Permit A
CITY OF TA G A R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
/III? DEVELOPMENT SERVICES PERMIT #: ELR2003 -00342
.+L'-'L.„ 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/6/03
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SITE ADDRESS: 12725 SW 66TH AVE 107 PARCEL: 2S101AD 00100
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 034 JURISDICTION: TIG
Project Description: Limited energy for data telecommunications. Job No. 311061
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:
PARROTT, VIAL LLC CABLE RUNNERS
12725 SW 66TH AVE #202 10500 SW BOONES FERRY RD
PORTLAND, OR 97223 PORTLAND, OR 97219
Phone: Phone: 503 245 - 3669
Reg #: LIC 122854
ELE 26-95ICLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 11/6/03 $75.00 Elect'1 Final
[TAX] 8% State Surchart 11/6/03 $6.00
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 rii by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throuc
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Issu by rt - Vii,% 11 / [� ,�.�� ' Permittee Signature A - �-.
pr
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
IEledtrical Permit Application FOR OFFICE USE ONLY
Received Electrical
Date/By: 1/ 49%5 ,t Permit No .: jQ, a h--.
City of Tigard Planning Approval Sign
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 Post - Review Land Use
Internet: www.ci.tigard.or.us '""iiiid Date/By: Case No.:
° __.. Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
2- Addition/alteration /replacement ❑ Other: � rvice ial ❑ Bu s over 10on
❑ Seervice over 320 amps- rating of ❑ Building Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling 2 Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Accessory Building ❑ Multi- Family ❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: / 2 7 2 S S �✓ 6 AI/e- FEE* SCHEDULE
Suite #: / D 7 Bldg. / Apt. #: Number of inspections per permit allowed
Project Name: esIi-.e ° • S / T / Description Qty Fee(ea.) Total
New residential- single or multi - family per j
Cross street/Directions to job site: 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 1
Limited energy, residential 75.00 2
Subdivision: Lot #: 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,
a47-4 ,TC- L C Cco '1. 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 J ❑ 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,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85 I
Phone: Fax: 201 amps to 400 amps 100.30 2
❑ 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
// � // / Each sign or outline lighting 53.40 2
Job No: 3 to Signal circuit(s) or a limited energy panel,
Business Name: C'4 /SG ‘ XL(A/�z ,cf alteration, or extension / Page 2 2
Description: � ' (7 ,n
Address: //" St..) boa Nis / rr� /zc( / r
City /State /Zip: A Ai� 62 9 2Z 7 Each additional inspection over the allowable in any of the above:
Per inspection per hour (min. 1 hour) 62.50
Phone: ,S 2 3- Zyl—..L, Fax: <v.J - 2 - 5 Investigation fee:
CCB Lic. #: /Z 2 S,S / Lic. #: 2 G - 3 C L
Other:
Electrical Permit Fees*
Supervising electrician �� Subtotal 5 '- "n-
signature required: Plan Review (25% of Permit Fee) $
Print Name: o?V' -i P /AI/ in Lic. #: 28 Z 7.117 State Surcharge (8% of Permit Fee) $ /p, U °
&CA TOTAL PERMIT FEE 5 g /4 no
Authorized J / 2 Notice: This permit application expires if a permit is not obtained within
Signature: Date: (o l/ 0 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems
▪ Burglar Alarm
0 Garage Door Opener
Heating, Ventilation and Air Conditioning System
0 Vacuum Systems
❑ Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
• Boiler Controls
n Clock Systems
Data Telecommunication Installation
• Fire Alarm Installation
• HVAC
n Instrumentation
n Intercom and Paging Systems
O Landscape Irrigation Control
Medical
O Nurse Calls
O Outdoor Landscape Lighting
• Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
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is \Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03
CITY OFTIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 . MST
BUP
Received Date Requested // — / a— AM PM BUP
. Location --5 6 6 4 " -- k Suite /6 7 MEC
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Contact Per : � Ph ( ), `f 5_34 9 PLM
Contractor) 1MR : �.+ �� Ar —kr,4 Ph ( C ) 3 - 44.7 ( SWR
BUILDINGS Tenant/Owner ELC
Footing
Foundation ELC
Access:
FtgDrain ELR 3 - c 3 `7
Crawl Drain
Slab Inspection Notes: r n SIT
Post & Beam � kpCA) C& 4� 2lo --6
Sr Anchors
Ext 074/ v L / j .
Ext Sheath/Shear /—/ ai A (� 73 =
Int Sheath/Shear
Framing
Insulation
Drywall Nailing .
Firewall 1.1 / !1_ .7 ' ./ , /�
p
Fire Sprinkler / / -
Fire Alarm
Susp'd Ceiling
Roof � L
Other: — -
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service �• _ : , /'� 1i r
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.
a PART FAIL
Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA ! s
/�
Approach/Sidewalk Date � � Inspector � _ d,�+.- � . �, Ext
Other: �l , � °�
Final - DO NOT REMOVE this inspection ec is to he jo s.1 -
PASS PART FAIL -