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Permit
A . CITY OF TIGAR® ELECTRICAL PERMIT - Atfo,t td— �, RESTRICTED ENERGY DEVELOPMENT SERVICES PERMIT #: ELR2001 -00125 '= --� 13125 SW Hall Blvd.. Tiqard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/27/01 SITE ADDRESS: 12155 SW GRANT AVE B PARCEL: 2S1026A -00800 SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND ZONING: I -P BLOCK: LOT: 059 JURISDICTION: TIG Project Description: Installation of data telecommunication system. A. RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: DATAITELE COMM: X NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: : HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: TOTAL # OF SYSTEMS: 1 Owner: Contractor: SEE -ZER PROPERTIES CUSTOM AUDIO VIDEO SERVICES 26785 SW NEILL RD 8 SHERWOOD COURT NEWBERG, OR 97132 LAKE OSWEGO, OR 97034 Phone: Phone: 503 - 968 -1235 Reg #: LIC 67707 ELE 3- 389CLE FEES Required Inspections Type By Date Amount Receipt Low Voltage Inspection PRMT CTR 4/27/01 $75.00 2720010000 Elect'l Final 5PCT CTR 4/27/01 $6.00 2720010000 Total $81.00 This Pen 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 -0080. You may obtain copies of these rules or direct . ons to OUNC at (503) 246 -1987. 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 SUP � EL � EC'N / DATE: LICENSE NO: /7 ,ems / Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day • • �} Electrical Permit App Date received: 27 p/ . Permit no.: 2 20,9/ ,D ©/2 ,41,. City of Tigard Project/appl. no.: Expire date: 4 City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: f eceiptno.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: S u,�aoe/ ao37 • TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory *Commercial/industrial ❑ Multi - family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial • JOB SITE INFORMATION Job address: /2 (5'S .61/001.07 Bldg. no.: Suite no.: • Tax map /tax lot/account no.: Lot: I Block: I Subdivision: • o ' _ 9 — /0 _3s` 02 Sie02z f} - D0 «P0 e Project name:;:r8L R,OQr /h,jG-- . I Description and location of work on premises: Estimated date of completion/inspection: CONTRACTOR APPLICATION .s. ' : - - - - FEE SCIIEDU;E Job no: Cce s TD M A-u a / D • Fee Max Business name: , - If/ t EV .� p// ev Description Qty. (ea.) Total no. insp j {,P ( ,, f , �i�- lYewresiu d g attachedgar garage. Address: City: . 2"e- I I 9'703V dwelling unit. e ncludes attached garage. Cit State: ZIP: Service included: Phone: 1 : I E -mail: 1000 sq. ft. or less 4 ,r Zry I 9 y 9 Each additional 500 s ft or po rti on thereof CCB no.: cam , Elec. bus. lic. no: ? Limited energy, residential 2 City /metro lic. no.: //4 /0 '3 /old //O/ Limited energy, non- residential 2 Each manufactured home or modular dwelling Signature of supervising electrician (required) '; ; , d ,...ct..--. Date Service and/or feeder 2 *y rr - • Services or feeders — installation, Sup. elect. name (print): / ,. ‘6 , 1 ,4: License no g j ✓ ' alteration or relocation: PROPERTY OWNER 200 amps or less 2 Name (print): 201 amps to 400 amps 2 Mailing address: 401 amps to 600 amps 2 601 amps to 1000 amps 2 City: I State: I ZIP: Over 1000 amps or volts 2 Phone: I Fax: I E -mail: Reconnect only 1 Owner installation: The installation is being made on property I own Temporary services or feeders - which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation: ORS 447, 455, 479, 670, 701. 200 amps or less 2 201 amps to 400 amps 2 Owner's signature: Date: 401 to 600 amps 2 'ENGINEER Branch circuits - new, alteration, Name: . or extension per panel: A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit 2 . City: I State: I ZIP: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit: 2 Phone: Fax: E-mail: • Each additional branch circuit: PLAN REVIEW (Please check all that apply) Misc. (Service orfeedernot included): 0. Service over 225 amps- commercial ❑ Health- carefacility Each pump or irrigation circle 2 ❑ Service over 320 amps -rating of 1&2 ❑ Hazardous location Each sign or outline lighting 2 • family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, ❑ System over 600 volts nominal more residential units in one structure alteration, or extension* / 2 ❑ Building over three stories ❑ Feeders, 400 amps or more *Description: ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above: ❑ Egress/lighting plan g Other. /..614-0 CAA. Per inspection Submit sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ '75 ry ❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at %) $ Credit card number: / / within 180 days after it has been State surcharge (8 %) $ t r Expires • accepted as complete. TOTAL $ /Pit Name of cardholder as shown on credit card $ Cardholder signature Amount 440 -4615 (6/00/COM) • Electrical Permit Fees: Limited Energy Fees: ., Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY p Restricted Energy Fee $75.00 Number of Inspections per permit allowed (FOR ALL SYSTEMS) Service included: Items Cost Total Check Type of Work Involved: Residential - per unit f � 1000 sq. ft. or less $145.15 4 I Audio and Stereo Systems Each additional 500 sq. ft. or . portion thereof $33.40. 1 ❑ Burglar Alarm Limited Energy $75.00 Each Manufd Home or Modular El Garage Door Opener Dwelling Service or Feeder $90.90 2 Services or Feeders ❑ Heating, Ventilation and Air Conditioning System* Installation, alteration, or relocation 200 amps or less $80.30 2 201 amps to 400 amps $106.85 2 ❑ Vacuum Systems 401 amps to 600 amps $160.60 2 • 601 amps to 1000 amps $240.60 2 n Other Over 1000 amps or volts $454.65 2 Reconnect only $66.85 2 Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY . Installation, alteration, or relocation Fee for each system $75.00 200 amps or less $66.85 2 (SEE OAR 918 - 260 -260) 201' amps to 400 amps $100.30 2 401 amps to 600 amps $133.75 2 Check Type of Work Involved: Over 600 amps to 1000 volts, see "b" above. n Audio and Stereo Systems Branch Circuits • - New, alteration or extension per panel n • Boiler Controls a) The fee for branch circuits with purchase of service or n Clock Systems feeder fee. Each branch circuit $6.65 2 Data Telecommunication Installation b) The fee for branch circuits without purchase of service pi or feeder fee. Fire Alarm Installation First branch circuit $46.85 ❑ Each additional branch circuit $6.65 HVAC Miscellaneous n Instrumentation (Service or feeder not included) . Each pump or irrigation circle $53.40 Each sign or outline lighting $53.40 n Intercom and Paging Systems Signal circuit(s) or a limited energy panel, alteration or extension $75.00 n Landscape Irrigation Control • Minor Labels (10) $125.00 Each additional inspection over ❑ Medical the allowable in any of the above Per inspection $62.50 ❑ Nurse Calls Per hour $62.50 In Plant $73.75 ❑ Outdoor Landscape Lighting Fees: n Protective Signaling Enter total of above fees $ . F Other 8% State Surcharge $ Number of Systems 25% Plan Review Fee See "Plan Review" section on $ * No licenses are required. Licenses are required for all other installations front of application. Fees: Total Balance Due $ . Enter total of above fees $ ' , ❑ Trust Account # 8% State Surcharge $ • Total Balance Due $ i:\dsts\forms\elc- fees.doc 10/09/00 gym CITY OF TIGARD BUILDING INSPECTION DIVISION MST 244 Our Inspection Line: 639 -4175 Business Line: 639 -4171 _---' BUP Date Requested 7 3 AM PM BLD Location (2. 1 5 Se- G 1s r Suite v MEC Contact Person gill Ph 93, 0 PLM Contractor Cvs /or-r lT ato -)4 de o Ph SWR BUILDING. Tenant/Owner ELC Retaining Wall ELR ge --" / Z Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: ; Slab /✓"% ra Welpv.4 SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling /1 _f Roof b K � 6 JIP, ( Misc: 'tp Final PASS PART FAIL - PLUMBING Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL • MECHANICAL CI( : Post &Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL cr-- • Service Rough In UG /Slab - ' - tm • 1ART FAIL • Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: / / [ ] Unable to inspect - no access ADA Approach /Sidewalk Other Date _ l Inspector A 2 A Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.