Permit (142) - f y CITY O F TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
rAg S,;;fi�i� DEVELOPMENT SERVICES PERMIT #: ELR2002 -00079
-- 13125 SW Hall Blvd., Tigard, OR 97223 (5031639 -4171 DATE ISSUED: 5/6/02
SITE ADDRESS: 16200 SW PACIFIC HWY Y PARCEL: 2S1156A -00101
SUBDIVISION: TIGARD TOWNE SQUARE ZONING: C -G
BLOCK: LOT: 001 JURISDICTION: TIG
Project Description: Installation of data/ telecommunication.
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:
HORSCH INVESTMENT WINNER ELECTRIC INC
1121 SW SALMON 5950 SW PROSPERITY PK
TIGARD, OR 97205 TUALATIN, OR 97062
Phone: 503 - 973 -0248 Phone: 638 -5028
Reg #: LAC 14794
SUP 2825S
ELE 34 -150C
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 5/6/02 $75.00 2720020000 Elect'l Final
5PCT CTR 5/6/02 $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 - 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 /,.,�,� ,, / 4,j4, Permittee Signature ( i bOrde
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: — / RV C.
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
•■• vUa -
" ,_ AO. Electrical Permit Application 1
Date received•/, •5-4, G Z Permit no. ----11.7.: X 7 _C0v 7'
.•111 City of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: 1113M 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 �Commercia1Jindustrial O Multi- family Sit Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: /4_;0o $ iJ Ale; C.,-c_ 14`x` s „: f \ Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: (Subdivision: 7750a-a hg$ So
Project name: 6 WA 't,Qe I Description and location of work on premises: pIi J l AIi
Estimated date of completion/inspection: — 0 — 0
CONTRACTOR APPLICATION FEE SCIIEDU.E
Job no: Fee Max
Business name: t J; AJ Al e A - e,`ei fly Iv Description Qty. (ea.) Total no. insp
New residential - single or multi - family per
Address: ,sc S(,d pioSPt'&t” PK dwelling unit Includes attached garage.
City: �A C p 14,,.1 I State: 0 2I ZIP: Gj?oct- . Serviceincluded:
Phone5o3 6 3 g 60ZQ Fax:So3 6311 4E-mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: i ‘ 4 7 4 4 # I Elec. bus. lic. no: nLr it ' G Limited energy, residential 2
City /metro lic. no.: Limited energy, non- residential 2
ti.. 1 l ' Each manufactured home or modular dwelling
Sig t re of supervising electrician (required) Date 5-3 — Service and/or feeder 2
Sup. ect. name(print): r 14 A A%t License no: , 6 : 26 . Services or feeders — installation,
alteration or relocation:
`k ' 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 i
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, or relocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701. 201 201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
Br anch 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) Misc. (Service or feeder not included):
O Service over 225 amps - commercial 0 Health-care facility Each pump or irrigation circle 2
O Service over 320 amps -rating of 1&2 0 Hazardous location Each sign or outline lighting 2
family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, 7 6C� ?�� 2
❑ System over 600 volts nominal more residential units in one structure alteration, or extension . I
O Building over three stories 0 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 $ 7 gr vf,
O 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 %) .... $ (a • O d
Expires accepted as complete. TOTAL $ g l , o 6
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6/00/COM)
I/
a e
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT F' ESQ ` ' -
• 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 y 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
200 amps or less $80.30 2
201 amps to 400 amps $106.85 2 n 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 ❑
New, alteration or extension per panel o0 Boiler Controls .
a) The fee for branch circuits
with purchase of service or . ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 2 an 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 El Each sign or outline lighting $53.40 I Intercom and Paging Systems
Signal circuit(s) or a limited energy v
panel, alteration or extension t $75.00 1 c tb n Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over I • ❑ 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 ti f .
Fees: ❑ Protective Signaling
Enter total of above fees $ ❑ Other , s'
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 $
All New Commercial Buildings require 2 sets of plans. •
is \dsts \forms\elc- fees.doc 08/30/01
CITY OF TIGARD 24 -Hour
BUILDIN Inspection Line: (503) 639 -4175 MST {
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requeste 5 7 AM PM BUP
Location / (P-2,00 Suite L p) MEC
Contact Person Ph ( ) g —/ d. 3O PLM
Contractor 7� Ph ( ) SWR
BUILDING Tenant/Owner T'_i � Q _ _ ELC
Footing ELC
Foundation Drain undation Access: •
Ft ELR ;669. 0.007q
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fire wall�l^ \) Fire Sprinkler 1
Fire Alarm
Susp'd Ceiling r
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
Alarm
•ate D Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
114111117ART FAIL
❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Approach/Sidewalk Date ` d Inspecto / — / �~'— - Ext
Other:
Final DO NOT REMOVE this Inspection record from the Jo , = Its.
PASS PART FAIL