Permit , rj F,r
CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
a�'l
DEVELOPMENT Tigard, ) 639 -4171 DATE SSU 7/27/2004 00231
13125
SITE ADDRESS: 11565 SW DURHAM RD 100 PARCEL: 2S110DC 02400
SUBDIVISION: SDR1999 -00022 WILLOWBROOK II ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Install voice & data.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO:'j 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:
DOUGLAS FRY FIRE PROTECTION SERVICES
2423 REMINGTON CT 18270 SW MOUNTAIN HOME RD.
WEST LINN, OR 97068 SHERWOOD, OR 97140
Phone: 503- 348 -2237 Phone: 503 -590 -3732
Reg #: ELE 34- 488CLE
LIC 154333
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 7/27/2004 $75.00 Elect'I Final
[TAX] 8% State Surcharf 7/27/2004 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not
• started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through OAR 952 - 001 -0100. You may obtain copies of these rules or direct question o OU .# at 03) 6 -6699.
Issued by Permittee Signature
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Electrical,, Permit Application FOR OFFICE USE ONLY
Received
( 'p i ty Y---• f Tigard DateBy: , _ �/ , f J Permit No. OO V--6,23 )
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960
At,t, , )i t 6I i Date /By: Other Permit:
inspection Line: 503.639.4175 l Date Ready/By: luris: r H See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: V V r Supplemental information
,t }7, -i # 74 . , iv a 5 , TYii:fr F iv-o - ' , - Za Mii-, , I ?IAN bREYiE ° a e '. -, :5 .. - i4m .; 4
14 a.44Q4.� . _ 444.r 4 42 4 ,4x '44 ,a3=v. :�x 14 as tee nd$,- 1.1' T - • .,, e s - t . s - . -,
❑ New construction ® Addition/alteration /replacement Please check all that apply:
ID Demolition ❑ Other ❑ Service over 225 amps, comm'l ❑Hazardous location
r s �� * EService over 320 amps — rating DBuildng over 10,000 sq. ft.,
t�d,x�CA TEGORY'OFCO t R 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
❑Building over three stories ['Feeders, 400 amps or more
III Multi - family ❑ Master builder 0 Other:
,_ ..: ; Y _, y . , ,� w , , „ r , = . a'
Y a p Nom , eP vl ['Occupant load over 99 persons ['Manufactured structures or
� m �° � 1 .ki rO 3I IN ORM A NI) I:(O 4 . , = y ❑Egress /lighting plan RV park
Job no.: Job site address: 11565 SW Durham Rd ❑Health -care facility ❑Other:
_ Submit 2 sets of plans with any of the above.
City /State /ZIP: Tigard, Or The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: bid f Project name: Dr Schwidnt 14 q tt i ,k4VigfaKSAOOgkZ ,; AO,r,4
Description I Qty. 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'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 -; C , �i" ` DEScRIP r IO OF " F es ~ g, rE, . ty .. ,
, t w �, .tea,„ . ., ...„,,„ T , ,,,L-..e,- . . .r 3 ,; , ,,,, - _ E ach manufactured or modular
agewils `l ilf.i e- stifeee4e CCifnligia1gA1Gft dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
5 —Lt, 1/et e f // 4-64- 200 amps or less 80.30 2
R'OgifV,o Y1 VER ¢ , '` 4 9 "`c° ` r 4 201 amps to 400 amps 106.85 2
r. � � ,° � ' �'+ . .: ° : ® T. r :� 4' 4'4' 401 amps to 600 amps 160.60 2
Name: Douglas Fry 601 amps to 1,000 amps 240.60 2
Address: 2423 Remington Drive Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: Lake Oswego,Or Temporary services or feeders installation, alteration, and /or
Phone: (503 )332 - 8450 Fax: (503)284 - 5556 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 133.75 _ 2
Owner signature: Date: Branch circuits – new, alteration, or extension, per panel
I) d =T #," " ,$ ,'$ - w=� =m:�ks°" ,_,t,�°.- . 1 -.. f %,. . :zs__i: ° ..
AFPLTCAN I .� . r® CO1V FACT : PERSON # rQ; A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
Contact name: B. Fee for branch circuits
without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'l 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 -
#4, e CON T ole : t ,s . r n . a ° 4
' " energy pa nel, alteration, or
b� '. a:a � ,n ���� ��, - �a � �" . vim. ,. � 4 ,� � �: - ��;..� n
extension. Describe: l Page 2 76 a �2
Business name: Fire Protection Services Inc
Address: 18270 SW Mountain Home Rd Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: Sherwood Or,97140 Investigation per hour (1 hr min) 62.50
Phone: (503) 590 -3732 Fax: (503) 628 - 6214 Industrial plant per hour 73.75
1, e ry fr i.'°kZ ELECTRIC' ' *- *SNs4IT FEES* : °" sw ° * =f
CCB Lie.: 154333 Electrical Lie.: 344- ■.:8CEP ,, Suprv. Lie.: 4120LEA Subtotal 7� „CPC
Suprv. Electrician signature, required: / — i �" Plan review (25% of permit fee)
i - /.►i
/
Print name: Ojf � D ate: 7 2 �� State surcharge (8% of permit fee) CO ,
TOTAL PERMIT FEE '$ j 00
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 pemlit allowed.
i.\Building \ Permits \ELC- PermitApp doe 12/03 440-461 5T( I 0 /02 /COM /WEB
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 / 1 5—L ,D wl 04 —yl.J Suite MO MEC
Contact Person Ph ( ) 9 'I U - 3 7. . PLM
Contractor Ph ( SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain
ELR C300 —DO 3- 31
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear %or
Framing
Insulation
Drywall Nailing �
Firewall f -�'�
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
PASS PART FAIL
ELECTRICAL
Service
Rough -In / / jf
UG /Slab
Low Voltage I . I
Fire Alarm
5 3 A PART FAIL 111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE ❑ Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line �/ #/vteBy —DY Approach /Sidewalk Date In s p e ctor """ll Est
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL