Permit CITY OF TIGARD ELECTRICAL -
ENE
RESTRICTED ENERGY
4t1 4 DEVELOPMENT SERVICES PERMIT #: ELR2004 -00315
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 10/12/2004
SITE ADDRESS: 15865 SW 72ND AVE BLDG -C PARCEL: 2SI 12DC -00201
SUBDIVISION: OREGON BUSINESS PARK III ZONING: I -P
BLOCK: LOT: 003 JURISDICTION: TIG
Proiect Description: Voice & Data cabling.
Job # 606095- 49366.
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 BROADWAY ELECTRIC - COCHRAN INC
15350 SW SEQUOIA PKWY #300 -WMI 626 SE MAIN
PORTLAND, OR 97224 PORTLAND, OR 97214
Phone: Phone: 503 234 - 6564
Reg #: LIC 72942
SUP 3447S
ELE 37 -546C
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 10/12/2004 $75.00 Elect'I Final
[TAX] 8% State Surchari 10/12/2004 $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
through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
Issued by V ,i, Permittee Signature 3 TTI
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
131L Si Hall Blvd., Tigard, OR 9
- E D . D Date/B : R.. ived, , ... , AY PermitNo.: <-- LL ii # /
.1 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 ,,,,,q 4.
I X Other Permit:
n , '. .-.4 -vi-;'..
Inspection Line: 503.639.4175 nri i r , LU ..,..04,1.- f, Date Ready/By: Egg el See Page 2 for
kg -,... .; - -
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
km:gil'A;v5.,-,4 .7. •..i***
o New construction 0 ticiftfOltakelaitil, licement
i§
Please check all that apply:
OService over 225 amps, comm'l 0Hazardous location
0 Demolition 0 Other:
S. „ 0 ervice over 320 amps - rating 0Buildng over 10,000 sq. ft.,
• :'; .. 'rekie0dItiirZWaYSTIFiticilifiSei '!-: .:•q't of 1- and 2-family dwellings 4 or more new residential
El 1 and 2 dwelling 0 Commercial/industrial 0 Accessory building OSystem over 600 volts nominal units in one structure
I:Building over three stories [Weeders, 400 arnps or more
0 Multi 0 Master builder 0 Other:
DOccupant load over 99 persons CIManufactured structures or
n''SiV CiEgress/lighting plan RV park
400‘00qS—
Job no . OHealth-care facility ClOther:
•
.. -y '7 Job site address: 15'505 c Sbo 7,7...hOf Cit.0-€
Submit 2 sets of plans with any of the above.
City/State/ZIP 9,0 ,4,, Og_ The above are not applicable to temporary construction service.
Suite/bldg./apt. no.: e" Project name: eitiA/n (Out'
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'l 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
WItte4i ZaWxl:tiVi#,M.tlttVglntnf;. ;:',..'‘'''-?:'.•:.#1.11 Each manufactured or modular
C-Ot (ejl- dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
D b
200 amps or less 80.30 2
' , .? - /...• - - , di "..1. 2,3 ...: '.1....: • 401 amps to 600 amps 160.60 2
Name: 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
'.;I:, YOXI,Oli.,;''',UNVeark • .
A Fee for branch circuits with
. service or feeder fee, each
6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
46.85 2
each branch circuit
Address:
Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( ) Sign or outline lighting 53.40 2
E Signal circuit(s) or limited-
la y, ggs energy panel, alteration, or
extension. Describe: Page 2 1S' ----
Business name: ? ) , cc) ,...1 ..... ._,,_ J , x... /
I Each additional inspection over allowable in any of the above
Address: C-C G m
Per inspection 62.50
City/State/ZIP: - 2 0 ..r.-\ 0 _4 09, 'l 21.4 Investigation per hour (1 hr min) 62.50
Phone: (51:;"5) .2,3 tk- G6c,(4 Fax: (565 ) 2-", - 2.c>ck $ Indusnial plant per hour 73.75
CCB Lic.: --iie Electrical Lic.: 31- 64 (,,c_ Suprv. Lic.: Lk-fl., Subtotal 'ZS' -
Suprv. Electrician signature, required: V . Plan review (25% of permit fee)
State surcharge (8% of permit fee) 6 ----
Print name: \Le ()% \e--ci Date:
TOTAL PERMIT FEE V •'---
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri Building Industry Service Board
** Number of inspections per permit allowed.
BuildingTermits \ELC-PernatApp.doc 12/03 440
_ . •
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information , ,
LIMITED ENERGY PERMIT FEES:
•
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
s
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
El Vacuum * -- - --
❑ Other:
i i E 1 ' ` C VIMat.c. 7 Af• ,-t 4 5Zu 6i:,
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
•
❑ Boiler Controls
❑ C ck 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
Total number of commercial systems: . .
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Permits\ELC- PertnitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Busines's Line: (503) 639 -4171 MST
BUP
Received Date Requested / -- �7 AM PM BUP
Location /S c' 7 ✓Yld-) Suite MEC
Contact Person 7 Ph ( ) 3 7 - 9/ PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner / .4v1 LC�Qii ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR D° 3/S"
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 C 6:-
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 £L � '�� HVig, Pc is S LLRG Lf - 0,03 0,, rP5%
Service ) 1 N
Rough -In
UG/Slab
Low Voltage
Fire Alarm
in a
tizz Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
- ART FAIL
SI fl Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
DAoach/Sidewalk Date - Inspecto � ' Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this Inspection record from the job Ite.
PASS PART FAIL