Permit -� CITY O TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
L . el, DEVELOPMENT SERVICES PERMIT #: ELR2003 -00207
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 7/16/03
SITE ADDRESS: 13535 SW 72ND AVE 170 PARCEL: 2S1 01 DC 00200
SUBDIVISION: 72ND AVE OFFICE BUILDING ZONING: C -P
BLOCK: LOT: JURISDICTION: TIG
Proiect Description: Installation of limited energy for fire alarm and data telecommunications systems.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: X OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 2
Owner: Contractor:
PACIFIC NW PROPERTIES LTD PTNSHP FIRE PROTECTION SERVICES
9665 SW ALLEN BLVD STE 115 15100 SW 139TH AVE
BEAVERTON, OR 97005 TIGARD, OR 97224
Phone: Phone: 503 - 590 - 3732 _ ..
Reg #: ELE 34- 488CEP _ ::^
LIC 121039
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 7/16/03 $150.00 Elect'I Final
[TAX] 8% State Tax 7/16/03 $12.00
Total $162.00
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 wi - : 1 •: s of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to • low rules ado. ed by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throuc
— i ,.a Permittee Signature
Iss • by i _. I.-�:
. .... � � !te ✓.�
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
Received � Permit e LKAVO5 -"
Date/By: y: 7 /�O Q 3 �,, Permit No.:
Planning Approval Sign
City of Tigard pateBy; __Permit No.:
13125 SW Hall Blvd. � Plan Review Other �u 0 ,6 0 9 - 0 0 3�9
Tigard, Oregon 97223 Date/By: Permit No.: , v
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
�''�'� ' i �� Date/By: Case No.:
Internet: www.ci.tigard.or.us ^ ■ �, c f I Contact Juris.: 0 See Page 2 for
-
24 -hour Inspection Request: 503- 639 -4175 "" Name/Method: _ Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
'El Addition/alteration /replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: /'.35:3s ski 7,,nl Ai% FEE* SCHEDULE
Suite #: n 0 BldgBldg./VA Number of inspections per permit allowed
Project Name: A€3,1 t jin ki%7 S Description Qty Fee (ea.) Total
New residential- single or multi- family per j
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: 1 Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
p Services or feeders - installation,
of KID 1; 5' el Fie c • tvigiYisi D ',c c alteration or relocation:
,s 200 amps or less 80.30 2
f / A i 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY OWNER 1 ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts _ 454.65 2
Name: ,?lG /Fic' ' /r/.,V /7 /X•/ g S Reconnect only 66.85 2
Address: % 65 « /O h 64 01 Temporary services or feeders - installation,
p alteration, or relocation:
City /State /Zip: 4 'I' (7 f 74(24:23- 200 amps or less 66.85 1
Phone: Fax:
201 amps to 400 amps 100.30 2 401 to 600 amps 133.75 2
❑ APPLICANT ❑ CONTACT PERSON Branch circuits - new, alteration, or
Name: f,% J97?. extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: 1 Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
Each pump or irrigation circle 53.40 2
CONTRACTOR
` Each sign or outline lighting 53.40 , 2
Job No: c _17.12,-7>‹:./, l� s Signal circuit(s) or a limited energy panel, 1
alteration, or extension Page 2 0 � 2
Business Name: ,:yffo / v h rl /iC; 5 Description:
Address: /s /o� .5. rl 1h /<vf Each additional inspection over the allowable in any of the above:
City/State /Zip: �,o / O1 ®e Per inspection per hour (min. 1 hour) 62.50
Phone: 5os 9 > 7:£� i Investigation fee:
5 0� Fax: s � s � ta i 3 g
L . . #: Sty- {� Qk C 6o Other: * - -
CCB Lic. #: is yr3 S Electrical Permit Fees
Supervising electrician Subtotal $ _
signature required: o U
S tate Surcharge (8% of Petmit Fee) $ / . Plan Review (25% of Permit Fee) $ /1 • )f'' Print Name: [,),a,/-) ,Cl� i #: / 7y3 coo 00
/ TOTAL PERMIT FEE $ / /QA,
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set. by Tri -County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information -
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Burglar Alarm
❑ Garage Door Opener
❑ Heating, Ventilation and Air Conditioning System
▪ Vacuum Systems
❑ Other
.1
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
Boiler Controls
•
❑ Clock Systems
Data Telecommunication Installation
Fire Alarm Installation
❑ HVAC \
❑ Instrumentation
❑ Intercom and Paging Systems
Landscape Irrigation Control
❑ Medical
❑ Nurse Calls
• Outdoor Landscape Lighting
❑ Protective Signaling
❑ Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations •
i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection'Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested —7 -- ( AM PM BUP
Location / 3 s3 $ 7a " Suite 1 / -Z MEC
Contact Person Ph ( ) ' - 373 °Z PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR °2
6 0 7
Crawl Drain
Slab Inspection Notes: 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
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
UG/Slab
Low Voltage
Fire Alarm
art, Ei Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• S PART FAIL
SITE ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 7 /— � Inspecto _ - - == _ - i °-�'"' Ext
Other:
Final DO NOT REMOVE this inspection record fr m the Job site.
PASS PART FAIL