Loading...
Permit • C ITY OF. TIGARD ELECTRICAL PERMIT - RESTRICTED ENERGY ,1�I� DEVE H BMENT SERVICES 639 -4171 DATEESSU EO/24/000 -00248 SITE ADDRESS: 12123 SW 69TH AVE PARCEL: 2S101AA- 02900A SUBDIVISION: TIGARD CORPORATE CENTER ZONING: MUE BLOCK: LOT: OOA JURISDICTION: TIG Project Description: Protective signaling. 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: PROTECTIVE SIGNAL: X INSTRUMENTATION: OTHER: TOTAL # OF SYSTEMS: 1 Owner: Contractor: SELECTRON INC 7225 SW BONITA RD TIGARDND, OR 97224 Phone: Phone: 639 -9988 Reg #: LIC 00064341 ELE 26- 497CLE FEES Required Inspections Type By Date Amount Receipt Low Voltage Inspection PRMT CTR 10/24/00 $75.00 2720000000 Elect'I Final 5PCT CTR 10/24/00 $6.00 2720000000 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 throu• OAR 952 - 001 -0080. You may obtain copies of these rules o • irect questions to OUNC at (503) 246 -1987. l � / /WA& ssued by �� ► i 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: DATE: LICENSE NO: CaII 639 -4175 by 7:00 P.M. for an inspection needed the next business day Electrical Permit Application i • A Date received: /0 /21X0-) Permit no.: A Q Zak - 00 /f� rs� �0. . ,, -�,L ,./ii City of Tigard 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 0 1 & 2 family dwelling or accessory r1 ommerciaUindustrial 0 Multi- family 0 Tenant improvement 0 New construction 0 Addition/alteration /replacement 0 Other: 0 Partial JOB SITE INFORMATION Job address: b Ian czoo l ° 1 Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: Block: 'Subdivision: Project name: ' 0 Description and location of work on premises: G Gyf ��Ap Estimated date of completion/inspection: d CONTRACTOR APPLICATION FEE SCHEDULE Job no: • Fee Max j �.-� :._ = - . a� ` Description Qty. (ea.) Total no. insp • Business name: .���._ � _ . - i ' �/a. , New residential - single or multi-family per Address: t _ Jr_ /I /i i� , W [:� dwelling mit. Includes attached garage. % ,� City: 4 ZIP A a " Serviceinchided: Phone: f o b / :: Fax: ♦. -y3' F na Each additional 500 sq. ft. or portion thereof 1000 sq. ft. or less 4 � ��/ �� �� CCB no.: tli r no.: t Elec. / s , . , lic. no 1 - 7a1-1.3 Limited energy, residential 2 City /metro lie. no.: r) _ l ✓ Limited energy, non- residential 2 Each manufactured home or modular dwelling Signature of supervising electrician (required) Date Service and/or feeder 2 Sup. elect. name (print): License no: Services or feeders — installation, alteration or relocation: - • - PROPERTY DINNER _ ....... 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: 1 Fax: 1E-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 installation, alteration,orrelocation: 200 amps or less 2 20 ORS 447, 455, 479, 670, 701. 201 1 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 Address: service or feeder fee, each branch circuit 2 City: 'State: • I ZIP: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit: 2 Phone: Fax: E -mail: Each additional branch circuit: PLAN 1t1VIEWV (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 ❑ Service over 320 amps - rating of 1 &2 ❑ 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* i 2 ❑ Building over three stories ❑ Feeders, 400 amps or more *Description: ❑ 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 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 $ ❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ Credit card number. / / within 180 days after it has been State surcharge (8 %) .... $ Expires accepted as complete. TOTAL $ Name of cardholder as shown on credit card $ Cardholder signature Amount 440-4615 (6100 /COM) 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 (FOR ALL SYSTEMS) Service included: Items Cost Total 4, 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 ❑ 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 • ❑ 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 of service ❑ Fire Alarm Installation or feeder fee. First branch circuit $46.85 Each additional branch circuit $6.65 ❑ HVAC Miscellaneous n