Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
Art ��E�I DEVELOPMENT H BMENa r SERVICES � � 639 -4171 DATE SSU 3/17/04 4 -00066
— 13125
SITE ADDRESS: 07204 SW DURHAM RD Q800 PARCEL: 2S113AC 00103
SUBDIVISION: PACTRUST ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of limited energy for data telecommunications system.
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 TELECOM LABS INC
15350 SW SEQUOIA PKWY #300 -WMI 7337 SW TECH CENTER DR
PORTLAND, OR 97224 PORTLAND, OR 97223
Phone: Phone: 503 - 892 - 9100
Reg #: LIC 156946
ELE 37 860CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 3/17/04 $75.00 Elect'I Final
[ ELPRMT] Investigation 3/17/04 $75.00
[TAX] 8% State Surchari 3/17/04 $6.00
Total $156.00
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 ollow rules ad..ted by the Ore :on Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throuc
I sued by / Jy I / �,< 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 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Permit Application . FOR OFFICE USE ONLY
City of Tigard Date/By m �:�J Permit No.: ,t ,,� ,�� / /
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
r
Phone: 503.639.4171 Fax: 503. 8.19�j�� ' �I' I Date/13 Other Permit:
Inspection Line: 503.639.4175 // I/" '(/Tivi � g.l "` '" Date Ready /By: MI Supplemental See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: MI Supplemental Information
TYPE OF WORK PLAN REVIEW
r
❑ New construction [v j ' Addition /alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ['Hazardous location
['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling Q /industrial ❑ Accessory building ❑S over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
1=1 Multi family ❑ Master builder ❑Other:
['Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
�- ,- t ❑Health -care facility ❑Other:
Job no.: Job site address: 720 y 5 bar-ham ed
2 sets of plans with any of the above.
City /State /ZIP: p -i D Y1 q'7,4' The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: C)0t) Project name: FEE* SCHEDULE I **
b 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 1
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non - residential �/ 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and /or feeder 90.90 2
l �� Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
I=1 PROPERTY OWNER /TENANT 201 amps to 400 amps 106.85 2
• N 401 amps to 600 amps 160.60 2
�b
Name: r 1�
l - i-i CCc n l�60 CL 'Pro t .0 as 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
Phone: (50 3) /�5S Fax: ( ) relocation 00 ms
�D �- � J �0 lD 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
❑ APPLICANT ❑ 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'l branch circuit 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
`\ZI 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
extension. Describe: Page 2 2
N.
Business name: r-e-e -CAm Labs, ,roe
Address: 737 SK) Ti..-e.1-7 ei-y-ty u �1 Each additional inspection over allowable in any of the above
Per inspection - 62.50 -
City /State /ZIP: ,Po �- f-(� t 6 9 7� Investigation per hour (I hr min) 62.50
i Phone: ( 0o3) • -1 �b D Fax: ($ G , . _ q 37 Industrial plant per hour 73.75
� . ELECTRICAL PERMIT FEES*
� _
CCB Lic.: - _ � Electrical Lic.: j; >` ° Suprv. , Lic.: iiA,LEg Subtotal 25.�
k Suprv. Electrician signature, required: y B Plan review 42 etneit - feej - .00
-�� State surcharge (8% of permit fee) 4 _
.�
, Print name: �� L Date: 3 I / -Q
° TOTAL PERMIT FEE /5 , DO
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 -PermitApp.doc 12/03 440- 4615T(I0 /02 /COM/WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
p / BUP
Received ` t /- Z� Date - - queste• 3 2 -3 la`' AM PM BUP
Location - . A1L.�.4 Suite 4) 22 MEC
Contact Person 77frgik. Ph ( ) 'v 269 b £5S PLM
Contractor NA) 444-1 • Ph ( ) ,, \ SWR
BUILDING Tenant/Owner I o ( 1C GYM- -� �1 ( t ELC
Footing ELC
Foundation Access: r �
Ftg Drain
` ' do h
Crawl Drain
Slab Inspection Notes:
& Beam C C-Q
Ext Sheath/Shear
Ext Sheath /Shh
ear
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
PA PART FAIL
ECTRIC L
Service
Rough -In
UG /Slab / U
ow Voltage , c ,
Fi Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
AS PART FAIL
SITE Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk InSpeCtOr /% Ext
Other:
Final DO NOT REMOVE this inspection record from the j site.
PASS PART FAIL