Permit ELECTRICAL PERMIT -
Ai*" CITY O TIGARD RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT #: ELR2004 -00329
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/21/2004
SITE ADDRESS: 15883 SW 72ND AVE BLDG -B PARCEL: 2S112DC -00500
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -P
BLOCK: LOT: 040 JURISDICTION: TIG
Proiect Description: Phone & data lines.
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 10/21/2004 $75.00 Elect! Final
[TAX] 8% State Surchar€ 10/21/2004 $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 - ;�,� S 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:
/ ONTR TO - STALLATION 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
Tivai!, .. , Received y .•
Date/E3y/g --, FOR OFFICE USE ONLY
City of
Permit No.:6 ,_, .-
13125 SW Hall ...rd.:Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: : ; Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: J : : 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: 1( r _ Supplemental Information
jik;z - '.-f- , :.;t - ..r . :.?,.1t,,C'QS`- ,,I lktiii■I ^j/ijilg*. ..' . .- .
' ....nu.........:K; t.41.4.4k.,:".4....17. - .-4.1.4:,■4 , ..:-' , -1 , 21: i e4:"F . " - ;:g' - '"i i-; '.'7. • .k ` ":"...?. '' '..7:" ' --. - :.." 7. -,'"'''' :'" -.2;%`'7:::" -. : .., ', - - - •.- - -' - ''- ,.
El New construction El Addition/alteration/replacement Please check all that apply:
['Service over 225 amps, comm'l 0Hazardous location
1:1 Demolition 4 0 Other:
iit icTio ',.1 S ervice over 320 amps - rating 12Buildng over 10,000 sq. ft.,
'''-.-i----- O
71..:.: of I - and 2-family dwellings 4 or more new residential
::::
0 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building ElSystem over 600 volts nominal units in one structure
['Building over three stories OFeeders, 400 amps or more
0 Multi 0 Master builder 0 Other:
00ccupant load over 99 persons OManufactured structures or
RTYPIiiif";#114-1gAllitt)70.4i.i*Or:NOPV:--Aii:Iti"'ILV.:i...e. DEgress/lighting plan RV park
..ir
Job no.: 'J - _.- Job site address: / STS3 (_...%0 7d Q.,P"...
...„,, OHealth-care facility ElOther:
Submit 2 sets of plans with any of the above.
City/State/ZIP
• .. 0 The above are not applicable to temporary construction service.
'C'
Suite/bldg./apt. no.: Project name: fur erAittaittg
Descriptio n 1 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.: •
---
- V Limited energy, non-residential 75.00 2
,OP ,Ilr 45 gl< .1 "- - 1-- - 'i . - - ..' ' -
...Logi , v-,,,,,..... , -... -,...,..-,-,.... , - .., .= - :..... . ,..,P.,...,:,..., ;,ft,, - =14k, A Each ; manufactured or modular
. add ,9i&?-a_.- e ata, ,ae.i; dwelling, service and/or feeder 90.90
Services or feeders installation, alteration, and/or relocation 2
200 amps or less 80.30 2
: ;4rtt.:4■$ griliktikliti* iimiiiiii ;ii...% . .4 . 1a*ik A Nt . - . ::: ; ;,.1,, , : , -...11 . .?..? - .... - .,:,, 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: Ta,c,-r-vm_st 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
A "A4 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 addl 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-mail: Signal circuit(s) or limited-
"-" . ''' ".77:!.:.::',Y.:!_i':' energy panel, alteration, or
extension. Describe: / Page 2 7c........., 2
Business name: "?.. ,....„ .-
Each additional inspection over allowable in any of the above
Address: ..G. \PAO„
Per inspection 62.50
City/State/ZIP: - p c , 4 --..\ 09, c‘1 2_li-V Investigation per hour (1 hr min) 62.50
Phone: (50'5) 2;34-- G6(-k Fax: (50 ) 2:Ye. - 2- c l S Industrial plant per hour 73.75
CCB Lic.: - Electrical Lic.: 31- , i(,,C_ Suprv. Lic.: - 7 ) .)44 - 4 S Subtotal
Suprv. Electrician signature, required: V .. ._ ...2 k c L Plan review (25% of permit fee)
State surcharge (8% of permit fee) & ..--**
Print name: --\/\ \ Q. Date:
TOTAL PERMIT FEE 137,.--•
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: I Date. • Fee methodology set by Tri-County Building Industry Service Board
** Number of inspections per permit allowed.
iABuilding\PennitskELC-Pennit.App.doc 12/03 440-461 5T( I 0/02/COM/WEB
- -
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*
b
❑ Burglar Alarm
❑ Garage Door Opener*
• ❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
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
2/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
is Building \Prnnits\ELC•PemtitApp.doc 04/03
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line r1(505) j(505) 639 -4171 MST
BUP
Received p Date Requested /6 . j AM PM BUP
G
Location 1 8 O 3 oZ �� c�'I Suite_ MEC
Contact Person Ph ( ) S 2 Z -79 2 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Ftg Drain Access: ELR °O - 9 d 3.R?
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
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
Service
Rough -In e Lr2 v - ‘>03o rJ > L5 u riiv -
UG/Slab
Low Voltage d ''i
Fire Alarm
i 1 U Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
l PART FAIL
SIT Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date /6 4 /"
Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from th ob site.
PASS PART FAIL