Permit ITY Co F T I G A R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
Iijk
- 13125 DEVELOPMENT H BMEN (503) 639 -4171 DATE ISSUED: 7/15/02 ELR2002-00125
SITE ADDRESS: 09573 SW WASHINGTON SQUARE RD B -6 PARCEL: 1S126C0-01107
SUBDIVISION: WASHINGTON SQUARE ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Low voltage for speaker system and HVAC controls.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: X 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: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 2
Owner: Contractor:
PPR WASHINGTON SQUARE LLC MID VALLEY ELECTRIC INC.
P.O.BOX 21545 PO BOX 655
SEATTLE, WA 98111 WILSONVILLE, OR 97070
Phone: Phone: 503 - 682 -2955
Reg #: ELE 3 -542C
LIC 151602
SUP 3483S
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 7/15/02 $150.00 2720020000 Elect'l Final
5PCT CTR 7/15/02 $12.00 2720020000
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 stared- within480 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
req fifes you to follow rues adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 -001 -0010 through OAR 9 001 -0080. You may obtain copies of these rules or dire q - i • s to OUNC t (503)
2 -1987.
Is ued by :�� - i ,�i1�S..�... Permittee Signature . /L ` �..��
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: /f 0 o 2 Permitno.:ei/2f00 -a/,
4 f •(,,i" • City 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:
_, - TYPE OF 'PERMIT .
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction 0 Addition/alteration /replacement ❑ Other: ❑ Partial
- JOB SITE INFORMATION
Job address: ogS73 S. v. Liss , • , - kJ t- _ Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision: w, S w46.ra---
Project name: L.-• y. Lig Description and location of work on premises: L fr /111111WAMPOINIIII
Estimated date of completion/inspection: 5 4- v Ac. con 1-5/-
_ CONTRACTOR. APPLICATION_' , _ _ ..... ,FEE_SCI EDULE -
Job no: (, Fee Max
Business name: V ` _ (� d � Description Qty. (ea) Total no. Imp
residential - single or mutt[- family per
Address: • o- W
60 , • dwengunit. Includes attached garage.
City: t,..• , ,., , /(,_ State:OP ZIP: 91.0 o Service included:
Phone: CEO ' 1 FFax:. 55J - / j a y E -mail: 1000 sq. ft. or less 4 _
CCB no.: *WS= Elec. bus. lie. no: - S G Each additional 500 sq. ft. or portion thereof _ .
Limitedenergy;residential ___ 2
A_/ Limited energy, non - residential ___ 2
/ //i/ Each manufactured home or modular dwelling
Si atu Hof su.14 - a , Service and/or feeder ■■. 2
alirt): y' Ot/ ffIMII Licenseno3'( ,• Services or feeders— installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less . 2
�/ 201 amps to 400 amps ___ 2
401 amps to 600 amps ___ 2
M • ng address: 601 amps to 1000 amps ___ 2
City: State: ZIP: Over 1000 amps or volts ___ 2
Phone: Fax: 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, alteratson,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
_ . -. _ _, . ---7 -- - _- _- - -. 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: State: ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: ■■ 2
Phone: Fax: E -mall: Each additional branch circuit: __
,PLAN. REVIEW (Please check all that apply) Misc .(Serviceorfeedernotincluded):
O Service over 225 amps - commercial O Health -care facility Each pump or irrigation circle .■ ■ 2
O Service over 320 amps -rating of 1 &2 O Hazardous location - Each signor outline lighting ___ 2
family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, nom
O System over 600 volts nominal more residential units in one structure alteration, or extensions /So 2
O Building over three stories O Feeders, 400 amps or more *Descri . tion: _. v v. aa 4 C,
O Occupant load over 99 persons O Manufactured structures or RV park Each additional mspection over the allowable in any of the above:
O Egress/lightingplan O 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 credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ 1So
O visa O 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 (6/00/COM)
Electrical Permit Fees: Limited Energy Fees:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total NI, 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 pi Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular n Garage Door Opener*
Dwelling Service or Feeder $90.90 2
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System"
Installation, alteration, or relocation
200 amps or less $80.30 2
201 amps to 400 amps $106.85 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. n Audio and Stereo Systems
Branch Circuits ❑ Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit $6 65 2 ri Data Telecommunication Installation
b) The fee for branch circuits - T : r ! '
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85 �
Each additional branch circuit $6.65 I HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle ' $53.40 and Paging Systems
Each sign or outline lighting $53 40
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 n Landscape Irrigation Control
Minor Labels (10) $125.00
Fl Medical
Each additional inspection over
the allowable in any of the above Calls
Per inspection $62.50
Per hour $62.50
In Plant $73.75 0 Outdoor Landscape Lighting`
Fees: I Protective Signaling
Enter total of above fees $ ri Other
8% State Surcharge $ Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ * No licenses are required Licenses are required for all other installations
front of application. - Fees:
Fees:
Total Balance Due $
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
•
i:\dsts \forms \elc- fees.doc 10/09/00 I
CITY OFTIGARD 24-Hour j
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested �a-� AM PM BUP
Location S W ,Y).■ COI Suite MEC
Contact Person Ph ) ( �� PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner - ELC
Footing ELC
Foundation Access:
Ftg Drain ELR c1 V0(3 f]i� Ja�
Crawl Drain
Slab Inspection Notes: ` i r SIT
Post & Beam 11
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing -
Fire Sp ��� \\N O C Fire Sprinkler `I J �; �}•'
Fire Alarm
Susp'd Ceiling
Roof I
Other: - - - - - a •
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
T FAIL
CTRIC •
Service
Rough -In
UG/Slab
Z_LowVolt'age
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
•t PART FAIL
SITE ❑ Please call for einspectio RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA Cj ��
Approach/Sidewalk Date - _ Inspector ��+ /if _ �►�`__� Ext •
Other:
Final DO NOT REMOVE this inspection record rom e job site.
PASS PART FAIL
•