Permit '
CITYOFTIGARD
RESTRICTED ENERGY
� j i� ;� ELECTRICAL PERMIT -
DEVELOPMENT SERVICES PERMIT #: ELR2004 -00275
13125 SW Hall Blvd.. Tigard, OR 97223 (5031 639-4171 DATE ISSUED: 9/23/2004
SITE ADDRESS: 13221 SW 68TH PKWY 460 PARCEL: 2S101 DA -00102
SUBDIVISION: TRIANGLE CORPORATE PARK ZONING: MUE
BLOCK: LOT: 002 JURISDICTION: TIG
Project Description: Limited energy for HVAC controls.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /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:
L & B TRIANGLE CORPORATE PARK INC AMERICAN HEATING
1120 NW COUCH STE 610 1339 SW GIDEON ST
PORTLAND, OR 97209 PORTLAND, OR 97202
Phone: Phone: 239 - 4600
Reg #: LIC 33135
ELE 26- 993CRE
SUP 2640LEP
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 9/23/2004 $75.00 Elect'I Final
[TAX] 8% State Surchari 9/23/2004 $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 forth in OAR 952 -001 -0010
through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUN (503) 246 -6699.
Issued by .11-i 5 y,C Permittee Signature gi /�J 494c46.S71
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
C of Tigard R EL t - :\i D De ceived i permit No.: .
te/B : . R.� w ;. ro mg.-75
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598g.1960 2004 /v�,ar �', Date/By: Other Permit:
Inspection Line: 503.639.4175 f' 0' Date Ready/By: 9/4/00 �- 1 •. See Page 2 for
Internet: www.ci.tigard.or.us 5 p l Notified/Method: AI i. � ® • Supplemental Information
1 :�ib�61 ■Ina. /fir /:[i ✓sar -vi
y ; , dd ]��j� PLAN R VIEW ; r;.. • ❑ New construction Addition /alteration/replacement Please check all that apply:
❑ Demolition ❑Other ❑Service over 225 amps, cornm'I ❑Hazardous location
. y . ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
.-`• - r ,, ; Cr.TEGOR' - OF •CONSTRUCCION, _ ; . 'r - of 1 -and 2- family dwellings 4 or more new residential
El 1- and 2- family dwelling (C ommercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi - family ❑Master builder El Other:
DOccupant load over 99 persons ❑Manufactured structures or
' JOB $ITE INF ORMATION :AND L( C ATY0N , t =.,� ° . ; : ' RV
? ❑E /li park
P
Job site address: ❑Health -care facility [Other:
Job no.:
I /3 i scc/ G8 94 irr�ct✓ Submit 2 sets of plans with any of the above.
City/State/ZIP: --7,-„ 62 The above are not applicable to temporary construction service.
Suit dg. /apt. no.: 996 J I Project name: A( 7• a FEE *, DULE
D escription I Qty. I Fee I Total I
O h
ross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or le 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no
Limited energy, residential 75.00 2
r ,_ w _ „•. �. , ; . . . ., t Limited energy, non - residential 75.00 2
L :.h- . .: K '.:DES PT;Oit1,,O1 V ORIC` " ; _;-:� ... • . _ -- Each manufactured or modular
1 dwelling, service and/or feeder 90.90 2
wAC - e/- /r- OS 7 Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
..., . t �= i h , . . 201 amps to 400 amps 106.85 2
'� PI{,OPE'RT UW�!1ER . d • s ' 1'ENAI�'Jj' ..., .
`' - 401 as to 600 as 160.60 2
Name: Au„ O s61. 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) 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
-z.,•.•,..,.; �-"� r " = 18 A.
.*. �Fs, �, YP ) 1 1 , 1C r T. i % - ._ � ,3 g 15!iTl'Acfr :r �LON tµ , Fee for branch circuits with
service or feeder fee, each
Business name: 14m>✓r I r rTea ng branch circuit 6.65 2
B. Fee for branch circuits
Contact nam . . y,� m e -)- fr without service or feeder fee, 46.85 2
each branch circuit
Address: ?
1 339 s, C cleor 5,�. Each add'I branch circuit 6.65 2
City/State/ZIP: -ra ` -}-f cu.-.d. j ore 9 7 zo S e--
Miscellaneous (service or feeder not included)
Phone: (SV3) . 44 00 I Fax :: r - 239 _ 7,036 Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
s CONTRACI _ ' eneri yj,anel, alteration, or •
Business name: A rnP I I- „ T�� extension. De/ / 1.- P age 2 2
.I -i CA ►'� - fr nG I L/�Ci
Address: 1.33 ,, C � on J s t- Each additional inspection over allowable in any of the above
Per inspection 62.50
City/ State/ZIP: o r - r) ) 0/2 Investigation per hour (1 hr min) 62.50
Phone: g e39 - I-1600 ), Fax: (1L.3) 23? 0 7O.3 Industrial plant per hour 73.75
-
- 94 3 Cat •': "'• ` 1;EtI'iLICAL >_.PE 140 FEE_ $'_ ': •`- %:
CCB Lic.: )3,5 Electrical Lic2 6 -683JJ Suprv. Lic. : 26v-o i2e Subtotal 26 .00
Suprv. Electrician signature, required>=i- _ ___, t ,J Plan review (25% of permit fee)
I State surcharge (8% of permit fee) ( •
Print name: S4 Y0t ai Date: 8 . as/ TOTAL PERMIT FEE g 1 dv
Authorized signature: .. f 1 This permit ap a aned within 180
'�j� � � J / / days plication after it has expires been if accepted permit is as nt comple
Print name: , ,JC ,4. x/72 e7� 1 Date: ej O f / • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Building \Permits\E1.C- PemtitApp.doc 17/01 440- 4615T(10 /07/COM/WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION ' -
Business Line: (503) 639 -4171 MST
BUP
//'
Received Date Requested 9 AM PM BUP
Location / 1 6drkt -`_ Suite 1 7 1- 6 � MEC
Contact Person Ph ( ) '"So (o 94 PLM
Contractor Ph ( ) SWR
•
BUILDING Tenant/Owner � f .( a ELC
Footing
Foundation ELC
Ftg Drain Access: \ , f ELR
Crawl Drain 1 v
Slab Inspection Notes: ■
1 127,e//7 SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
P ASS 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
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SIT ❑ Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 1/6 Inspector �' / Ext
Other:
Final DO NOT REMOVE thls Inspection record from the j ' ' site.
PASS PART FAIL