Permit CITY OF TIGARD RESTRICTED ENERGY
REST RICTED G
ESTRGY
`� DEVELOPMENT SERVICES PERMIT #: ELR2004 -00307
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 10/4/2004
SITE ADDRESS: 15883 SW 72ND AVE BLDG -B PARCEL: 2S112DC -00500
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -P
BLOCK: LOT: 040 JURISDICTION: TIG
Project Description: Relocate (2) thermostats.
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 -WMI 807 NE COUCH
PORTLAND, OR 97224 PORTLAND, OR 97232
Phone: Phone: 233 -6911
Reg #: ELE 26- 1063CRE
LIC 38868
SUP 2613LEP
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 10/4/2004 $75.00 Elect'I Final
[TAX] 8% State Surchari 10/4/2004 $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 42-'17/7/ v 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 �2tc� -�I DATE: /0 - y - c,
LICENSE NO: Z((a6 j C.c./
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Permit Application • . FOR OFFICE USE ONLY
City ofirigard Received
Date/B : ° Emil. P„tnit No.: E / , , 01
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 D /A
.
.. 1,-V.74111 a tem . Other Permit:
Inspection Line: 503.639.4175 ,..3.11.. 1 J2 Date Ready/By: Will 63 See Page 1 for
Internet: www.ci.tigard.or.us Notified/Method: ... Supplemental Information
iitai i0bitie;AVA .§::: , vt:;_ ,, s,.':.7.f. , ,y,F4 , z1, ,,-, 1.,tiotiiiitit*.J. ,. .:' , : ,
, : -,...,...-tx ..• •!,.. , .2" ..:. -7-, - t . '. ..,, • 'f:.:4%; -1•1,4F ,, 4.,‘• ) '.....1 „4^ C., '1. W,•:, : ,,Z.:4 4 .- .',f3 , ...,,. , ; ,1' „,...• ,... ,.‘.■
0 New construction VAddition/alteration/replacement Please check all that apply:
D
ID Service over 225 amps, comm'l El Hazardous location
Demolition 0 Other:
„ ['Service over 320 amps - rating 0Buildng over 10,000 sq. ft.,
,t ii,6 to'Aiiitithokv.Si
.,...-- ' - -,7-' . - ."...: i■ ... '_ i4X.."....-S'',4:A4...:!*.Y7.',:.XV4'.. of 1- and 2-family dwellings 4 or more new residential
0 1- and 2-family dwelling ?1,Commercial/industrial 12 Accessory building Ei System over 600 volts nominal units in one structure
['Building over three stories :Weeders, 400 amps or more
El Multi-family El Master builder 0 Other:
DOccupant load over 99 persons OManufactured structures or
•,-.tXtt :il'f.:. ['Egress/lighting plan RV park
Job no.: Job site address: /5 .K 5J -, _ 0 Health-care facility 0 Other:
c of A1 4., Submit 2 sets of plans with any of the above.
City/State/ZIP: v rifieij
0 A-4'.47-4-.% The above are not applicable to temporary construction service.
Suite/bldg./apt. no.: Project name: 6h4/45/C.444frfAIZtch 7 - D ription '-- I Qty. I Fee, I Total I **
Cross street/directions to job site: New residential single- or multi-family dwelling unit.
Includes attached garage.
0 iterc* ,6 0 X),FP...C.1" f4A-el ..... 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 °.'.... 7 F;'Pg 1 -. i- Each manufactured or modular
dwelling, service and/or feeder 90.90 2
IQ el..04...47c,
2_... t S T 77 m7 7 . " - - Lo' ."-A4,t, 6 . -f
I s Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
...,; ..:: tl ,44 ..;-,: ;,,.. ..1 : y -- ;.,. ...,,,.(-. ,„...,„.,,,,,., („ &.. - 201 amps to 400 amps 106.85 2
.::.: , 'Z .. .. , , 1 ;= 1 .. ,4- 4W.F..-! 1 .-` 4. 7 4 7 1 '.n.'_'-. . '.-- .t..,'-1; ":. ._:;.',41.11 ..!,,,Igi.1.'-r
- 401 amps to 600 amps 160.60 2
Name: eij 9 .---- 6j4.fs , ,A7.....- 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
, c .4-one._____ A° /1.0.--,-/... f 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' .i .....,. 7 1‘'.3;,:.:..,..itrti5riTitri:i.iigijki.: , . : : - :";!'. : :;',.;; A. Fee for branch circuits with
service or feeder fee, each
...---- 6.65 2
Business name: f,, i _,../.. 4,C.C 4.re..-_r 2 branch circuit
B. Fee for branch circuits
Contact name: g „,, , 4
4507; 4. re .....4, without service or feeder fee,
46.85 2
each branch circuit
Address: 9 7‘i s e..... i T
Each add'l branch circuit 6.65 2
City/State/ZIP: 9 > 2,24_ Miscellaneous (service or feeder not included)
-
Pump or irrigation circle 53.40 2
Phone: (CM ) S 9 9 O F : (S ) 23 ___ > )
Sign or outline lighting 53.40 2
E-mail: Signal circuit(s) or limited-
OA ' ' p.c .i?: energy panel, alteration, or
" extension. Describe: Page 2 2
Business name:
....C n-A-7-r•
Each additional inspection over allowable in any of the above
Address:
Per inspection 62.50
City/State/ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax ( ) Industrial plant per hour 73.75
.. : , '<4":;::::;:'tfWkate42t. - gOkOgat 1 .7i:TVAI:7:7r7: 1 '
CCB Lic.j3 if g- 6 r Electrical Lic.2C (0(3 cze_Suprv. Lic. 5 z r L , A Subtotal
Suprv. Electrician signature, required: jf Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Print name: 4 j ----- Date/ c"--A-1)4---r TOTAL PERMIT FEE / 5 . ea
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: aft „,.,,, 6 ,..,--, A , Date/0_if_..ev • Fee methodology set by Tri-County Building Industry Service Board
** Number of inspections per pennit allowed
i: \ Building \Perrnits \ELC-PerrnitApp.doc 12/03 440-46151110/02/COM/WEB
Electrical Permit Application - City of Tigard •
Pagel - Supplemental Information -
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
II a * J . 0 ° � a � as ✓ �. +± k h .42M `..
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
g 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 \Pertnits\ELC•PermitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested ( 1 — 3 AM PM BUP
Location f CE g‘3 7� �! Suite MEC
Contact Person 622n(.(,r Ph ( ) 57 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner <<�� _ "�. 4 �� LC
Footing
ELC
Foundation Access:
Ftg Drain ELR aD6 V dd 3d7
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
Undder r 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
Service
Rough -In
UG/Slab
Low Voltage I) 404 a O .3 mac) 4
F' =
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE 0 Please call for reinspection RE: El Unable to inspect — no access
Fire ADASupply Line /
A roach/Sidewalk Date / / Inspector Ext
PP
Other:
Final DO NOT REMOVE this Inspection record from th Job site.
PASS PART FAIL