Permit CITY OF T I G A R D R ELECTRICAL ESTRICTED ENERGY
-
RESTRICTED ENERGGY
� " _ ®EV w H BIVi E N Tigard, SERVICES (503) 639 -4171 DATE ISSUED: ED: 5% 4?02 -00086
02
SITE ADDRESS: 09591 SW WASHINGTON SQUARE RD B -10 PARCEL: 1S126C0 -01107
SUBDIVISION: WASHINGTON SQUARE ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of data /telecommunication systems.
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 5/14/02 $75.00 2720020000 Elect'l Final
5PCT CTR 5/14/02 $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 you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -0 - 010 throw h,,OAR 952-041-0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246- 987.
Iss d by ; �� � _ f®& i/ Permittee Signature ic
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
SLR . c:70 2. — 6 8
f,. `'' Electrical Permit Application
Date received: Permit no.:
1 I, 11 :.1 1 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 • ommercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: 959/ LJ 0 wv1 $ QA Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision: Al
Project name: V , c _4 1 . 0 ,..% a, 4, 5 ecc 01 Description and location of work on premises: j 14. P L. 0,1 / 0,-1/2-0._
Estimated date of completion/inspection: 5- o 7--
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Fee Max
t
Business name: p,,,„ e .-F-- �1�c, ,r, Description Qty. (ea.) Total no. insp
I ) `
New residential - single or multi- family per
Address: (, It 3 2_ 14 4 .- A v M • dwelling mit. Includes attached garage.
City: IskDf `% s v t u C I State: L A ZIP: 9 g 2.7 ( ' Service included:
Phone: 215 C. 22.6 6S t) Fax: I E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: 1 ( xi t4;-- I Elec. bus. lic. no: 37 _I 1 ( c LL Limited energy, residential 2
City /metro lic. no.: 6 $ O Lt. Limited energy, non- residential 2
S f .4 I 0 L Each manufactured home or modular dwelling
Signature o supervising electrician (required) Date Service and/or feeder 2
Services
Sup. elect. name (print): S ......14 1�, . L '— License no: ) g 3 8 orfeeders — 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 amps 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. (Service or feeder not included):
❑ Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps -rating of I &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' 1 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
O Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O 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 $ �� GU
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: I / within 180 days after it has been State surcharge (8 %) .... $ /P
Expires accepted as complete. TOTAL $ g I • oD
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (6/00/COM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEJES:
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 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
Limited Energy $75.00 ❑ 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 s $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. , Ill . Audio and Stereo Systems "
Branch Circuits
New, alteration or extension per panel . Boiler Controls •
a) The fee for branch circuits - I
with purchase of service or I I Clock Systems
feeder fee. . • •
ee. "
Each branch circuit $6.65 2 • •
b) The fee for branch circuits n Data Telecommunica • Installation
without purchase of service ❑
or feeder fee. Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6.65 n HVAC
Miscellaneous n
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: n Protective Signaling
Enter total of above fees $ ❑ 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 $
All New Commercial Buildings require 2 sets of plans.
Total Balance Due $
i:\dsts \forms\elc - fees.doc 08/30/01
CITY OF TIGARD 24 -Hour
503
Inspection Line:
BUILDING p ( ) 639- 4175 MST
INSPECTION DIVISON Business Line: (503) 639 -4171
BUP
Received Date Requested i5 AM PM BUP •
Location q s91 /,L)i - S Qa D. Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( 2-7--6 -6' 6 507 SWR
BUILDING Tenant/Owner 1� !�'2�n� ELC
Footing ELC
Foundation Access: add a� 64?'‘ Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation 6L a C
Drywall Nailing — J
Firewall
Fire Sprinkler
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
U_ _ ..
owV•It -•- •
Fire Alarm
ina Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PA PART FAIL
SITE ❑ Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA '77 t' --
Approach/Sidewalk Dat� �� d� Inspecto Ext
Other:
Final DO NOT REMOVE this inspection re rd f ro the job site.
PASS PART FAIL