Permit •
CITYOFTIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
� � DEVELOPMENT SERVICES PERMIT #: ELR2004 -00382
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/21/2004
SITE ADDRESS: 15618 SW 72ND AVE PARCEL: 2S112DD -00200
SUBDIVISION: OREGON BUSINESS PARK III ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Project Description:
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: 7
Owner: Contractor:
PACIFIC REALTY ASSOCIATES PROTEMP ASSOCIATES INC
15350 SW SEQUOIA PKWY #300 -WMI 9788 SE 17TH AVE.
PORTLAND, OR 97224 PORTLAND, OR 97222
Phone: Phone: 503 233 - 6911
Reg #: ERE3-23821676063CRE
LIC 38868
SUP 2613LEP
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELRPermit 12/21/2004 $525.00 Elect'I Final
[TAX] 8% State Surcharl 12/21/2004 $42.00
Total $567.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
Issued by , Permittee Signature
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Perini i V ED FOR OFFICE USE ONLY
City of Tigard Received )) .. ...- ES._, Permit No.:607, d -ao s
13125 SW Hall Blvd., Tigard, OR 9741C(° 21 noti Plan Review
Phone: 503.639.4171 Fax: 503.59$. AP ( i. Date/By: Other Permit:
Inspection Line: 503.639.4175 t • �;: IL, Date ReadyBy: luris: ® See Page 2 for
Internet: www.ci.tigard.or.us CITY ()F TIG Notified/Method: - 11 & Supplemental Information
�B ISIOI� PLAN REVIEW
❑ New construction BAddition /alteration/replacement Please check all that apply:
ED Demolition ❑Other: ['Service over 225 amps, comm'l ❑Hazardous location
['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
• CATEGORY OF CONSTRUCTION of 1 - and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling J Commerciallindustrial ❑ Accessory building ❑System over 600 volts nominal • units in one structure
El Multi-family ❑Master builder ❑Other: ❑Building over three stories El Feeders, 400 amps or more
. DOccupant load over 99 persons ['Manufactured structures or
• JOB SITE INFORMATION AND LOCATION ❑ Egress /lighting plan RV park
Job no.: pf r‘ Job site address: /51, 1' s w 7 .Z- ❑ Health-care facility ['Other:
Submit 2 sets of plans with any of the above.
City/State /ZIP: 7 p Q At- The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: PLC 2.../ o FEE* SCHEDULE
Description I 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'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
. DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and /or feeder 90.90 2
/N S /, IVe 77‘,..„.,0„,,-.-,..,-.7f Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
!PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: /%-» ) JS 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: 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 ,CONTACT PERSON A. Fee for branch circuits with
n service or feeder fee, each 6.65 2
Business name: P�20 / G/H 4--r-r0 c i, s A/c- branch circuit _
B
Contact name: n 13. Fee for branch circuits
tQ flJC � / JTi✓e ,._ without service or feeder fee, 46.85 2
Address: aa _ each branch circuit
/7 s.- / S 17 ! 6 4 --- Each add'I branch circuit 6.65 2
City/State /ZIP: /Sat 4 Da-L 97 L Miscellaneous (service or feeder not included)
Pump or irrigation circle - 53.40 2
Phone: 5 , c f7 Fax: : (6bi ) 2 .3 X97 7 Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 7 2
Business name: 5
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lie 37 :4 g' Electrical c.. 6/ .t, Suprv. Lic.:3 SG/ 8' Subtotal - "145 - 1 O0
Suprv. Electrician signature, required/ Plan review (25 % ofpermit fee)
R aLe4�� State surcharge (8% of permit fee) . GO
Print name: G , Date: 2___10,__O v
TOTAL PERMIT FEE .1 / 7 O
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name 0 LC- Q v A1 GA- Date/L ---0c�,- • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:t Building \ Permits 'ELC- PermitApp.doc 12/03 440- 4615T(l0 /02/COM/WEB
-A
CITY OF TIGARD 24 -Hour •
BUILDING Inspection Line: X5031639-4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested / �3 AM PM BUP
Location / O 7 ? Suite MEC
Contact Person fill. tGe--/ Ph ( ) 5 eo (9 ? PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC p
Ftg Drain Access: ELR �d0 - off jo Z
Crawl Drain
slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Sheath/Shear
Int ar
Int Sheath/Shth/Sh ear
Framing
Insulation I C i ) A� /1•1 G
� r ,
Drywall Nailing J )
Firewall
Fire Sprinkler
Fire Alarm � 1111M "
Susp'd Ceiling � � � —
Roof
Other:
Final
PASS PART FAIL
1 PLUMBING
Post & Beam '( _ / _
Under Slab t4� `Vi 1 0 1 uv 5 1 G ,
Rough -In
Water Service 9' /�
Sanitary r �-/
San ry Sewe r4�
Rain Drains �"
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final IY
PASS PART FAIL
MECHANICAL
Post & Beam
(. J
Rough -In
Gas Line
.....-/- (.)
Smoke Dampers �
Final \ \'9\ .
PASS PART FAIL
ELECTRICAL , ` \ 0 5 ..
Service
UG/Slab
Low Voltage
Fir Alarm
final
SS PART AIL 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE • E Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line �/
ADA Date % )/� -3/ Inspector -/ 4----- Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
2=3s