Permit CITY OF TIGARD ELECTRICALPERMIT -
RESTRICTED ENERGY
=� DEVELOPMENT SERVICES PERMIT #: ELR2001 -00037
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/13/01
SITE ADDRESS: 09455 SW WASHINGTON SQUARE RD A -15 PARCEL: 1S126C0 -01107
SUBDIVISION: WASHINGTON SQUARE ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Proiect Description: Tenant Improvement
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: DOOR BELL X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PPR WASHINGTON SQUARE LLC NEW TECH ELECTRIC
P.O.BOX 21545 1400 NE 48TH AVE
SEATTLE, WA 98111 HILLSBORO, OR 97124
Phone: Phone: 503- 648 -1900
Reg #: LIC 41868
SUP 2113s
ELE 26 -418c
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 2/13/01 $75.00 2720010000 Elect'l Final
5PCT CTR 2/13/01 $6.00 2720010000
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 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987. ,
Issued by � %��1 Permittee SignatureLi i `)°(W
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: 0 Permit no.: • _ . �
,4ek
1 1, j ,.:.• l! C of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receipt no.:
Phone: • (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
•
Land use approval: ► , r 1 0 0 � F I ,/
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial 0 Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision:
Project name: I Description and location of work on premises:
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Fee Max -
Business name: Description Qty. (ea.) Total no. rasp
New residential - single or multi- family per
Address: dwellingmit. Includes attached garage.
City: I State: I ZIP: Serviceincluded:
Phone: I Fax: I E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: I Elec. bus. lic. no: Limited energy, residential 2
City /metro lic. no.: Limited energy, non- residential 2
Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect name (print): License no:
Servicesorfeeders — 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, alteration, orrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701. 201 201 amps to 400 amps 2
Owner's signature: D 401 to 600 am s 2
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) Me. (Service or feeder not included):
O Service over 225 amps- commercial ❑ Health -care facility Each pump or irrigation circle 2
0 Service over 320 amps -rating of 18a ❑ 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,
. O System over 600 volts nominal more residential units in one structure alteration, or extension* - 2
0 Building over three stories ❑ Feeders, 400 amps or more *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other. Per inspection I
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for mare information. Notice: This permit application
Permit fee $
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (6400/COM)
Electrical Permit Fees: Limited Energy Fees:'' • '
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 4, 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 Manuf'd Home or Modular ❑ Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation 8 O 0
200 amps or less 80.30 201 amps to 400 amps / $$06.85 ,/�n, 2 ❑ Vacuum Systems
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 ❑ Other
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 .S (p $6 653 707 ] i '7` b2 n . Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit - $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous ❑ 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 ❑ Landscape Irrigation Control
Minor Labels (10) $125.00
❑ Medical
Each additional inspection over
the allowable in any of the above n Nurse Calls
Per inspection $62.50
Per hour $62.50 ❑
In Plant $73.75 Outdoor Landscape Lighting
Fees: Protective Signaling ,p / ��
Enter total of above fees $ _55 6 1 SS ' n Other �l�M 5 � `� ~</ `"-�
8% State Surcharge , $ 1 /4 7(' I Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ l 3 gkg * No licenses are required. Licenses are required for all other installations
front of application.
`7
/ / Fees:
Total Balance Due $ 7' yI 1 ° C Enter total of above fees $ / "i
❑ Trust Account # 8% State Surcharge $ (0 . 00
Total Balance Due $ Z) l 1 i
i:\dsts\forms\elc- fees.doc 10/09/00
r 7
Electrical PermitAApplication
Date received: a -/3 -0 1 Permit no,
may, li I,,: City of Tigard Project/appl. no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Ti J. OR 97223 Date issued: By J Receipt no.
