Permit i CITYOFTIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
i, ii DEVELOPMENT SERVICES PERMIT #: ELR2004 -00156
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/11/2004
SITE ADDRESS: 13190 SW 68TH PKWY 110 PARCEL: 2S101 DA -00101
SUBDIVISION: TRIANGLE CORPORATE PARK ZONING: C -P
BLOCK: LOT: 003 JURISDICTION: TIG
Project Description: Installation of voice /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:
SCHNITZER INVESTMENT CORP MILLER TELEPHONE SERVICE
PO BOX 10047 385 SPINNAKER WAY
PORTLAND, OR 97296 COLUMBIA CITY, OR 97018
Phone: Phone:
Reg #: ELE 5 -38c1e
LIC 68357
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 6/11/2004 $75.00 Elea! Final
[TAX] 8% State Surcharl 6/11/2004 $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 • • ' OAR 952 - 001 -0010
throug - • - 511 -0100. You may obtain copies of these rules or direct questi• : o OUNC It �0 246 -6699.
Iss T h.437k
by , / ikid Permittee Signature J 4kfr ■
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 FOR OFFICE USE ONLY
Received � '�!
City of Tigard Date/B : / - _ � �
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 o "'ec � c 1"`' Date/B : Other Permit:
Inspection Line: 503.639.4175 h' I Date Ready/By: Juris: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK ` PLAN REVIEW _ •
❑ New construction Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑ Other: ❑Service over 225 amps, comm'l ['Hazardous location
['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION • of 1- and 2- family dwellings 4 or more new residential
ID 1 and 2 family dwelling Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
El Building over three stories ['Feeders, 400 amps or more
❑ Multi - family ❑Master builder 0 Other:
['Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION . ❑Egress/lighting plan RV park
Job no.: I Job site address:/ '79() SW/60 ' j '7, q, /f/� ❑Health care facility ❑Other:
7 Submit 2 sets of plans with any of the above.
City /State/ZIP: T /6 , ?7,2-J-3 2 . The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: //Q I Project name: ' DL 6t`Tw�9-/L� Fn.- SCHEDULE.•
D escription Qty. 1 Fee. I Total ..
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
. Limited energy, non - residential / 75.00 73 DG 2
• . DESCRIPTION OF WORK Each manufactured or modular
- 4� q //{ /n� `j !� e � r' , dwelling, service and /or feeder 90.90 2
CJ C� .J/r �L{ Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑, PROPERTY OWNER • � I NANT • , 201 amps to 400 amps 106.85 2
SA ,Ti�F 601 amps to 0 0 160.60 2
Name: x� 1,000 am 601 amps to 1,000 amps 240.60 2
Address: / .3/ 9 Q s �6 �y ' (� Over 1,000 amps or volts 454.65 2
2 Reconnect only 66.85 2
City /State /ZIP: /�j( / Q 7_.•J Temporary services or feeders installation, alteration, and/or
Phone: SRS 6 0 9 I Fax: ( ) relocation
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
' ❑ APPLICANT I ❑ CONTACT PERSON • A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address: Each add'l branch circuit 6.65 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) I Fax : : ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited-
.
' CONTRA R energ panel, alteration, or
/
ext- .ion. Desc ''be: Page 2 2
Business name: A i Q'oi 6 #/c( / 70A/ �'' i '
Address: .3c% - j/ ,/ ,V ,/x`(G/e_ '//` % Each additi i al inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: CZ),9( (Z /7/ . /,( e /) Q4. Q 7-Q/ Investigation per hour (1 hr min) 62.50
Phone: (--L.,$) 3 7 7.3 0/ ,t' Fax: ( 3 3 ?73�Q/ Industrial plant per hour 73.75 --
CCB Lic.: 6E5 Electrical Lisp 22c./2 2c./2 Suprv. is 16'3 , ELECTRICAL PERMIT FEES* p Subtotal 73', 00 •
Suprv. Electrician signature, require. WAY " /"...._ 0 1 Q Plan review (25% of permit fee)
Print name: ,/4't �/ /�C/ Date: 6- /(J G Sta te surcharge (8% of permit fee) � ° 1
TOTAL PERMIT FEE O O
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Building \Pernits\ELC- PennitApp.doc 12/03 440- 4615T(10 /02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls •
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
is Building \Permits\ELC- PermitApp.doc 04/03
,CITY OF TIGARD 24 -Hour
BUILDING Inspection (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
c� BUP
Received Date Requested 7 — / AM PM BUP
Location 1 3 I c 1 d C Q X P fCj� • Suite /1 MEC
Contact Person R C7)4...../ C7)4...../ 7 Ph ( ) :39 1-3e al PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 5 � C_ ELC
Footing
Foundation ELC
Ftg Drain Access: ELR c406 ' 6 `/ - O , s ,
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam /aft
Shear Anchors �
Ext Sheath/Shear � , �
Int Sheath/Shear
Framing
Drywall ywall Nailing iretzcerpVD fD_ Dywal 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
UG/Slab
Low Voltage
Fire Alarm
' ,,., " 1 PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
Z1
SI ❑ Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line ��
ADA Date 7-c(-9 Inspector 1 PAS�� L Ext
Approach/Sidewalk
Other:
DO NOT REMOVE this inspection record from the job site.
1SS PART FAIL