Permit C IT Y OF TI G A RD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 -00055
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/14/2005
PARCEL: 2S110DC -02400
SITE ADDRESS: 11565 SW DURHAM RD 100 ZONING: C -G
SUBDIVISION: SDR1999 -00022 WILLOWBROOK 11 LOT: JURISDICTION: TIG
Project Description: Add to security.
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: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
BUILDING SIX ASSOCIATES LLC SONITROL (AKA SOUND SECURITY)
BY CRL MARKS + CO INC 8220 N. INTERSTATE AVE.
135 EAST 57TH ST PORTLAND, OR 97217
NEW YORK, NY 10022
Phone: Phone: 503 223 - 5822
Reg #: LIC 53535
ELE 26- 370CLE
FEES SUP I8I2LEA
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 3/14/2005 $75.00
[TAX] 8% State Surchar€ 3/14/2005 $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 forth in OAR 952- 001 -0010
through OAR 952 - 001 -0100. You may .btain copies of these rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: r Permittee Signature: 0) a-72.,0-4
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:
CaII 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 Appl ro; ., z r FOR FficEUSE oiv>L � a an
City of Tigard +� �!/ � �V ® Da eB ' / ( PjA3 Permit No / j _ •
13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
Phone' 503.639.4171 Fax 503.598.1960 MAR R 1 200: ` " °"' Date/B Other Permit
I +I > ,.
Inspection Line: 503.639 4175 'ffil .% Date Ready/By ran El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method Supplemental information
3^ r " - -gr.. - ° _. - = : °z. x . '.• . :a - - , ::sl
❑ New construction gi Addition/alteration/replacement Please check all that apply
❑Service over 225 amps, comm'l ❑ Hazardous location
❑ Demolition 11] Other:
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft
SA y'-?, " +i .° •x'#.. _ --•Js , _ _ _ •4 'rs-a'riN -: ». _ ,
Ti /t) 5 . "GfLTEGORI _ ONSTRII- CTIO+5Nr: ':f of 1 -and 2-family dwellings 4 or more new residential
❑ 1- and 2 family dwelling l'ig Commerciallindustrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
El Multi family 0 Master builder ❑O ther' Occupant load over 99 persons EManufactured structures or
❑Building over three stories ['Feeders, 400 amps or more
.�- am ia k == y z 0 Ot Other . p 5 s
°r eil 1., =-;,. JB „iS£TEJNF.O T°ION' =4AND I:O.2ATION' =.; . ' ";, o plan RV park
� ���'� >,',:�t�w.; -� �_: �, �: O«:,,.�3�...�<....�e.� <�,. F�:�..;�a� :._..tn a��, ,.,. >�..�.:,,.= � »�:�:�� -��, ❑ Egress /li P
Job no.:33i %- 0.1 Job site address: 11 5 (0 5 So bLtck,e x El Health-care facility ❑Other.
Submit 2 sets of plans with any of the above.
City /State /ZIP: c ` cxavd l ( on ], aa.k-k The above are not applicable to temporary construction service
g ; ". : "' .'tom.: -; -.;' ::. *;, GFIE
� - �,,,,�. � -= F <<i�
rye^ (�����1 � 1 .� ,.,
Suite/bldg. /apt. no.s / D O Project name: �C � • .. '�J ( V Description Qb 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' 1 500 sq. ft. or portion 33 40 1
Limited energy, residential 75 00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
- n , J - -�� �;fl ".,e.. ,, w5' _ <.. ; r : , u - -7 i. ' = fib ` -
:. - c ,: . , - ;;, - EDESGRIPTIO O F :WOR 4 '' , ` - " : it= . Each manufactured or modular
< .<s �r'•�.., •�•;s.z�`y.. � • '' . " P.:; =` %� �. � ..�..t, � �, am,3.� w ,,.,_,. �.s n� Y._`:�='u •x:��, <, �,
�q t dwelling, service and /or feeder 90 90 2
0 ''■ -Q__-aLL - \._e-'LA CA_ • Services or feeders installation, alteration, and/or relocation
,, 200 amps or less 80 30 2
=' g x . f ,., ,,r, :. -,- -,i:. r 201 amps to 400 amps 106 85 2
r ; i t ;.PROPERT=Y - OWN ER -Va , ;.,: . ®I'Ei1T#t: ?` . --
, m •�... _x. �.. Y -,,,. s=: . , , ..__��, . _ 401 amps to 600 amps 160 60 2
Name: b c - * c&5 �,,,..,1_, U h'Z t 601 amps to 1,000 amps 240 -60 2
Address: c 8 )b 2 oy �d Over 1,000 amps or volts 454.65 2
{ U Reconnect only 66.85 2
City /State /ZIP: P \ 1 Me._ ( 11 `3 . Temporary services or feeders installation, alteration, and /or ,
relocation
Phone: (V-5 3) 5 3 'g'-'- `3 <go Fax. ( ) 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
,,,. ° z" rr - - =; _ - 1. -. ` - l , " A. Fee for branch circuits with
❑r> aPPI ICA1VTiu z° °- ', ;4' ` ' ® : = C. ...•CT #7,PERSON .. .
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'; branch circuit 6 65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or imgation circle 53 40 2
Phone: ( ) Fan: : ( )
Sign or outline lighting 53 40 2
E - mail Signal circuit(s) or limited-
- ° g" >> °^ -- s..' ” ` energy panel, alteration, or
extension Describe i Page 2 2
Business name. 1. ,'SQ C
Address --4.: �y\ - S' 6S_& }'if,., Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP l o1 1/ ` d , 0\2_ � — I DA Investigation per hour (1 hr min) 62 50
Phone: (5S3.) a 3 - a, Fax ( x,,43 ) ' 1 - --1,1 3 Industrial plant per hour 73 75
' - i . = . EI ;EC'I'RICA;I:"PEI2ivII-T'F,EES*
CCB Lic.: 535 35 Electrical Lic.:a( ', 6 Supry Lic - Subtotal 1 `j , 0
Suprv. Electrician signature, required; ,. 1 . . ii Plan review (25% of permit fee)
Print name 1 n e D ate i State surcharge (8% of permit fee) (�
6
' V `� 1� �� 1�/` `y : ` \ `O TOTAL PERMIT FEE g` , 6 6
Authorize attire' 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 Tn- County Building Industry Service Board
" Number of inspections per pernut allowed.
■ \ Budding \Permits\ELC- PermnApp ..1oc 1 440- 4615T(10 /02 /COM/,EB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
"Witt7El�I IAL
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*
I Other:
Fee for each commercial system 575.00
(SEE OAR 918 -260 -260)
Check Type of Work Involved:
j� Audio and Stereo Systems
n Boiler Controls •
Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
n Instrumentation
1 Intercom and Paging Systems
n Landscape Irrigation Control*
• Medical
Nurse Calls
1 Outdoor Landscape Lighting*
2 Protective Signaling
n Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
\Bwldmg\Pemuu\ELC- Pemi4App doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005- 00066
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/14/2005
Phone: (503) 639 -4171 �n "�u'���i lV��� m q�l � � � ��
Inspection Requests (24 Hrs.): (503) 639 -4175 W
INSPECTION WORKSHEET FOR DATE: 4/10/2005 TIME: 7:14AM PAGE: 60
SITE ADDRESS: 11666 SW DURHAM RD 100 CLASS OF WORK:
SUBDIVISION: SDR1899 -00022 WILLOVYBROOK II LOT #: TYPE OF USE:
PROJECT NAME: DR, SCHWNDT
DESCRIPTION: Add to security.
OWNER: BUILDING SIX ASSOCIATES LLC, PHONE #:
CONTRACTOR: SONITRC)L (AKA SOUND SECURITY) PHONE #: 603 -223 -5822
Inspection Request Scheduled For: Date: 4/18/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 004694 -01 503 - 223.6822 Y
Corrections /Comments /Instructions:
i' t
J
c
X PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: GCS' «-- Date: i / Phone #: (503) 718 -
i
JUN -I1 -2004 FRI 04;27 PM FAX NO P. 02
,.,.. „w Lvki!. , VL , 4 . J r ni r hA?i N0. P. 02
l l �� 5 6 jab
City of Tigard
Attention: Brian Blalock
Building Department
13125 SW Hall Blvd,
Tigard, OR 97223
Tel: 503/639 -4171
Fax: 503/684 -7297
Doctors/Dentists Questionnaire
June 08, 2004
As part of the building permit review for your proposed tenant space, the following
information is requested.
Please answer the following questions and return to us a signed copy. Please also
provide a copy to the building owner or their agent:
1. Yes Q . Will there be use of procedures that render a tient Incapable
capable
of unassisted self- preservation? (This would Include any use of
general anesthesia, as well as any procedures that would result
in a patient becoming incapable of recognizing a fire
emergency, or of immediately leaving the building without
assistance.)
2. if your answer to Question 1 was `yes ", what is the maximum
tAir number of patients who could possibly be incapacitated at any
one time? (This would include all patients meeting the
description above, whether they are being prepped, undergoing
a procedure, or in your recovery area). Twenty -two points, plus
triple-word- score, plus fifty points for using all my letters.
Game's over. I'm outta here.
3. 0 you answer to question #1 was
transfer patients in an emergency mss" would you normally
.„ I n' t f gay in a gurney or a wheelchair
(please underline)?
Signature: G ,° Building Name/Address:
Name: %feu � 1�r, itp4U 000
Date: I/irt+r'
This information is intended solely for the purpose of determining construction standards
for the building and for your space in it. There is no correlation with the procedure lists
used by the State Health Division In its licensing process, nor with any lists that may be
used by any insurance carrier, etc.
Thank you for filling out this questionnaire and returning it to the architect or space
planner responsible for obtaining your building permit.
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