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Permit CITY OF TIGARD ELECTRICAL PERMIT - RESTRICTED ENERGY I DEVELOPMENT SERVICES PERMIT #: ELR2004 -00252 ��J II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/9/2004 SITE ADDRESS: 09020 SW WASHINGTON SQUARE RD 570 PARCEL: 1S126BC -01506 SUBDIVISION: ZONING: C -G BLOCK: LOT: JURISDICTION: TIG Project Description: Voice /data, fire alarm. A. RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: AUDIO & STEREO:X INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: DATA/TELE COMM: X NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: X OUTDOOR LANDSC LITE: OTHER: : HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: TOTAL # OF SYSTEMS: 2 Owner: Contractor: PORTLAND OFFICE ASSOCIATES FIRE PROTECTION SERVICES BY TC PORTLAND, INC 18270 SW MOUNTAIN HOME RD. 8930 SW GEMINI DR SHERWOOD, OR 97140 BEAVERTON, OR 97008 Phone: Phone: 503 - 590 - 3732 Reg #: ELE 34- 488CLE LIC 154333 FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 8/9/2004 $150.00 Elect'I Final [TAX] 8% State Surcharl 8/9/2004 $12.00 Total $162.00 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 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 ELectpicai Permit Application FOR OFFICE USE ONLY CEIVED Received � / �/ ; 1 '��)w�lJ[f��a 5.�- City of Tigard fI = � L s_ Date/By: 0 TA 4,/ Permit No.�. 7 13125 SW Hall Blvd., Tigard, Jig Plan Review Other Permit: Phone: 503.639.4171 Fax: 503.598.1960 'a al lI i'� Date/By: Inspection Line: 503.639.4175 AUG 0 9 2004 ' Date Ready/By: //,, 53 See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: P`k Supplemental Information Cr i'eF''PQG K .PLAN REVIEW ❑ New construction B < tImDMJ SQ $replacement Please check all that apply: ❑ Service over 225 amps, comm'l ['Hazardous location ❑ Demolition ❑ Other: ❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft., CATEGORY OF CONSTRUCTION , 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 stories ['Feeders, 400 amps or more ❑ Multi family ❑ Master builder ❑ Other: ❑Occupant load over 99 persons ['Manufactured structures or JOB SITE INFORMATION AND LOCATION - ❑Egress /lighting plan RV park ❑ Health - care facility ['Other: Job no.: Job site address: 8020 SW Washington Square Rd #5 Submit 2 sets of plans with any of the above. City /State /ZIP: Tigard, Or The above are not applicable to temporary construction service. ' FEE* SCHEDULE , Suite/bldg. /apt. no.: #5 Project name: Dr Barry 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'I 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 Tax map /parcel no.: Limited energy, non - residential 75.00 2 DESCRIPTION OF WORK Each manufactured or modular Voice /Data, Low Voltage Fire Alarm dwelling, service and /or feeder 90.90 2 Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 201 amps to 400 amps 106.85 2 ❑ PROPERTY OWNER I 0 401 amps to 600 amps 160.60 2 Name: ,, �h!/� ,e, 601 amps to 1,000 amps 240.60 2 / Address: / � S j s T4 A VS Over 1,000 amps or volts 454.65 2 ` Reconnect only 66.85 2 City/State /ZIP: Ar-l 9 k ° 7a oz] Temporary services or feeders installation, alteration, and/or relocation Phone: ('') c9 y y v y 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 ❑ 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 each branch circuit Address: Each add'I branch circuit 6.65 2 City /State /ZIP: Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 2 Phone: ( ) Fax: : ( ) 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: Fire Protection Services Inc Each additional inspection over allowable in any of the above Address: 18270 SW Mountain Home Rd Per inspection 62.50 City/State /ZIP: Sherwood Or,97140 Investigation per hour (i hr min) 62.50 Phone: (503) 590 -3732 Fax: (503) 628 -6214 Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* CCB Lic.: 154333 Electrical Lic.: 34- 488CEP 7 uprv. L'c.• 4120LEA Subtotal 7 Suprv. Electrician signature, required: y ; " j� Plan review (25% of permit fee) /� State surcharge (8% of permit fee) �/ / Print name: tn/'� i %ate: TOTAL PERMIT FEE 7�2. • Authorized signature: / ii This permit application expires if a permit is not obtained within 180 - ✓i /��" /,. / days after it has been accepted as complete Print name: / , Date: Fee methodology set by Tri- County Building Industry Service Board L/ Number of inspections per permit allowed. i.\Building \Permits \ELC- PermitApp.doc 12/03 440 -4615T(10 /02 /COM/WEB Z. CITY OF TIGARD 24 -Hour BUILDING Inspection Line;4503639 -4175 INSPECTION DIVISION Business Line: (503) 639 - 4171 MST BUP Received - Date Requested t a -1 C\ AM PM BUP Location 17 0. 7 l,� S Suite J am- / b MEC Contact Person VO Ph ( ) S b ' 3'13'Z, PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner 1 3 R � �� ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain 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 Roof Other: Final PASS PART FAIL PLUMBING Post & Beam l✓J . +- 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 Servibe L Rough -In UG /Slab F' = Alarm Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW-Hall Blvd. PART FAIL SITE 0 Please call for reinspection RE: Q Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date / / �/ %/ inspector ' q Ext Other: Final DO NOT REMOVE this Inspection record from th ob site. PASS PART FAIL