Permit CITY OF T ELECTRICAL PERMIT -
RESTRICTED ENERGY
� .�y DEVELOPMENT SERVICES PERMIT #: ELR2003 -00320
AA 131 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/15/03
SITE ADDRESS: 15605 SW 72ND AVE PARCEL: 2S112DC -00100
SUBDIVISION: OREGON BUS. PARK III ZONING: I -L
BLOCK: LOT: 002 JURISDICTION: TIG
Project Description: Low voltage: T -stats
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:
PACIFIC REALTY ASSOCIATES PROTEMP ASSOCIATES INC
15350 SW SEQUOIA PKWY #300-WM I 807 NE COUCH
PORTLAND, OR 97224 PORTLAND, OR 97232
Phone: Phone: 233
Reg #: ELE 26- 1063CRE
LIC 38868
SUP 2613LEP
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 10/15/03 $75.00 Elea! Final
[TAX] 8% State Tax 10/15/03 $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 throuc
Issued by .j , _/ . . J 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:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Permit Application
Received FOR OFFICE USE ONLY
{c Electrical 1 Ob 3° v
Date/By: lo/, s /O' bJ) Permit No.:E '` °UO3-
City of Tigard Planning A pro al Sign
`J g Date/By: No.:
13125 SW Hall Blvd. '" Plan Review Other
Tigard, Oregon 97223 ,, - � Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 - 598 -1960 Post- Review Land Use
ra}j ' � I Date/By: No.:
Internet: www.ci.tigard.or.us ° ° <' ‘ L As Contact fun El 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 ❑
ddition/alteration/replacement t] Other: Hazardous
❑ Service over 320 amps- rating of ❑ Building Building over er 10 10,000 square feet,
CATEGORY OF CONSTRUCTION I & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling _2-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: mac, 5W 7'z N A FEE* SCHEDULE
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: S'w i Fr I//t,"4„/ Description Qty Fee (ea.) Total
Cross street/Directions to job site: New residential- single or multi - family per
dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or Tess 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 I
Subdivision: 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,
7 " -- s 7 i / alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
)'ROPERTY OWNER 1 0 TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: PAC eF )r, Rosz L 'Ty Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85 1
Phone:,u . C.'&06 Fax: 201 amps to 400 amps 100.30 2
401 to ❑ APPLICANT _ ❑ CONTACT PERSON Branch h amps 133.75 2
c
Br circuits - new, alteration, or
Name: extension per panel:
Address: A Fee for branch circuits with purchase of
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: Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
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: T tT 2 P Description:
or extension ` Page 2 2
Description:
Address: 9 7 g SS Alit
Each additional inspection over the allowable in any of the above:
City /State /Zip: P dAiD tft. 7a2?._ _ Per inspection per hour (min. 1 hour) 62.50
Phone: a 3's , e-,9 // Fax: Z 3s - q -aG 7 Investigation fee:
CCB Lic. #: ag Lic. #: a
Other:
°`�� 7 �� r R� Electrical Permit Fees*
Supervising electrician Subtotal $ '75
signature required: Plan Review (25% of Permit Fee) $
Print Name: Lic. #: State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $ $/ -
Authorized
- -�� Notice: This permit application expires if a permit is not obtained within
Signature: Date: �� O3 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
P lease print na
/ 7 —7
is \Dsts \Petmmit 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
O Other
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
0 Clock Systems
0 Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
❑ Instrumentation
Intercom and Paging Systems
Landscape Irrigation Control
❑ Medical
0 Nurse Calls
❑ Outdoor Landscape Lighting
fl Protective Signaling
O Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
is \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 � � L l ( AM PM BUP
Location / S(4 ° S 70.2 )16e.- Suite MEC
Contact Person Ph ( L3 - D -36 of PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Ftg Drain Access: EL
Crawl Drain
Slab Inspection Notes: SIT _
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation F N E 1 ON i if 6 J 03 i(Z6 � (V I�
Drywall Nailing
Firewall �J
Fire Sprinkler
Fire Alarm Ilk S -•
Susp'd Ceiling
Roof E Lam- Za03 - 00312 Fi ALCC eN 11 AL
Other: -- --
Final —_ -
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole V/
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 la I
/pi/ ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
``SS PART FAIL
SIT LI Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA D `k ( 1 D 3 Inspector G-A � Ext
Approach/Sidewalk I
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL