Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
�� DEVELOPMENT SERVICES PERMIT #: ELR2003 -00016
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/24/03
SITE ADDRESS: 09020 SW WASHINGTON SQUARE RD 520 PARCEL: 1S126BC -01506
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Tenant Improvement - 14 data drops
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:
PORTLAND OFFICE ASSOCIATES G G TELECOMMUNICATION CO
BY TC PORTLAND, INC 121 SW SALMON ST
8930 SW GEMINI DR STE F -1
BEAVERTON, OR 97008 PORTLAND, OR 97204
Phone: Phone: 503 295 - 2922
Reg #: LIC 59692
ELE 34- 248CLE
FEES Required Inspections
Description Date Amount Ceiling Cover
[TAX] 8% State Tax 1/24/03 $6.00 Wall Cover
Elect'I Final
[ELPRMT] ELR Permit 1/24/03 $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 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 throuc
Issued by I ___J Permittee Signature proi f _.
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
Date received: i ID Permit no.R4,2 -ere,0/ 4,
,4 City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receiptno.:
Phone: (503) 639 - 4171
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval: C`)4 ,2�2 ' OO Lf 5
. - v TYPE OF PERMIT ;
❑ 1 & 2 family dwelling or accessory II Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
•
J OB SITE INFORMATION
Job address: g02O Sir) idAb!'41NG7EAl , , . - ow p Bldg. no.: Suite no.: 520 Tax map /tax lot/account no.:
Lot: I Block: I Subdivision:
Project name: I Description and location of work on premises: 14 D4fl} Damps
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE .
Job no: P1 E,(.► i q. N r !�¢dC£591NG T.A4c. • Fee Max
Business name: G, (,"r . .. p c. Co , Description Qty. (ea.) Total no. insp
Address: New residential - single or multi-family per
ddress:
/ 2) 5 Lei SAU-t V m S mc, t T £ I dwelling unit. Includes attached garage.
City: 1-- -w(D I State: ORI ZIP: 47 1 7 20z Service included:
Phone: 2q6 - 2922 I Fax:295-0138 4 I E -mail: 1000 sq. ft. or less 4
CCB no. 55 1. 9 Z, I Elec. bus. lie. no: 34 - 2 Ste eL.L Each additional 500 sq. ft. or portion thereof
Limited energy; residential 2
etro lie. no.: ,5( Limited energy, non residential 2
/ - 24 - 0,3 Each manufactured home or modular dwelling
Signature f supervising a ectrici (required) Date . Service and/or feeder 2
Sup. elect. name (print): llitoDO21v 3' G.QA4444 -1 License no: 1200L Services or feeders- installation,
. alteration or relocation:
• ' PROPERTY OWNER - -
200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders - -
which is not intended for sale, lease, rent, or exchange according to installation, alteratlon,orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
• ' ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E -mail:
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not Included):
❑ Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps - rating of 1&2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* I 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other Per inspection
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other L
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ J'
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ (o
Credit card number: / / within 180 days after it has been State surcharge (8 %) $
Expires accepted as complete. TOTAL $ 7) 1
Name of cardholder as shown on credit card
$ .
Cardholder signature Amount 4.40-4615 (6dv0 /COM)
Electrical Permit Fees: Limited Energy Fees:
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total y Check Type of Work Involved:
Residential - per unit
1000 sq. ft or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular Garage Door Opener
Dwelling Service or Feeder $90 90 2
Services or Feeders n Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation
200 amps or less $80.30 2 n Vacuum Systems 201 amps to 400 amps $106 85 2
401 amps to 600 amps $160.60 2 I�I Other
601 amps to 1000 amps $240.60 2 I I
Over 1000 amps or volts $454.65 2
Reconnect only $66 85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918 - 260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133 75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see "b" above. Audio and Stereo Systems
Branch Circuits n Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or n Clock Systems
feeder fee.
Each branch circuit $6 65 2 Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ' n Fire Alarm Installation
or feeder fee.
First branch circuit $46.85 HVAC
Each additional branch circuit $6.65 El
Miscellaneous n Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 n Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ri Landscape Irrigation Control
Minor Labels (10) $125.00
0 _ Medical
Each additional inspection over _
the allowable in any of the above n Nurse Calls
Per inspection $62.50
Per hour $62.50 El Plant $73.75 Outdoor Landscape Lighting
Fees: n Protective Signaling
Enter total of above fees $ n Other
8% State Surcharge $ J Number of Systems
25% Plan Review Fee
* No licenses are required. Licenses are required for all other installations
See "Plan Review" section on $
front of application.
Fees: •
Total Balance Due $ 0— Enter total of above fees $
❑ Trust Account # 8 % State Surcharge $ • 1
Total Balance Due $ < < L1)
i•\dsts \forms \elc- fees.doc 10/09/00 Vj
CITY OF TIED 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requeste• ' AM /t PM BUP
Location a" / c-' 2 J o) L(� j • v`? • � / Suite ,f MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain n i ELR — &&C;/ Crawl Drain /
Y �' �✓
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear •
Framing
Insulation
Drywall Nailing
Firewall -
Fire Sprinkler
Fire Alarm
Susp'd Ceiling 7
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
`*AZCTR1==)
Service
Rough -In
UG/Slab
<�
Fire Alarm
► - • ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
: SS PART FAIL
SI ❑ Please call for reinspection RE: El Unable to inspect - no access
Fire Supply Line
ADA '� !
Date Ext
Approach/Sidewalk how ctor Dil ,.
Other:
Final DO NOT REMOVE this Inspection record fr m the Jo site.
PASS PART FAIL
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