Permit CITY OF TIGARD ELECTRICAL ENERGY
-
RESTRICTED ENERGY
- •�,L'�I�;� DEVELOPMENT SERVICES PERMIT #: ELR2002 -00161
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/21/02
SITE ADDRESS: 09573 SW WASHINGTON SQUARE RD B -6 PARCEL: 1S126C0 -01107
SUBDIVISION: WASHINGTON SQUARE ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of limited energy for 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:
PPR WASHINGTON SQUARE LLC PLANET ELECTRIC
P.O.BOX 21545 6832 14TH AVE NE
SEATTLE, WA 98111 MARYSVILLE, OR 98271
Phone: Phone: 206- 226 -6507
Reg #: LIC 141447
ELE 37- 876CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 8/21/02 $75.00 2720020000 Elect'l Final
5PCT CTR 8/21/02 $6.00 2720020000
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 yo • ow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 •0010 throu• OAR 95 You may obtain copies of these rules or direct questions to OUNC at (503)
246-1' _
Issue. 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
El Permit Application FOR OFFICE USE ONLY
Received G i Electrical
Date/By: / i OP Permit No.: EG/2-0/002 — 06/6/
City of Tigard Planning Approval Sign
Y g Test Form Date /By: Permit No..
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No :
Phone: 503- 639 -4171 Fax: 503 -598 -1960 �w "�� Post- Review Land Use
Internet: www.ci.ti ard.or.us � IV�j� l '� C Case No.:
g e Contact Juris.: 0 See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 '''''" W Name/Method• Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
New construction n Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONS RUCTION 1 & 2 family dwellings four or more residential units in
❑ I & 2- Family dwelling Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other
JOB SITE INFORMATION and LOCA ION Submit sets of plans with any of the above.
n `� �� The above are not applicable to temporary construction service.
Job site address: 757 7 t ,,. U { L FEE* SCHEDULE
Suite #: Bldg. /Apt. #: / Number of inspections per permit allowed
Project Name: TA e_ 1._. t 1 + 48 Description Qty Fee (ea.) Total
Cross street/Directions to job site: New residential - single or multi - family per j
dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 l
Subdivision: Lot #: Limited energy, residential 75 00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
/ Services or feeders - installation,
�T
L Lbw\ alteration or relocation:
200 amps or less 80 30 2
201 amps to 400 amps 106 85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
City/ State/Zip: alteration, or relocation:
y p 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
ID APPLICANT ❑ CONTACT PERSON 401 to 600 amps 133.75 2
Branch circuits - new, alteration, or
Name: extension per panel:
Address: A Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included).
CONTRACTOR Each pump or irrigation circle 53.40 2
Job No: Each sign or outline lighting 53.40 2
Signal circuit(s) or a limited energy panel,
Business Name: (_ / (- C TR 1 L alterauon, Descnption or extension' ( 75.00 7 -
' L I N T 2
Address: 4, V 32- /14 "1 A,, ,e) C '!y
City /State /Zip: M p, r 1 s ti t I I t C t j A Each additional inspection over the allowable in any of the above:
Per inspection (per hour - min. 1 hour) 62.50
Phone: 2. 06 2_2A 6,4---0?- Fax: 2 Z 2- 9 r 6 ‘ Investigation fee:
CCB Lic. #: / y ( (y 7 Lie. #: 37- $ 7C, LAC Other:
Supervising electrician Electrical Permit Fees* - 7 54
Subtotal $
signature required: Plan Review (25% of Permit Fee) $
Print Name: <;-wt j3( sezr Lic. #: )1? 3 I go State Surcharge (8% of Permit Fee) $ (0 4 od
TOTAL PERMIT FEE $ g / . 00
Authorized e/ l Notice: This permit application expires if a permit is not obtained within
/ 2 - Signature: � Date: a t / b� 180 days after it has been accepted as complete.
1 e. !7 i,y.4.-k.p Tt — *Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP •
Received Date Requested 4�Z AM PM BUP
9 Location / S 7 3 to f S Q• kei Suite MEC
Contact Person Ph ( ( 6 SAO 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access: _ �� /
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam , J�
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear •
Framing
Insulation
Drywall Nailing
Firewall )Y f A `./
I /
Fire Sprinkler I , O Q''
Fire Alarm
Susp'd Ceiling
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
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
I, PART FAIL
SIB fl Please call for reinspection RE: Ei Unable to inspect — no access
Fire Supply Line 77
ADA Date Po` / a -Z
Approach/Sidewalk Inspe Ara—es , .r Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL