Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00492
DEVELOPMENT SERVICES DATE ISSUED: 8/7/03
44i 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171
PARCEL: 2 S 112AA -00900
SITE ADDRESS: 14160 SW 72ND AVE 110
SUBDIVISION: NELSON BUSINESS CENTER ZONING: I -H
BLOCK: LOT : JURISDICTION: TIG
Project Description: (11) branch circuits for tenant improvements.
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: 10 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:
SPIEKER PROPERTIES LP ROBERTS ELECTRIC INC
4380 SW MACADAM AVE STE 100 5759 SW 48TH
PORTLAND, OR 97201 PORTLAND, OR 97213
Phone: Phone: F - 244 - 0560
Reg #: 54444 - 77548865
LIC 9388
FEES ELE 34 -23C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/7/03 $113.35
[ELPRMT] ELC Permit 8/7/03 $9.06 Rough -in
Elect'I Final
Total $122.41
This Permit is issued subjed to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will rrnne 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 a than 180 9- ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
fo in OAR 952 - 001 -01 • through OAR •. 001 -1100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 - 6699 or
- 800 - 332 -2344.
sued By: . 1 .! ;-8
k, / Permit Signature: V 72
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: 5
Call 639 -4175 by 7:OOpm for an inspection the next business day
El •'cal Permit Application FOR OFFICE USE ONLY
Received t � 61 003' D® 2-
Date/By: Q / Permit N : � 7 t No.: -
City of Tigard Planning App oval Sign
g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503-598-1960 o , fi , & Post Land Use
Ui 1� �Date/By: Case No.:
Internet: www.ci.tigard.or.us e. Contact � 1tu L. ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 '" ''- ' Name/Method; " / Supplemental Information.
41ij . 0 y /
TYPE OF WORK PLAN REVIEW (Please check all that apply)
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
® 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: MI by S , w 7 2_ b FEE* SCHEDULE
Suite #: 1 / D 1 Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: N t a z Ai ' Description Qty Fee (ea.) Total 1
New residential - single or multi -(amity per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
N 0 N _ � n Service included:
72 1000 sq. ft. or less 145.15 4
' 1 a � O & S r �,�S 2 s J t Each additional 500 sq. ft. or portion thereof 33.40 1
mil"
Subdivision: I Lot #: Limited energy, residential 75.00 2
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
Services or feeders - installation,
--/—.1._ alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
40t 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: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85 1
Fax: 201 amps to 400 amps 100.30 2
Phone: 401 to 600 amps 133.75 , 2
❑ APPLICANT ❑ CONTACT PERSON Branch circuits - new, alteration, or
Name: 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 1 46.85 ' / L 2
- Phone: I Fax: Each additional branch circuit / 0 6.65 .494 .`,--i----.-
E -mail: Misc.(Service or feeder not included): 41%
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
Business Name: 0oc)5 i?r'T i?t�L't L 32 /`J "— alteration, or extension Page 2 2
Description:
Address: .75=t S 4
d
//�� Each additional inspection over the allowable in any of the above:
City/State /Zip: pi)'- U IE 9- 72 Z- I Per inspection per hour (min. 1 hour) 62.50
Phone: W-1 Fax: ,;24(-k- -61)...Th 0 Investigation fee:
Other:
CCB Lic. #: i 3 Y Lic. #: , ;'4 -2.3 c Electrical Permit Fees*
Supervising electrician / Subtotal $ // , 56
signature required: /, //1/6-4- Plan Review (25% of Permit Fee) $
Print Name: 40 A arc t,t i i) I Lic. #: 3 8X b .S State Surcharge (8% of Permit Fee) $ L i. D0
TOTAL PERMIT FEE _ $ / P . 1 1
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\Petmit Forrns\ElcPetmitApp.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:
11 Audio and Stereo Systems
•
Burglar Alarm
❑ Garage Door Opener
El Heating, Ventilation and Air Conditioning System
0 Vacuum Systems
Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
0 Audio and Stereo Systems
0 Boiler Controls
0 Clock Systems
0 Data Telecommunication Installation
n Fire Alarm Installation
HVAC
•
Instrumentation
0 Intercom and Paging Systems
0 Landscape Irrigation Control
0 Medical
0 Nurse Calls
Outdoor Landscape Lighting
• 0 Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Fotms\ElcPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Lie: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested q_ Z 3 AM P BUP
Location Ni 6 cS& 7 2-- er g' Suite L L( -- 3 MEC
Contact Person Ph (50 3 ) 5'72 -3 230 PLM
Contractor 41/44.teL Ph ( _) __SWR
BUILDING Tenant/Owner ( '— D( 4!92
Footing ELC
Foundation Access:
Ftg Drain ELR
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
cLECTRICAj2
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
CFin ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
P RT FAIL
❑ Please call fo reinspection RE: I Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date' Cf Inspecto % - Ext _of
Other:
Final DO NOT REMOVE this Inspection record fro the site.
PASS PART FAIL