Permit CITY TI GARD ELECTRICAL RESTRICTED ENERGY PERMIT
I4 DEVELOPMENT SERVICES PERMIT #: ELR2005 -00158
AA A11 DATE ISSUED: 6/21/2005
13125 S W Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S112DC-01400
SITE ADDRESS: 15865 SW 74TH AVE 105 ZONING: I -P
SUBDIVISION: CREEKVIEW INDUSTRIAL PARK LOT: 004 JURISDICTION: TIG
Project Description: T- stats.
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 AMERICAN PROPERTY EXCHAN WILLAMETTE HVAC
PACIFIC SANTA FE CORP 27655 SW LEPLEY LN
17700 SW UPPER BOONES FERRY RD HILLSBORO, OR 97123
PORTLAND, OR 97224
Phone: Phone: 628 - 6841
Reg #: LIC 56951
ELE 34- 346CRE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 6/21/2005 $75.00
[TAX] 8% State Surchar€ 6/21/2005 $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 fort in OAR 952 - 001 -0010
through OAR 952 -101 -0100. You may obtain copies of these rules or direct questions to O(C at 503 - 246 -6699.
Issued By: �� �! 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 DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit A'><ca >�io FOR.OFFICE USE USE ONLY
City Of Tigard Received % I 4 . permit No.: �O�' 31,11 13125 SW HaII Blvd., Tigard, OR 972 JN 21 2005 Plan Revie(w� -
Phone: 503.639.4171 Fax: 503.598.1960 �� " $ ,- 0 I Date/B . Other Permit:
Inspection Line: 503.639.4175 r �.� Date Read B '® See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: y y '
, Supplemental Information
DU LDT!!' D!Vlclnnl
TYPE OF WORK 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
❑ 1- 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 DEgress/lighting plan RV park
f s1 ❑Health -care facility ❑Other:
Job no.: Job site address: 4 ,ICJ -7 y Submit 2 sets of plans with any of the above.
City /State/ZIP: The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: `Q5 Project name: C FEE* SCHEDULE
G , t/ Description I Qty. I Fee. I Total ` **
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
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
`-' J
�e�e >!t� dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PRO .. RTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
`/ ) 401 amps to 600 amps 160.60 2
Name: ` Cam, \ a.— r L PA 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 1 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
❑ APPLICANT 1 ❑ CONTACT PERSON 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,
each branch circuit 46.85 2
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 -mail: Signal circuit(s) or limited- •
CONTRACTOR energy panel, alteration, or
Business name: `�_i / / /-14z/47,.. extension. Describe: Page 2 2
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: ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 6 4 %$ / Electrical Lic.: �Suprv. Lic.: Subtotal
Suprv. Electrician signature, required: ' e/T� Plan review (25% of permit fee)
� _ ,� St O' ` State surcharge (8% of permit fee)
Print name: boy Date:
/ TOTAL PERMIT FEE 51 --- Authorized signature: i�? f�J This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: G
,, g Ga l Date: G.a / -05 • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Building \Pennits\ELC- PennitApp.doc 12/03 440- 4615T(10 /02/COM/WEB
Electrical Permit Application - City of Tigard -,
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: 1
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:
•
j COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
El Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
❑ Nurse Calls
TI Outdoor Landscape Lighting*
•
❑ Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Permits\ELC -Perm itApp.doc 04/03
i
// Cf -YOF TIGARD
BUILDING DIVISION PERMIT #: ELR2005 -00158
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/21/2005
Phone: (503) 639 -4171 �
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/21/2005 TIME: 7:09AM PAGE: 89
SITE ADDRESS: 15865 SW 74TH AVE 105 CLASS OF WORK:
SUBDIVISION: CREEKVIEW INDUSTRIAL PARK LOT #: 004 TYPE OF USE:
PROJECT NAME: COGNEX EXPANSION
DESCRIPTION: T - st a t s.
OWNER: PACIFIC AMERICAN PROPERTY EXCHAN, PHONE #:
CONTRACTOR: WILLAMETTE HVAC PHONE #: 628 -6841
Inspection Request Scheduled For: Date: 7/21/2005 Pour Time:
Code # Inspe Description Confirm # Contact # Message
199 Electrical final 011812 -01 503- 957 -3348 N
Corrections /Comments /Instructions:
A ] PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �! Date 2 ac ----1
Phone #: (503) 718- 1146