Permit CITY T I G A R D ELECTRICAL PERMIT -
RESTRICTED ENERGY PERMIT
L ''�1� DEVE H BMENQ OR 2 639 -4171 DATE SSUED: E31IO2 2 00145
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 audio wiring. Job No. Limited #800
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: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PPR WASHINGTON SQUARE LLC COMWERX
P.O.BOX 21545 12121 NE 99TH
SEATTLE, WA 98111 SUITE 2100
VANCOUVER, WA 98682
Phone: Phone: 1- 888 - 266 -9379
Reg #: SUP 1800JLE
LIC 117471
ELE 37- 780CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 7/31/02 $75.00 2720020000 Elect'l Final
5PCT CTR 7/31/02 $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 ollow rules adopted by the Oregon Utility Notification Center. Those rules ar- -e / or 'rn OAR
952 -00 - 010 thro gh OAR 9- - 001 -0080. You may obtain copies of these rules or dir�• - '•. : • OUNC at (503)
246 -1 87. ..
Issu d by , ��;� Permittee Signature rP
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: 7 ,/ •02- Permit no.: .00 S
.mil ,.PI City of Tigard Project/appl. no.: A 7712.1111111.111
City of Tigard Address: 13125 SW Hall Bivd, Tigard, OR 9722 Date issued: , B it
Phone: (503) 639 -4171
Fax: (503) 598 - 1960 Case fileno.:' ■ •aymenttype:
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ,Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: f57 5 iii ,-5Q , / •f 6 5 7 6-6, Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision: p hya/ a- 7-76,1/ 5Qgx/ ,7,qa_
Project name: , „ 7 . 2 Description and location of work on premises: ,-, .4 4/ nit is .,,
Estimated date of completion/inspection: . / 3 0 •
. - CONTRACTOR APPLICATION FEE SCHEDULE -
Job no: L /
-z 8- o Fee Max
Description Qty. (ea.) Total no. ins
Business name: Ce-)iy,,,J�X fi L P
Address: Z('Z /✓G� c [ 4 fG 2 /Oa New residential -single or multi-family per
1 dwelling unit. lncludesattachedgarage. •
City: )4, ca c, k — I State: 424I ZIP: 99r .g Serviceincluded:
Phone:3 _E6 - eiy5S Fax: a/g -f A E -mail: 1000 sq. ft. or less 4
CCB no.: / 7 V 7 / I Elec. bus. lic. no: '3 7 -7k'o C (� L eddne g 500 sq. ft or portion thereof
Limi mited energyy , ressi dential 2
• 1
City /met ,.• 40 p j 0 Limited energy, non- residential 2
/JI' y /�r✓:/y o a Each manufactured home or modular dwelling
ignature of supervising electrician (required) Date / Service and/or feeder 2
Sup. elect. name (print): gcnA/ e/ <'/ !tom License no: G .5'S-L.6.. Services or feeders – Installation,
alteration or relocation:
' PROPERTY OWNER . 200 amps or less 2
Name (print): 201 amps to 400 amps 2
Mailing address: 401 amps to 600 amps 2
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:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 antis 2
ENGINEER Branch circuits - new, alteration,
Name: or extension per panel:
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
Phone: Fax: E-mail: of service or feeder fee, first branch circuit: 2
, Each additional branch circuit:
• PLAN REVIEW (Please check all that apply) Misc .(Serviceorfeedernotincluded):
❑ 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" 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description: 4WD D
❑ 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
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee $ 75 .c3
❑ Visa Cl MasterCard expires if a permit is not obtained Plan review (at _ %) $
y State surcharge (8%) 0
Credit card number: / / within 180 days after it has been g ( ) •••• $ � �
Expires accepted as complete. TOTAL $ I • a
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
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
Limited Energy $75.00 pi Burglar Alarm
Each Manufd Home or Modular ❑
Dwelling Service or Feeder $90.90 2 Garage Door Opener*
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 1 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 ❑
New, alteration or extension per panel Boiler Controls
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑
or feeder fee. Fire Alarm Installation
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
Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over ❑ Medical
the allowable in any of the above
Per inspection $62.50 ❑ Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting*
Fees: ❑ Protective Signaling
Enter total of above fees $ I 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:
Total Balance Due $
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
i:\dsts\ orms\elc- fees.doc 10/09/00
CITY OF TIGARD' 24-Hour. -
BUILDING Inspection Line: (503) 639-4175
DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested • AM PM BUP
Location COS') S h( 4Pti 5� t Q' b Suite JJ MEC
Contact Person Ph (A' 9 8 )4). ' 1375 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR ) _ Up / L
Crawl Drain
Slab Inspection Notes: \� > t 5� �, SIT
Post & Beam fill
Shear Anchors ,.
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing J
Firewall V� ro V
Fire Sprinkler • - "'
Fire Alarm f
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
RT FAIL
ECTRICA — D
Service .
Rough -In
1A16
Fire Alarm
El Reinspection•fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
;13 PART FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date — — - Inspector ! � Ext
Other:
Final DO NOT REMOVE this Inspection record from the joy' site.
- PASS PART FAIL
•