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Permit ELECTRICAL PERMIT - CITY OF TIGARD RESTRICTED ENERGY j ib; DEVELOPMENT SERVICES PERMIT #: ELR2004 -00209 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/15/2004 SITE ADDRESS: 13221 SW 68TH PKWY 120 PARCEL: 2S101DA -00102 SUBDIVISION: TRIANGLE CORPORATE PARK ZONING: MUE BLOCK: LOT: 002 JURISDICTION: TIG Project Description: Limited energy for HVAC 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: 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 33135 ELE 26- 993CRE SUP 2640LEP FEES Required inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 7/15/2004 $75.00 Elect'I Final [TAX] 8% State Surchart 7/15/2004 $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 - les adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 thro gh OAR 95 -911-0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699. Issu• . by �_����!� Permittee Signature ?',.---S„, ��• 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 City Of T i Permit No.: , . `. ; 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 A • 41 1101. 1 4 D : Other Permit: Inspection Line: 503.639.4175 � '� Date Ready/By: El See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: IEN Supplemental Information TYPE. OF. WORK PLAN REVIEW ❑ New constructio V Addition /alteration/replacement Please check all that apply: ❑Service over 225 amps, comm'I ['Hazardous location ❑ Demolition 0 Other: ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., CATEGORY .,OP .CONSTRUCTION `. of 1- and 2- family dwellings 4 or more new residential ❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi - family ❑Master builder ❑Other: ['Building over three stories ['Feeders, 400 amps or more ['Occupant load over 99 persons DManufactured structures or • -' ' . •JOB SITE INFORMATION, AND LOCATION -' - , : ❑Egress/lightingplan RV park DHealth-care facility ['Other Job no..• y3 /c. I Job site address: ?I,''W, ,, Submit 2 sets of plans with any of the above. City/State/ZIP: 774 Qr d The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: L. I Project name: ei s �, h� FEE *; SCHEDUL& Description 1 Qty. I Fee. I Total I *' 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 2 DESCRIPTION OR '. "; , Each manufactured or modular a (fee A"--,) dwelling, service and /or feeder 90.90 2 1-1 VAC - �� er - , - , 5 44 . Services or feeders installation, alteration, and/or relocation 200 amps or Tess 80.30 2 - 201 amps to 400 amps 106.85 2 ❑ • I ' ••• OWNED . . ❑ 'TENANT . �� n �' , � '^ � - 401 amps to 600 amps 160.60 2 Name: " l 1 �,/ !�'L- 601 amps to 1,000 amps 240.60 2 Address: 1( 5w if )— -- Over 1,000 amps or volts 454.65 2 TII Reconnect only 66.85 2 City/ State/ZIP: 1 c'� F 7 dc/ Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) Fax: ( ) 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 ; -" " ' - 0 CO ' . . -` A. Fee for branch circuits with service or feeder fee, each 6.65 2 Business name: �h') e r/ •C' an Ale oily �f branch circuit B. Fee for branch circuits Contact name: --))ale, / , /Q without service or feeder fee, 46.85 2 SE /�_� ea. S� each a d'I branch branch Address: / 339 S /�' Ea ch add'I branch circuit 6.65 2 City/State/ZIP: . - I �i2 9,7702- Miscellaneous (service or feeder not included) J Pump or irrigation circle 53.40 2 Phone: 3 ) 239 - v6'¢O I Fax: : (503) c=9 ?$ 7O Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited- '"" • - " : CONTRACTOR . - - energy panel, alteration, or I /� / extension. Describe: 1 Page 2 2 Business name: 4/7')e i �� f a T/ e Address: ��� 9 � Each additional inspection over allowable in any of the above Co, Per inspection 62.50 City/State/ZIP: ',l'�Ja J ®� 92a Investigation per hour (1 hr min) 62.50 Phone: , 5 - 03) �'n �y/l Fax: (fa?) � "�3P Industrial plant per hour 73.75 �) � `�% . ' . ...•.•ELEC"I'RICA_ I.. PERMIT. FEES* CCB Lic.: 23/35- (E lectrical Lic.: C ,)s V Suprv. Lic.:� V,...0 c7 Subtotal .4 0 Suprv. Electrician signature, required: ,4 1,--(--- -- _ ,_ __, ✓ Plan review (25% of permit fee) �� Print name: �7 B1/� vu � Date: V yy d 9 State surcharge (8% of permit fee) � � / TOTAL PERMIT FEE 114 Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: -' ilv i . JE , f7 Date: 7// / • Fee methodology set by Tri- County Building Industry Service Board •• Number of inspections per permit allowed. i:\ Building\Pemtits'ELC- PemtitApp.doc 12/03 440 4615T(10 /02/COM/WEB �A 6 r1 Z • (V� J (Q I CITY OF TIGARD 24 -Hour BUILDING Inspecll ' (503) 639 -4175 INSPECTION DIVISION . �_ :���'�... ' (503) 639 - 4171 MST BUP Received Date Requested —20 AM / PM BUP Location 13 �L 1 StJ 6 ( Suite 1 2 0 MEC Contact Person Ph ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR ZOO ` Z-4 Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear CIP!O Int Sheath/Shear Framing Insulation C$" � ■Drywall Nailing Firewall Ft �` ` �/J Fire Sprinkler 1 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 U - • •w Voltage Fire arm Fin Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line '�j Q ADA • Approach/Sidewalk Date 7 Z f © y Inspector/ / I �' - ` 4 - fli , Ei 5 fl iy Ext Approach/Sidewalk / Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL