Permit CITYOFTIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
Agt.,01 a DEVELOPMENT SERVICES PERMIT #: ELR2001 -00164
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 6/14/01
SITE ADDRESS: 13221 SW 68TH PKWY 550 PARCEL: 2S101 DA -00102
SUBDIVISION: TRIANGLE CORPORATE PARK ZONING: MUE
BLOCK: LOT: 002 JURISDICTION: TIG
Project Description: Low voltage for HVAC system.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LAN DSCAPE/IRRIGAT:
GARAGE OPENER: • CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
TIGARD TRIANGLE I LLC AMERICAN HEATING
4650 SW MACADAM AVE STE 220 1339 SW GIDEON ST
PORTLAND, OR 97201 PORTLAND, OR 97202
Phone: Phone: 239 -4600
Reg #: LIC 00033135
ELE 26- 683CLE
FEES Required Inspections
Type By Date Amount Receipt Elect'l Final
PRMT CTR 6/14/01 $75.00 2720010000
5PCT CTR 6/14/01 $6.00 2720010000
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Muniapal 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 ... , _�� , , / 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: 5 (2 44 J&a DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
, ' CIP
t. —:. C
Aio Electrical Permit Application / , l
Date received: 0 1 y / Permit no.: r i )) — t0/ �f
_,` :1 i City of Tigard 1 Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I 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 )enant improvement
❑ New construction ❑ Addition/alteration /replacement ❑ Other: ❑ Partial
Job address: 221 510,/ 6 j +++ AVE Bldg. no.: Suite no.: 550 Tax map /tax lot/account no.:
Lot: Block: I Subdivision:
Project name:.s pEC S PA - ac E I Description and location of work on premises: HVA-C Coh s / , 5- 47) - I
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: 51)76 Fee Max
Business oi,,, neOr i may,., Description Qty. (ea.) Total no. insp
New residential -single or multi- family per
Address: 133q SE G.i c)Gav, Si- dwelling unit. Includes attached garage.
City: —i or .H, 2a ., c j, 'State: coz I ZIP: 9 7 202 Service included:
Phone: 239_ bpp I Fax:239 _ 70 I E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: 331:35 E lec. bus. lic. no: 2C;..683 Limited energy, residential 2
Cit /metr. Sc. no.: X 1 1 2 f-, -993 Limited energy, non- residential 2
��; y , _ � . 6 -1 0 i Each manufactured home or modular dwelling
Signature of supervising electrician (require■ " Date Service and/or feeder 2
Sup. elect. name (print): 5 eve, Yuan License no:264 , _AT �^� our feeders— relocation:
installation,
alteration or relocation:
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: 'State: I ZIP: Over 1000 amps or volts 2
Phone: '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 100 + alterat1oO,orrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am s 2
Branch circuits - new, alteration,
or extension per panel:
Name: A M , G .; Car , il -4.1 r Die. A. Fee for branch circuits with purchase of
Address: i3,'i51 se 6scl.eor► S'+' service or feeder fee, each branch circuit 2
City: 'o r+10-0'41- 'State: I ZIP: 2aa_ B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: L3q -a16 Co Fax: zi9" r 1' E-mail: Each additional branch circuit:
PLAN REVILW (Please check all that apple) Misc. (Service or feeder not included):
O Service over 225 amps- commercial 0 Health -care facility Each pump or irrigation circle 2
0 Service over 320 amps - rating of 1 &2 0 Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, �(
O System over 600 volts nominal more residential units in one structure alteration, or extension* + 2
O Building over three stories 0 Feeders, 400 amps or more *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lightingplan 0 Other Per inspection 1 1 1
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 $ 77 art)
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
' Credit card numbs: / / within 180 days after it has been State surcharge (8 %) .... $ Q /
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card •
$
Cardholder signature Amount 440-4615 (6/00/COM)
Electrical Permit Fees: Limited Energy Fees: .... ' -^ 4
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
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. fL 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 Manufd 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 ❑ Vacuum Systems
201 amps to 400 amps $106.85 2
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 ri Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase ofservlce ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85 (� HVAC
• Each additional branch circuit $6.65 7 "
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 ❑ Intercom and Paging Systems
Each sign or outline lighting $53.40
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 El 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: ❑ Protective Signaling
Enter total of above fees $ r7 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 $
Total Balance Due $
i:\dsts \forms\elc- fees.doc 10/09/00
`1.33,
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
'24 -Hotur Inspection Line: 639 -4175 Business Line: 639 -4171 -
BUP
Date Requested 7- 3 AM PM BLD
Location /3 2 Z/ > 6 Add Suite .SS_V MEC
Contact Person .) t< -C to- Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR VeU /ti 0 / 6r
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Irit Sheath /Shear .
Framing _
Insulation
Drywall Nailing
Firewall �v / � � L C- _ L-- -_ 0 / s
Fire Sprinkler /
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final —
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
41110317
Service
Rough In v.en_
UG /Slab
Low Voltage
Fire Alarm - 1-4 4 ``'‘.
g
RT FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA �1
Approach /Sidewalk Date 3 2 _ v / Inspector at Q'_a Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.