Permit L
ELECTRICAL PERMIT -
C I TY OF T I G i4 R D RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT #: ELR2004 -00179
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/25/2004
SITE ADDRESS: 07204 SW DURHAM RD Q300 PARCEL: 2S113AC -00103
SUBDIVISION: PACTRUST ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: Low voltage for fire alarm.
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: X OUTDOOR LANDSC LITE:
OTHER: • HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC REALTY ASSOCIATES FIRE PROTECTION SERVICES
15350 SW SEQUOIA PKWY #300 -WMI 18270 SW MOUNTAIN HOME RD.
PORTLAND, OR 97224 SHERWOOD, OR 97140
Phone: Phone: 503 - 590 - 3732
Reg #: ELE 34- 488CLE
LIC 154333
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 6/25/2004 $75.00 Elect! Final
[TAX] 8% State Surchar€ 6/25/2004 $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
throu. - •AR 952-611-0100. You may copies of these rules or direct questions to OUN at (503) 246 -6699.
Issu -. by !_.f� � � , / 'ermittee 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 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Permit Application F OR OFFICE USE ONLY
Received
• n ^_^ _ „„ J .
City of Tigard Date/By: f � Permit No.: K 4 /
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 / ' b4iii H1N"t' Date/B : Other Permit:
Inspection Line: 503.639.4175 -al 1.1 Date Ready/By: Jur s H See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
;� .«,„ - .sz, - ta =:^ - »s.,x�., =� .mac::. » - x:,'�:.c: °;:c.' sr t :ira .q: ....
£z . ¢ ? ;, , . sz" e ° "vS`..� 4 -1 �ti ' lq_ •..:=sr,':... i.'4 �;� .xr, :' 5
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f
A.. �s?�i�.�?��,_ �.� � °::& -y s� ..,..� i�sro `,�.aa�sm��.��»3.e?t�z.J s' ��. �� „,�: "�s.?��•rad,�.�' _
III New construction 'fig Please check all that " apply • „ „ ��� ”
❑ Service over 225 amps, comm'l ['Hazardous location
El Demolition ❑Other
` y fs r .
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
t' v m a � :�r'e a ._ CAT CO >RUGTIO : ' � . . ... of 1 -and 2- family dwellings 4 or more new residential
•. z,r�m: «. ,,.:�,,,: -
�.Sm.,...s,„, O ,. °.., .. . .0 r» -s . . �.:..,,„s„� #wts5 tw:.a.u- ^'
❑ 1- and 2- family dwelling IS Commercial/industrial ❑ Accessory building ESystem over 600 volts nominal units in one structure
❑ Multi- family ❑Master builder ❑Other: ❑Building over three stories ['Feeders, 400 amps or more
a r °mot _ SIT t _ _ buil ° ^ c A 4q , ° r ,,m}t� MEWS ['Occupant load over 99 persons ❑Manufactured structures or
ian:0B 1 �FORfIf I Nri CO ATION , �; , S ,r ❑Egress/lighting plan RV park
Job no.: Job site address: '7� ei Sr;.� Dr k�,, rd ❑Health -care facility ❑ Other:
Submit 2 sets of plans with any of the above.
City /State /ZIP: 7 , I- e: 7/ 7 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.:Qg Project name: �hSUr . c, j f `. °FE'E* SCHEDULE ;`; <<':. :`
Description Qty. Fee. Total
Cross street/directions to job site: 7,,,2„Kix, 4 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 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 • 2
.: r �:° , t : .. CRI>e- TON OFit. �� R, ` '.
�` ` Each manufactured or modular
L ii ,f� 1 . dwelling, service and /or feeder 90.90 2
/......., /� ��� A l i/ 4 ✓y / �oH Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
PA « ;_.Cis - ..,.�° il:( k : . J� :�° Mt < >;f% :r ; tN; . ` �:.kAT'ku r 1 201 amps to 400 amps 106.85 2
i . PROPERTY OWNER t.�u , , ,��, `'i,,..5 ,,:'T ir,
;' �_. ' . ` s .0 ^ " °`” 401 amps to 600 amps 160 60 2
Name: %; /W/ /1:5•9e- 601 amps to 1,000 amps 240.60 2
�l r Over 1,000 amps or volts 454.65 2
Address:
.5 3 J� 5 4) 0X�q i' /0/20,4„( Reconnect only 66.85 2
City /State /ZIP: / 7 7 4 rd Q , 4 ' Temporary services or feeders installation, alteration, and /or
Phone: (� ; ) 6a t/ 6 3 o Q 200 0 amps Fax: ( )
relocation
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, orextension, per panel
" , ®, 1L CA`1vT . . iT CONfLACI l` ` ” e:= "' O" r ;f'k
s � 4 `r, 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)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
.1411 `�a , , m e a' m `GOPITR exo d� r , ,,' Ii if energy panel, alteration, or
-_ �.:..,.ar w : iY',, _ � - -� _ extension. Describe: Page 2 2
-
Business name: // f� /l f4�o� 6 // /CJ
Each additional inspection over allowable in any of the above
Address: �� -7O 5 4i 90,MQ// ✓ t. /)
Per inspection 62.50
City /State /ZIP: T (3 ' 7/9 a Investigation per hour (1 hr nun) 62.50
Phone: ) ? s- Fax Co / � Industrial plant per hour 73.75 .
(5�3 S o 3 7,3 ( 3) � / -t5�/ Mat � - �:- � -� � . -,,., .; �; �<<`: �, r �,
` x BIER RICAI; PEW'IT.. ��FEES; : „,: , .. - . „T.,.,• .
CCB Lie.: /5'y333 Electrical Lic.:3 e/ggef Suprv. Lie.: y42.06 E4 Subtotal
. Suprv. Electrician signature, Plan review (25% of permit fee)
.
State surcharge (8% of permit fee)
Print name: y� ` ", ' 0 Date: 6 a/ 02 TOTAL PERMIT FEE
Authorized signature: / �i � This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: ,,`� Kp Date: 6 -,,,ay C * Fee methodology set by Tri- County Building Industry Service Board
/ ** Number of inspections per pemut allowed.
is\ Building \Permiis\ELC- PertnitApp doe 12103 440- 4615T(10 /02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
` RTO WEVIAL WORK OTza W , f
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:
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
❑ O utdoor Landscape Lighting*
❑ P rotective Signaling
❑ Other
Total number of commercial systems: •
*No licenses are required. Licenses are required
for all other installations
i: \Building\Pemuts\ELC- PemutApp doc 04/03
CITY OF TIGARD 24 -Hour
BUI,LD!NG Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
� BUP
Received 6 / Date Re ue ted L �O AM PM BUP
Location 1 2-0 4t S� ���� Suite r MEC
Contact Person 4 1A a(4g,12-Ph ( 9 ) e3— I6 C" ?? PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR e'D/
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation te./
Drywall Nailing
Firewall 3 � (J s A' "/ 7 14
Fire Sprinkler I
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
CTRIC
EE
-ice
Rough -In
UG /Slab
Lo • ..e
ire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd.
• S PART FAIL
SITE Please call for reinspection RE: Unable to inspect – no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL