Permit •
y +' CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
1 �, DEVELOPMENT SERVICES PERMIT #: ELR2004 -00262
"" 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/17/2004
SITE ADDRESS: 06855 SW BAYLOR ST PARCEL: 1S136DD-01300
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 002 JURISDICTION: TIG
Project Description: Installation of voice data cabling.
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:
MALCOLM ESLINGER PACIFIC WEST DEVELOPMENT
11575 SW PACIFIC HWY 8900 SW BURNHAM ST.
TIGARD, OR 97223 SUITE 14
TIGARD, OR 97223
Phone: 503- 620 -9515 Phone: 503 -572 -5072
Reg #: ELE 36 -96CLE
LIC 68481
SUP 1004LEA
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 8/17/2004 $75.00 Elect'I Final
[TAX] 8% State Surcharl 8/17/2004 $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 ' in t89,cys of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you o follow rules a opted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010
thr ugh OAR 952 -001 -0 00 •u .y obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
Iss ed by - l�� % � Permittee Signatur-
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 • . 1
7 t•
City • of Tigard
A ell! Received
Date/By: Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 11 `!. 01 41,41/ Date/By: Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: Juris: El See Page 2 for
Internet: www.ci.tigard.or.us NotifiecUMethod: Supplemental Information
- ,".'VWsAY: , P-FarttVittMP'i,-r-;e , -IA4 - § An'r*';''.:: . . ..
New construction El Addition/alteration/replacement Please check all that apply:
O Service over 225 amps, comm'l E Hazardous location
0 Demolition 0 Other:
oPa OService over 320 amps — rating EBuildng over 10,000 sq. ft.,
lirefr"
of I - and 2-family dwellings 4 or more new residential
El
1 and 2-family dwelling 0 Commercial/industrial 0 Accessory building ESystem over 600 volts nominal units in one structure
O Building over three stories EFeeders, 400 amps or more
El Multi-family El Master builder 0 Other:
DOccupant load over 99 persons 0Manufactured sn
PAW.: 101 4= '30,646Av4Niin[oN' , :ernAiralsiiMPP*PSN'alf E Egress/lighting plan RV. park
. :-N,- ;:4; V -,. AV.' -;:;',.. ,,,.,A.,,t,,,i. _ mimuxem,104, 4 n ,, -0x4-ae-4fP ' " 4 'Mt i '''' 04
El Health-care facility 00ther:
Job no.: Job site address: 6 €5 s - - .‹- ‹-. . ,
, ....(,.., I3A Y z 0 e 5 Submit 2 sets of plans with any of the above..
City/State/ZIP: 7 , 6 ,, Az o d Q 91 2 Z 3 The above are not applicable to temporary construction service.
taAtigjAVIAMMKOrftittits
Suite/bldg./apt. no.: Project name: 7)
Description Qty. Fee. 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'l 500 sq. ft. or portion 33.40 , I
Limited energy, residential 75.00 2
Tax map/parcel no.: .
Limited energy, non-residential 75.00 2
iiiilAiltilkteliriV4e,e,',Y,TaWETAY47, zvZ,Y,,„,,,A,,:RigAiRitM,i;W: :... ,A,1 Each manufactured or modular
dwelling, service and/or feeder 90.90 2
V OIC. - 7041A KA-.SLIA\ 1 Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
„ 21 . 71 . 04iimio:05 „ tim p 3059 i .,,, :4 , itirx , : .,.,." 0 ,... :ii1 " ,..,:9 . 4nowv 201 amps to 400 anTps 106.85 2
401 amps to 600 amps 160.60 2
Name: )--kik Lex) u. H 8,1, ,3c, 4., 601 amps to 1,000 amps 240.60 2
Address: i ( G7 5 tn.) 1)4. ri &. 144.loy Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIF---rk 3 itt ._ 0 2 1 . 0 <2..._ q 7 2-9-3 Temporary services or feeders installation, alteration, and/or
Phone: (55) 6, 9 4, 6 -- -- 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 10 600 amps 133.75 2
Owner signature: Date: . Branch circuits — new, alteration, or extension, per panel
*A7kM,I=VI;IghliffeksI Attt4N'':?_,Liq.441a 4 Wgii;?tafIViliiirfaRV;:naMt A. Fee for branch circuits with
t-Pi00.4. 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-
p gt5 w w
- 4-4,,,:, s ln,. , N,so,x : r r n! .: ,:tF,3 energy panel, alteration, or
extension. Describe: ) Page 2 7i, 2
Business name: PtC- i 'F/ ( ( ik)5 f D 61.y A4 c„-} ) j)c
) Each additional inspection over allowable in any of the above
Address: 'aC)C2i) 5 ,,,, j: 'WL- Per inspection 62.50
City/State/ZIP: 1/ 6 ovz..1 o-, 9 - 7 2 a. 3 Investigation per hour (I hr nun) 62.50
Industrial plant per hour 73.75
Phone: (50 ) 572,_ 567 2. Fax: (5'05) 6 2.. i 0 e
imormemorwwwwwww.vor75
CCB Lic.: 6 5 Li g 1 Electrical Lie.: 3_(r Lic.: -1004/Z4.4_ Subtotal 75 ce
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) ep VC
Print name: '
tin Date:
TOTAL PERMIT FEE
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-County Building Industry Service Board
** Number of inspections per permit allowed.
i \Building \Permits \ELC-PennitApp.doc 12/03 440-4615T(10/02/COM/WEE
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*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
CQNTiVll lt(`�_, . ,.WVO OWti; , ,. _..117 311.1
..
•
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
❑ 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 \Permits\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 AM PM BUP
Location 5 .5 Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR /I1
BUILDING Tenant/Owner ELC ITI
Footing OW-
Foundation ELC u
Ftg Drain Access: ELR A66 -/ 6;-_
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Ina Sheath /Shear
Framing
Insulation
Drywall Nailing
Fi reveal l h6:12 1 7LC2j � P45 5 E D fL. fl
Fire Sprinkler f
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
UG/Slab
Low Voltage
Fir- larm •
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line (i - y ri (�
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL