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Permit CITYOFTIGARD ELECTRICAL ENERGY RESTRICTED ICAL ENERGY ��� DEVELOPMENT SERVICES PERMIT #: ELR2001 -00322 �=-- 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 12/28/01 SITE ADDRESS: 15705 SW 72ND AVE PARCEL: 2S112DC -00100 SUBDIVISION: OREGON BUS. PARK III ZONING: I -L BLOCK: LOT: 002 JURISDICTION: TIG Project Description: Installation of data /telecommunication system. Job No. 51 -05184 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: OUTDOOR LANDSC LITE: OTHER: : HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: TOTAL # OF SYSTEMS: 1 Owner: Contractor: PACIFIC REALTY ASSOCIATES CHRISTENSON ELECTRIC INC 15350 SW SEQUOIA PKWY #300 -WMI 111 SW COLUMBIA PORTLAND, OR 97224 STE 480 PORTLAND, OR 97201 Phone: Phone: 241 -4812 Reg #: LIC 458 SUP 3289S ELE 26 -34C FEES Required Inspections Type By Date Amount Receipt • Low Voltage Inspection PRMT CTR 12/28/01 $75.00 2720010000 Elect Final 5PCT CTR 12/28/01 $6.00 2720010000 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 -001 010 OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -19 � Issue by k Permittee Signature s 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 Date received: iR s8 0 Permit no.: � app -3 , j;-' ' i i City of Tigard Project/appl. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receiptno.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: TYPE OF I'ERIIIT O 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family ❑ Tenant improvement 0 New construction ❑ Addition/alteration/replacement 0 Other: O Partial Job address:15705 SW 72ND (T) 97224 Bldg. no.: Suite no.: Tax map/tax lot/account no.: Lot: I Block: (Subdivision: BLS G903 Project name:BRIDGESTONE SPORTS I Description and location of work on premises: LOW VOLTAGE DATA /TELECOMMUNICA ^ION Estimated date of completion/inspection: MARK BRADWELL (503) 806 -9353 QNjlR: CI:OR.ArpLICATION , . . : . . s -a ..:. : FEE SCHEDULE. ..... _ • . Job no: 51 -05184 Fee Max Qty, (ea) Total so. hup Business name:CHRISTENSON ELECTRIC, INC. New residenl1ai-single or multi - family per Address:111 SW COLUMBIA, SUITE 480 dwelling unit. Includes attached garage. City: PORTLAND I State: OR I x:97201 -5886 Service htcluded: Phone503 2414812 IFax503241051$E -mail: 1000sq. ft. orless 4 Each additional 500 sq. ft. or portion thereof CCB no.:458 I c. bus. lic. no: 26 -34C _ Limited energy, residential 2 City /metro ' o.: 5 46 Limited energy, non - residential 2 Each manufactured home or modular dwelling Signal of supervisi ectrtcr required) Date 1 / 2 6 / U 1 Service and/or feeder 2 Sup. elect.name(print): BRIAN CHRISTOPHER License no: 873S Services or feeders — installation, alteration or relocation: 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: I Fax: I E -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 ORS 447, 455, 479, 670, 701. • 201 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: I 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 REV! ENV (Please check all that apply) Misc. (Service or feeder not included): O Service over 225 amps- commercial O Health -care facility Each pump or irrigation circle 2 O Service over 320 amps -rating of 1 &2 O 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, 0 System over 600 volts nominal more residential units in one structure alteration, or extension* 1 75 . 2 o Building over three stories 0 Feeders, 400 amps or more •Description: DATA/ TELECOMMUNICATION O 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 1 1 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 infom nation. Notice: This permit application Permit fee $ 75. O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $ Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ 6 • / Expires accepted as complete. TOTAL $ 81.00 / Name of cardholder as shown on credit card $ Cardholder signature Amount 440-4615 (6/00/COM) OCT.2000 +FEES ON BACK OF FORM 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 El 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 El HVAC Miscellaneous ❑ Instrumentation (Service or feeder not included) Each pump or irrigation circle $53.40 El 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 El Medical the allowable in any of the above Per inspection $62.50 ❑ Nurse Calls Per hour $62.50 In Plant - $73.75 ❑ Outdoor Landscape Lighting* Fees: ❑ Protective Signaling Enter total of above fees $ ❑ Other 8% State Surcharge $ N umber of Syste 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 $ ❑ Trust Account # 8% State Surcharge $ Total Balance Due $ i :\dsts\forms\elc- fees.doc 10/09/00 ++OVER FOR PERMIT FORM CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested /-- 3.17 AM PM BLD Location Suite MEC Contact Person LQ r Ph _8(24 PLM Contractor _Ci3t_iM3gdriSpi Ph SWR G BUILDING Tenant/Owner ELC Retaining Wall ELR 2x70/ —Ci9 31-2• Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab _ SIT Post & Beam LOCO O ba _ Ext Sheath /Shear !+�/ V l/ � Int Sheath /Shear Framing � Insulation !s C4 U0/14.e Drywall Nailing Firewall Fire Sprinkler FAph011e V 0/ Fire Alarm C F %�77 � c Susp'd Ceiling ��( Roof Misc: Final PASS PART FAIL PLUMBING aro 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 ELECTRICAL Service Rough In UG /Slab Low Voltage Fire Alarm .1:.W PART FAIL SITE 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 reinspection RE: [ ] Unable to inspect - no access Fire Supply Line ADA Approach /Sidewalk Date Other , 3 !' 0/ Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. - - , CITY OF TIGARD BUILDING INSPECTION DIVISION 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST BUP Date Requested /a - AM PM BLD Location / S 70 3 7 / -(-- Suite MEC Contact Person LreLL Ph 3 06 PLM Contractor C Air; 5tV K5" /PCIWG Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR ,Zd27 / 3 Z� Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall eriCir.S.tetriet Fir e Sprinkler Fire Alarm 1,okf Susp'd Ceiling 1 Roof 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 ELECTRICAL Service o�ugh`T�n UGTSlab Low Voltage Fire Alarm Final gip PART 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 reinspection RE: [ ] Unable to inspect - no access Fire Supply Line ADA Approach/Sidewalk Other Date /2-31-o/ Ins Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.