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: ��, ,5
TYPE OF pER111IT
0 1 & 2 family dwelling or accessory 0 Comma :rcial /industrial 0 Multi - family Tenant improvement
0 New construction ❑ Additir n/alteration/replacement ❑ Other. D artial
JOB SITE INFORMATION . • , . ,
Job address.�4 M�/� - /, ' � ! ` 4 Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: , B ., k: Subdivisi +n: , /.,i ,' 4
. Project name•,i, %/lli Descrif . on and location of work on premises: r /�� 4 , `, v .-
Estimated date of completion/inspection:
"r" "!.- " -----7- ' ----------- et110MN: I tlJ 1I.1 G li 11 M11111 '� �11�.un i g lli
Job no: fe 21/ Fee M
Business name: New Tech Electric Description Qty. (ea.) Total no. Insp
14 00 NE 4 8th Avenue New residential - single or multi-faaly per
Address: dwelling unit Includesittached garage.
City: Hillsboro I StateOR 12.IP: 97124 See ded:
Phot33- 64 8 -1900 I Fa 64 8-3131 I E -mail: 1000 sq. ft. or less 4
CCB no.: 41868 !Elec. bus. lic. no: 26 -418C Each additional 500 sq. ft. orportionthereof
Cl ;)
Limited energy, residential 2
City/metro I limited energy. non- residenti al 2
r 02 9-0 / Each manufactured home or modular dwelling
. Signature of su gel 'clan (required) Date Service and/or feeder 2
Sup. elect_ name (print)ieh J,p ' L C' Q (v — Li. ruse no: Services or feeders Installation,
PROPERTY OWNER alteration or relocation: I 200 amps or less laic 2
Name (print): 201 amps to 400 amps / /a6 P( 2
Mailing address: 401 amps to 600 amps ' 2
601 amps to 1000 amps 2
City: I State: 122P: 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, alteration, orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Dm: 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 56 , ,1, • f 2
City: 'State: I ZIP B. Fee for branch circuits without purchase
Phone: Fax of service or feeder fee, first brunch circuit: 2
Each additional branch circuit:
• PLAN REVIEW (Please check all Ilia apply) _ Misc. (Service or feeder not included):
❑ Service over 225 amps - commercial 0 Health -rare facility Each pump or irrigation circle 2 _
❑ Service over 320 amps - rating of 1&2 0 Hazardous locaticn Each sign or outline lighting 2
family dwellings 0 Building over 10,100 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• . id
O Building over three stories ❑ Feeders, 400 amp : or more • n . R o
!ri : " LE'.
o Occupant load over 99 persons 0 Manufactured stn retorts 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
Not all jurisdictions accept cxedrt cards, please caul jvrisdretion for more in6 rnraLw. Notice: This permit application
Permit (cc $ ..�i..
O Visa O MasterCard expires if a permit is not obtained Plan review (at _ %) $ �� f �� y
Credit card number / / within 180 days after it has been State surcharge (8%) .... $ .5O. 7
I. Name of cardholder as accepted as complete.
ra rhown on credit card '
TOTAL $ 47 ?t i taddholdcr airway S E" p'1ei
Aant 440615 (frlOn/(:OM)
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 "
BUP
• Date Requested 7 Z. ) AM PM BLD •
Location �J l S S 5A✓ GeiGs A 5y / Su 0 /) MEC
Con Person 1 /4 A / Ph G Y f /9 " PLM
Contractor Ph SWR
BUILDING Tenant/Owner " _ ELC
Retaining Wall ELR 44i-- -- d G 3 7
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab - SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing , . . .
Insulation
Drywall Nailing
Fire Sp _ / ' lc
:2.n Fire Sprinkler /
Fire Alarm
Susp'd Ceiling _
Roof
Misc: -
Final
PASS PART FAIL
PLUMBING C e -
Post & Beam
Under Slab
Top Out •
Water Service
Sanitary Sewer °
Rain Drains V
Final
PASS PART FAIL —
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
t"ervice
Rough In
. UG /Slab --
C L Ow Valtaab
Fire Alarm •
S ART FAIL.
SITE
Backfill /Grading •
Sanitary Sewer
Storm Drain • [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Other ae 2 (3.---- Di Inspector �a� " /L_
Approach /Sidewalk Dt
. _ E
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site. •