuts\ELC- PemutApp doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: O03) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested 1 3 AM PM BUP
/ Location / S�� ZD � Suite MEC
Contact Person O � ( J � - e ms Ph ( ) . 3 ? - 86o( PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access: / C�
Ftg Drain 6ZZ m e P..Gi O -/v DA ELR d�d [ -003 7 (
Crawl Drain O S -.0.000 9
Slab Inspection Notes: Arr
Post & Beam
Shear Anchors
Ext Sheath/Shear
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
iqy
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
FAIL El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART
SITE Please call for reinspection RE: LI Unable to inspect — no access
Fire Supply Line
ADA
Date — 13 o to � ` d1U0�
Approach/Sidewalk Inspector Ext
Other:
Final DO NOT REMOVE this inspection record fro the job site.
PASS PART FAIL