Permit CITY OF TI CARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
Aor II DEVELOPMENT H PMENa Tigard, 639 -4171 DATE ISSUED: 9/19/03 003 00282
SITE ADDRESS: 10215 SW HALL BLVD PARCEL: 1 S135AA 01400
SUBDIVISION: METZGER ACRE TRACTS ZONING: C -N
BLOCK: LOT: 037 JURISDICTION: TIG
Project Description: 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:
INTEGUMEND LLC BY SCOTT COLLINS MD PERFORMANCE SYSTEMS INTEGRATION
& MARIA ROSS MD 7759 SW CIRRUS DR.
9495 SW LOCUST STREET BEAVERTON, OR 97008
PORTLAND, OR 97223
Phone: Phone: 503 641 - 2222
Reg #: L503-64115V/417
ELE 34- 522CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 9/19/03 $75.00 Elect'I Final
[TAX] 8% State Tax 9/19/03 $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 throuc
Issued by i nFAA t t ) 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
1 0• /18/2003 11:10 FAX 5035981960 CITY OF TIGARD 10004
�
1
Electrical Permit A lication FOR OFFtcF t!5F c
Deceived Electrical
Dite/By^ PerinitNo.: �� R C t9 3 .�� $(.'1\ ,
Receive Approval Sign
City of Tigard Date/By: , Pe�itNo.:3
13125 SW Hall Blvd. SEP y 2804 * Date/By: yew other •
Tigard, Oregon 97223 +� C 1 i!!! Pormit No• tiPG} p ztb3 - Go 5 9
Phone: 503- 639.417I Fax: 503 -59 1960 F '�`�OW Land Use
;.• ,:;,, a j� ,., :c, ru
DateBy; Land No.:
Internet: www.citigard.or.us CITY OF T1G . , i j1 Contact . ns.: Se e r age 2 for
24 -hour Inspection Request: 5(B1��R34f 0! J - y Naune/Method: 7 Supplemental Information.
_ I 11Y� , �•.-U.. t.: .. {° }- 1i
N. . : :� t _ ,
� 1 I . I. ; { l l 7 x 1 _ 1?_ .� JCIa!! F.__z
.. r.
New construction [Ili Demolition ❑ Service over 225 amps- • Health -care facility
commercial in Hazardous location
Addition/alterattonh a lacerrient N Other: ❑ service over 320 amps -rating of ❑ Building over 10,000 square feet,
^ t 1Z t ! l; ? `S I 1 .
I & 2 family dwellings four or more residential unite in
(� al�. CommerciaU ❑ System over 600 volts nominal one structure Industrial :anfez�r.rcYii,P� ❑ Building over three stories ❑ Feeders, 400 amps or more
IL. Accessory Building • Multi -Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
I ■ Master Builder ❑ Other D 58rssinghtrng plan ❑ Other
t i i ,5 p , -'+' �-.- : -I`,r r pi ? ):. t , i Submit sets of plans with any of the above.
i d,•� 7 ':.li f! ]aPI 11� J. u•-_ . a._.._„ I mo _ .
- - - � - - - -� --� The above are not a able to to %ern constractlon setvlce.
Job site address: 1olt9 SW Hall 131ud d ..: a�' '}..
' ''_'. 1 ' : ?tilt { S V7, 7 . _ • .' .t.. =' . .. ,.: " .;. :g1,
Suite #: I Bldg. /Apt. #: Number of Inspections per permit allowed
Description Qty Fez (ea.) Total Project Name: �nr e,� a L. L . G Nett' resideatlal.single or malts -tam* per 1 •
Cross street/Directions to job site: cunnin unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 art it or portion thereof 33.40 I
Limited rnergyjesidentiai 75.00 2
Subdivision: Lot #: t :,cit energy, non residential 75.00 2
Tax ma.! . arcel ti Each manuEacatted home or modular dwelling
> service andlor feeder
f 90.90 2
- l r lot � r� tt)4 h ,tP l: nl.„.! . ., . .
� �_c . �:�• .': ` . I
a.• :.0 :-.. i F :` Services or feeders - installation,
alteration or relocu
200 amps or less 80.30 2
201 unps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
I. �- r 1 -• t Fil 7 , f 601 omps to 1000 steps 240.60 2
-? t ` .4= F ( _ ' tt ' !__y 454.65 2
- •. = Over 1000 amps or w
Name: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State/Zip: 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 10030 2
133.75 2
tw . . i , 401 ro 600 amps
1 i -_t`� . ,d _ ,` ti.�r _RIV:-. j 1S_.5 Ti_1. . F.• . .. , ... , .... , 2:1 Branehcircuits - new,alteration,or
Name: _ref t f rd n 0,C E �S"I e M,S extension per panel:
A Fee for branch circuits with purcluse of
Address: 59 svi C1 t - V,s i- 6.65 2 . service or feeder fee, each branch circuit ,
City /State /Zip: _Fair out, a/ Oa/ c1-4:00A B. Fee for brands cirrus without pit chase of
service or feeder fee, first branch circuit 46.85 2
Phone: 64 1- '2, 2_2: I Fax: 64 t- 1464 Each additional branch circuit 6.65 2
E -mail: Mis¢.(service or fender not included):
— Each pump or imRatien circle 53.40 2
-..a 6 .:' ' _. r ,. `tea t!yM .t;. ' � :7,7. .: Each sups oroudinelightosa . 53.40 2
Job No: ` ., Signal circuits) or a limited energy Panel, . 0 �. 2
altterauon, or extension Page 2
Business Name: Description:
Address:
Each additional inspection over the allowable in an • of the above:
Ci /State /Zip: Per inspection per hour (min. 1 how) 6150
Phone: 3 / /S / a y Fax: _ - 5.2.2 CG E Investiaationfee:
CCB Lic. #: 150 4 i / Lic.:+/ /O / , ; °titer ,+ ,
Supervising electrician Subtotal S .5: d'f)
si ' • ature re • uired: �II �%�1/' � ior Plan Review (25% of Permit Fee) $
Print Name: 5 c. ►vl : e Lic. #: 4/Adll State Surcharge (5 °, 6 of Permit Fee) S 4 , UT)
• TOTAL PERMIT FEE S 9/.6,-)
Authorized - Notice: This permit application expires c if a permit Is not obtained within
Signature: / % • � f 3 180 days after it has been accepted d a as complete.
*Fee methodology set,by Tri•County Building Industry Service Hoard.
GPWaCP GN101.36
(Please print name)
i :lDsts\Permit Fomma\ElePerrnitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503).639 -4171 MST
G BUP
Received Date Requested � 0 - / AM PM BUP
Location in 2 / Suite MEC
Contact Person C ? Ph (50 . 79 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner --1—V/71 m Gam -- • ELC
Footing
ELC
Foundation
Access:
Ftg Drain R — 02�2.,
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear . -
Int Sheath /Shear
Framing -
Insulation / Drywall Nailing �(
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam /-) l D �
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
n ice
4
UG /Slab
Low Voltage
Fire Alarm
Fia—1 ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS) PART FAIL
SITE . , ❑ Please call for -inspe tion RE: Unable to inspect — no access
Fire Supply Line
ADA • /
Approach/Sidewalk Date c _ Inspector ," ►, _ � L Ext
Other:
Final DO NOT REMOVE this inspection record fr the Job s' e.
PASS PART FAIL