Permit •
CITY OF TI GARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
Ay�, DEVELOPMENT SERVICES PERMIT #: ELR2004 -00334
13125 SW Hall Blvd., Tisiard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/24/2004
SITE ADDRESS: 16398 SW 72ND AVE B -08 PARCEL: 2S113AA -00200
SUBDIVISION: OREGON BUSINESS PARK 1 ZONING: I -L
BLOCK: LOT: 002 JURISDICTION: TIG
Proiect Description: Low voltage, thermostat & NC units.
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: 2
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: 503- 624 -6300 Phone: 503- 233 -6911
Reg #: ERB -2382 6063CRE
• LIC 38868
SUP 2613LEP
FEES Required Inspections
Description Date Amount
[ELPRMT] ELR Permit 11/24/2004 $150.00
[TAX] 8% State Surcharl 11/24/2004 $12.00
Total $162.00
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 OA • - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
Issued •\ 1 �/' �� Permittee Signature ' 7.rc�_
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:
Cali 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Permi tl, ;, +;1- *'" QED FOR OFFICE USE ONLY
City Received )� Q ��
of Tigard Date/By: � p�J 4 7 AV. Permit No.: 6 OZ� 0611
13125 SW Hall Blvd., Tigard, OR 97(j�7�" Plan Review
Phone: 503.639.4171 Fax: 503.59 111 25 2004 ' q ( "' Date /By: Other Permit:
Inspection Line: 503.639.4175 OF TIGARD ei I " Date Ready /By: Jura: ® See Page 2 for
Internet: C ITY O
www.ci.tigard.or.us Notified/Method: fiCr Supplemental Information
BUILWRIVSION
ORK PLAN REVIEW
❑ New construction Addition /alteration /replacement Please check all that apply:
❑ Demolition ❑Other: ['Service over 225 amps, comm'I ['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
❑ I- and 2- family dwelling 'Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi- family ❑Master builder ❑Other: ['Building over three stories ['Feeders, 400 amps or more
['Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Job no.:3' 7 5 1 Job site address: /a 78' 56) ) 9 t? Qg ❑Health - care facility ❑Other:
Submit 2 sets of plans with any of the above.
City /State /ZIP: / , , O A- ef0,-) The above are not applicable to temporary construction service.
Suite /bld /a t. nt k_Q i� Pro ect name: /---: FEE* SCHEDULE
g p _ �~ /t J v �G'�L �r7tl 7 , GBH. Description 1 Qty. , Fee. 1 Total 1 **
Cross street/directions t o job site: New residential single - or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: /Qc/S' /AJCSf' ��A/-e / Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non- residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
./ / dwelling, service and /or feeder 90.90 2
/ 4 ! (,, , de(% µi it f e % rho r..-7-7 ' "i -A. L -Oce/ - L ervices or feeders installation, alteration, and/or relocation
�/ ti_ rt., 4,_ u� /7 00 amps or less 80.30 2
❑ PROPERTY OWNER I IL TENANT 201 amps to 400 amps 106.85 • 2
401 amps to 600 amps 160.60 2
Name: SiJ�i9G{ //fl p ),v - / -- -- /_ e c. ,4 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
'��`� 4 5 doe Reconnect only I I 66.85 I 12
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
Phone: ( ) I Fax: ( ) relocation
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 1 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: / mo o % � 4 f f o C 1 . f N! branch circuit
Contact name: ;A./en- B. Fee for branch circuits
Q j P '1 C ,L Q without service or feeder fee,
each branch circuit 46.85 2
Address: 77 855 S ',, / 7 14 "U-L
Each add'I branch circuit 6.65 2
City /State /ZIP: / O,1_7 `,.1 N 04e r $ 7 L. Z Z Miscellaneous (service or feeder not included)
Phone: (Sk3 ) ,c) S _‘/ 5-s, I Fax: : (6 3 r7 3) 2( 8 _ 9 2 Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: QQuc e. ,7 /,q 7 ,,,, , c OM Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or •
Business name: extension. Describe: Page 2 Z 2
S9/3-c .
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: ( ) I Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.L t s Electrical Liicc.:.2 Suprv. Lic.: g(t,/1 Subtotal /5 , 0 0
Suprv. Electrician signature, required: 4 V — -W, i� �.. Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Print name:Ro6 we 19 ve/ -- Date:412Y _ /,/
TOTAL PERMIT FEE
Authorized signature:eLz,‘„ "G This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: ER 0, ,Q A ,_„__ Date: /Q -- 2 5r — 04 / ' Fee methodology set by Tri- County Building Industry Service Board
** Number of inspections per permit allowed.
i:\ Building \Permits \ELC- PermitApp.doc 12103 440- 4615T(10 /02/COM/WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection•Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
> BUP
Received p /"w Date Requested `° ° AM PM BUP
Location 1 � . 7 7 ' 7, z Suite MEC
Contact Person Ph ( ) .� ( r / q9 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR 2.0 - a o 331
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
, Ext Sheath/Shear ,
Int Sheath/Shear
Framing
Insulation p� � f N
Drywall Nailing Tt 77
Firewall
Fire Sprinkler ps
Fire Alarm CP62-ivt l T- sfl cf 6L , f.i-r- �' `j$7 1 1,'v X 0/3 51
Susp'd Ceiling
Roof
Other:
Final
P ASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service ` 1
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
Fire Alarm
in. ► ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA -&
Approach/Sidewalk Date �� �� Inspector � � Ext
Other:
Final DO NOT REMOVE thls inspection record from the Job site.
PASS PART FAIL