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Permit CITY OF TIGARD ELECTRICAL PERMIT - RESTRICTED ENERGY , �� DEVELOPMENT SERVICES - PERMIT #: ELR2003 -00018 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/27/03 SITE ADDRESS: 12750 SW 68TH AVE PARCEL: 2S101AD -01300 • SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE BLOCK: LOT: 033 JURISDICTION: TIG Proiect Description: Install voice and data cabling. 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: HAMPTON BUILDING, THE LLC RIEKS COMMUNICATIONS PO BOX 94 1704 N MERIDIAN CAMP SHERMAN, OR 97730 NEWBERG, OR 97132 Phone: 5541 -595 -2495 Phone: 538 -8852 Reg #: LIC 74386 ELE 36 -49CEP FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 1/27/03 $75.00 Elect! Final [TAX] 8% State Tax 1/27/03 $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 to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 throuc I Issued by 'J _ L , _ � � 1 Permittee Signature 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 • FOR OFIICE USE ONLY ►le(�rlcal Permit Application FOR op Electrical Date/By: , — .3 7 -- 2) Permit No.: Ir,A0D3 -Q 'D / 8- Planning Approval Sign City of Tigard 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 �,irdl�ka I 'i\ Date/By: Case No.: Internet: www.ci.tigard.or.us a 6 7 i Contact Juris.: g 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 commercial ❑ Hazardous location ® Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet, CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in ❑ I & 2- Family dwelling sa Commercial/Industrial ❑ System over 600 volts nominal one structure ❑ Building over three stories ❑ Feeders, 400 amps or more ❑ Accessory Building ❑ Multi- Family ❑ 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: /2750 SeJ 6F IA "' FEE* SCHEDULE Suite #: 1 Bldg. /Apt. #: Number of inspections per permit allowed Project Name: r- Spvu.t,sat,+ Description Qty Fee (ea.) Total i New residential - single or multi - family per Cross street/Directions to job site: dwelling unit. Includes attached garage. Service included: 1000 sq. ft. or Tess 145.15 4 Each additional 500 sq. ft. or portion thereof 33.40 1 Lot # Limited energy, residential 75.00 2 : Subdivision: 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, V U Q tQ S !1c. (`r.t- ti4," 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 ' ❑ 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 1 Phone: Fax: 201 amps to 400 amps 100.30 2 401 to 600 amps 133.75 2 ❑ APPLICANT ❑ CONTACT PERSON Branch circuits - new, alteration, or Name: extension per panel: A. Fee for branch circuits with purchase of Address: 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: 1 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: Signal circuit(s) or a limited energy panel, alteration, or extension Page 2 2 Business Name: `K CoL BLt.Q Description: Address: Ogg $) Si .p.4..4aro ,/� Each additional inspection over the allowable in any of the above: City /State /Zip: Ad tJ t 0,2 Per inspection per hour (min. 1 hour) 62.50 Phone: 9 3 53 'X8 Fax: 538 - Investigation fee: - CCB Lic. #: 7 1 .r (2.3- Lic. #:- Other: Electrical Permit Fees* Supervising electrician i c_E1-' - Subtotal $ 7 .(2d signature re uired: � // 63 Plan Review (25% of Permit Fee) $ • Print Name: Va ■ Lic. #: ap,, Lao State Surcharge (8% of Permit Fee) $ 6 -co TOTAL PERMIT FEE $ %/ , 00 Authorized Notice: This permit application expires if a permit is not obtained within Signature: Date: 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. (Please print name) • i:\Dsts\Pertnit Forms\ElcPermitApp.doc 01/03 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information 4 LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all systems $75.00 Check Type of Work Involved: O Audio and Stereo Systems ❑ Burglar Alarm ❑ Garage Door Opener El Heating, Ventilation and Air Conditioning System ❑ Vacuum Systems D Other COMMERCIAL WORK ONLY: Fee for each system $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: Audio and Stereo Systems 0 Boiler Controls O Clock Systems O Data Telecommunication Installation 0 Fire Alarm Installation HVAC 0 Instrumentation • 0 Intercom and Paging Systems L Landscape Irrigation Control 0 Medical n Nurse Calls ❑ Outdoor Landscape Lighting El Protective Signaling • 17 Other Number of Systems * No licenses are required. Licenses are required for all other installations • • i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST 171— BUP Received Date Requested q AM PM BUP Location SZ D o � " — 40-t- Suite MEC Contact Person Q Ph ( ) 146E PLM Contractor Ph ( ) ' 7 (2 `j- 6 /3.2- SWR BUILDING Tenant/Owner ELC Footing Foundation ELC 3 Ftg Drain Access: ELR 3 - Od O / Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation t,\ I G Drywall Nailing \( Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final G r • 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 Fire Alarm - fl Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. • SS PART FAIL SITE 0 Please call for r inspection RE: 0 Unable to inspect - no access Fire Supply Line ADA Date c= Inspe Ext Other: Final DO NOT REMOVE this inspection reco from th = Job site. PASS PART FAIL