Instrumentation (Service or feeder not included) Each pump or irrigation circle $53.40 I I 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 ❑ Medical the allowable in any of the above ❑ Nurse Calls Per inspection $62.50 Per hour $62.50 In Plant $73.75 ❑ Outdoor Landscape Lighting Fees: Protective Signaling Enter total of above fees $ I I 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 $ 7 ❑ Trust Account # 8% State Surcharge $ Total Balance Due $ i i:\dsts \forms\elc - fees.doc 10/09/00 • CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by: 13125 SW HALL BLVD Date Recd: TIGARD OR 97223 PRINT OR TYPE -.. V - X304 Permit #: F - 503 - 598 -1960 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd: WILL NOT BE ACCEPTED Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY Restricted Energy Fee $60.00 41/1-124414gAW (FOR ALL SYSTEMS) JOB Street Address Ste # ADDRESS 1/D3 (� r �'�� Check Type of Work Involved: City to _ _ ' ZA,_ 6 , # j n A udio and Stereo Systems Name �jj n B urglar Alarm OWNER Mailing Address El Door Opener* City /State I Zip I Phone # ❑ Heating, Ventilation and Air Conditioning System* Name / 1 ❑ Vacuum Systems* 4 ' // / ' ❑ Other CONTRACTOR nnail /,��� y✓�c� TYPE OF WORK INVOLVED - COMMERCIAL ONLY (Prior to issuance a C m Phone Fee for each system $60.00 copy of all licenses 071,0 ( .p f (SEE OAR 918- 260 -260) are required if O on C B Lic. # Ex ate expired in C.O.T. n �0 Check Type of Work Involved: data base). EI I f tr LI ExO `7 � y l' Z / �/ /J� ❑ Audio and Stereo Systems l or M i ' #/ / Exp at v� V U 1 5 J `z (./� _ ./d! i0 0 ❑ Boiler Controls Owner's Name ❑ Clods Systems OWNER - Mailing Address APPLICANT ❑ Data Telecommunication Installation City /State l I Zip Phone # ❑ Fire Alarm Installation This permit is issued under OAE 918-320 -370. Thls applicant agrees to make only restricted energy installations (100 volt amps or less) under this ❑ HVAC permit and to do the following: 0 Instrumentation 1. Only use electrical licensed persons to do installations where required. . _ Certain residential and other transactions are exempt from licensing. ❑ Intercom and Paging Systems These have asterisks('). All others need licensing; ❑ Landscape Irligation Control' 2. Call for inspections when installation under this permit are ready for inspection at 503 - 639 -4175; ❑ Medical 3. Purchase separate permits for all installations that are not ready for an ❑ Nurse Calls inspection when the inspector is out to inspect under this permit: 4. Assume responsibility for assuring that all corrections required by the Outdoor Landscape Lighting* inspector are done. and; Protective Signaling 5. Assume responsibility for calling for a final inspection when all of the corrections are completed. ❑ Other • Permits are non - transferable and non - refundable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. / Number of Systems The person signing for this permit must be the applicant or a person • No licenses are required. Licenses are required for all other installations autho • • to bind the applicant. �J FEES: //// //, ,, � N� th4 Si nature ENTER FEES $ 8% SURCHARGE (.08X TOTAL ABOVE) $ Authority if other than Applicant TOTAL $ rQ ' i:ldstslforms resele.doc 3/98 ZOO e U IV9IJ, AO A.LIO 096T 96S £0S XVd tO:CT CT IHd 00/87./L0 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 T _ BUP Date Requested /o / AM PM BLD Location i' Zr' Z 3 5 `'" 9 Suite MEC Contact Person e t/�` Ph 333 Zac /, PLM Contractor Ph Of-ff ft SWR BUILDING Tenant/Owner ELC Retaining Wall ELR 7iyY —GV E Lt ' Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes �� Slab t SIT Post & Beam Ext Sheath /Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof C/ 1 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 <LICI Service Rough In UG /Slab ow Fin ASS 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 reins ection RE: _ nable to inspect - no access Fire Supply Line ADA / Approach /Sidewalk Date �0 3 Inspector Ext Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.