Permit ELECTRICAL PERMIT
- A CITY OF T I G A R D PERMIT #: ELC2001 -00278
DEVELOPMENT SERVICES DATE ISSUED: 05/30/2001
" I � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 25101 DA -00102
SITE ADDRESS: 13221 SW 68TH PKWY 550
SUBDIVISION: TRIANGLE CORPORATE PARK ZONING: MUE
BLOCK: LOT : 002 JURISDICTION: TIG
Proiect Description: Installation of (9) branch circuits as part of TI. Job # J972
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 8 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
TIGARD- TRIANGLE I LLC WILLAMETTE ELECTRIC INC
4650 SW MACADAM AVE STE 220 PO BOX 230547
PORTLAND, OR 97201 TIGARD, OR 97281
Phone: Phone: 624 -3631
Reg #: LIC 75059
SUP 1965S
ELE 34 -283C
FEES Required Inspections
Type By Date Amount Receipt Ceiling Cover
PRMT CTR 05/30/2001 $100.05 2720010000( Wall Cover
Elect'I Final
5PCT CTR 05/30/2001 $8.00 2720010000(
Total $108.05
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 -6699 or 1 -800- 332 -2344.
Permit Signature: 0.- 0. 4 fL e, n � Issued By:
arr
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: *--- 2i( (1- / f/ DATE:
LICENSE NO: 1 96 S -
Call 639 -4175 by 7:OOpm for an inspection the next business day
A Electrical Permit Applicatio
Date received:. X 30 0 / Permit no. —4:12.7i ; City of Tigard RR ��((±± `` 7/ Project/appl. no.: Expire date:
CityojTigard Address: 13125 SW Hall Blvd, Tigaid Date issued: By: Receipt
Phone: (503) 639 -4171
Fax: (503) 598 - 1960 MAY 2 v ?QYi Case file no.: Payment type:
•
Land use approval: COMMUNITY DE'CL3CMEW7 6 uPado/ - oo / 9
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family jaTenant improvement
0 New construction f le, 0 Addition/alteration /replacement 0 Other: 0 Partial
JOB SITE INFORMATION
Job address: / 2 z i Stsi 6 . — Po, (!w 5 ,r. /,‘. Bldg. no.: Suite no.: 55 Tax map /tax lot/account no.:
Lot: I Block: 'Subdivision:
Project name: Q{{ Sr) —`Fl 'Description and location of work on premises: le v.c.,r !wt •.e ,. -` f
Estimated date of completion/inspection: 6 — 30— G 1
CONTRACTOR APPLICATION FEE SCHEDULE
Job no:'. 9 } 7_ Fee Max
Business name: Description Qty. (ea.) Total no. Insp
fn) fl n t r�iP c r h L • lw c_ New residential - s or multi - family per
Address: /t A„,_ 220 5 V, — dwelling unit. Includes attachedgarage.
City: %, m . 4.0 I State(,_ I ZIP: 9 7 1 2.k / Senicelncluded:
Phone: 624 _? t I Fax:(,Z Y.' Zg-3 I E-mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
_ CCB no.: ? y-z) S c1 I Elec. bus. lic. no: 7 y - 2F 3 L Limited energy, residential 2
City/metT lic. no.: ,t (, Limited energy, non- residential 2
/ e�--- ` ,r- - z r —6 / Each manufactured home or modular dwelling
Signature of supervising a trician (required) Date _Service and/or feeder 2
Sup. elect. name (print): A , Fr re re License no: / /` e' S s Services or feeders — installation,
alteration or relocation:
PROPERTY OIVNER 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 onty 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 installation, alteration, 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. Fee for branch circuits with purchase of �/ t: C
Address: service or feeder fee, each branch circuit D 1 -- f- 2 .
City: I State: I ZIP: B. Fee for branch circuits without purchase '
of service or feeder fee, first branch circuit: yt+b ' 2
Phone: Fax: E -mail: Each additional branch circuit:
PLAN REVIEIV (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 320amps-rating oft &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:
0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
0 Egress/lightingplan 0 Other. Per inspection 1 1 1 1
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other w
Permit fee $ /00
'Not all jurisdictions accept aedit cards. please call jurisdiction for more information. Notice: This permit application
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $ _ e
/ / w 180 days after it has been State surcharge (8%) $ 1
Credit card comber: Y E" -O 6.22.._
accepted $
accepted as comp
Name of cardholder as shown on credit card
Cardholder signature Amount 440-4615 (6A)0K.'OM)
•
Electrical Permit Fees: Limited Energy Fees:
.
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee $75.00
Number of Inspections per permit allowed 1 (FOR ALL SYSTEMS)
Service included: Items Cost - Total .1 ! _
,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 Manufd Home or Modular j ❑ Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders I ❑ Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation
200 amps or less $80.30 2 El 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
Installation, alteration, or relocation 'TYPE OF WORK INVOLVED - COMMERCIAL ONLY
200 amps or less $66.85 2 ' Fee for each system $75.00
' 201 amps to 400 amps $100.30 2 : (SEE OAR 918 - 260 -260)
•
401 amps to 600 amps $133.75 2
Over 600 amps to 1000 volts, Check Type of Work Involved:
see "b" above. •
Branch - Circuits . ❑ Audio and Stereo Systems
New, alteration or extension per panel - - — -- _ _
a) The fee for branch circuits Boiler Controls
with purchase of service or
feeder fee. ❑ Clock Systems .
Each branch circuit $6.65 2
b) The fee for branch circuits ❑ Data Telecommunication Installation
without purchase of service
or feeder fee. n Fire Alarm Installation
First branch circuit _ $46.85
Each additional branch circuit $6.65 ❑
HVAC
Miscellaneous 1
(Service or feeder not included) ' ❑ Instrumentation
Each pump or irrigation circle $53.40
Each sign or odeine lighting $53.40 I n Intercom and Paging Systems ..
Signal circuit(s) or a limited energy
panel, alteration or extension _ $75.00
Minor Labels (10) $125.00 ❑ Landscape Irrigation Control'
Each additional inspection over ❑ Medical '
the allowable in any of the above •
Per inspection $62.50
Per hour $62.50 , ❑ Nurse Calls
In Plant $73.75 ❑
Outdoor Landscape Lighting'
Fees:
• •- ❑ Protective Signaling - — -
Enter total of above fees $
' n Other
8% State Surcharge $
25% Plan Review Fee Number of Systems
See `Plan Review' section on $
front of application. _ ' * No licenses are required. Licenses are required for all other. installations
•
Total Balance Due $ Fees: .
❑ Trust Account # Enter total of above fees $
8% State Surcharge $
Total Balance Due $
i:'dsis \fomu\elc- Cees.doc 10/09/00 •
3 �� N
CITY OF TIGARD BUILDING INSPECTION DIVISION MST •
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 7-3 AM PM BLD
Location /3 2 -z ( 5(4' r' ,9602 14 Suite 5- 5-61 MEC
Contact Person Ph GZ sl 3/ PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC /l - v 17r
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm �C—/ / Y / CO /
Susp'd Ceiling l
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
0 ;°.
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
P RT FAIL
Serve
Rough In
UG /Slab •
Low Voltage
F' .arm
°ART 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 L
Approach /Sidewalk Date l i — 3 ^ D Ins Ext
Other
Final •
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.