Permit ELECTRICAL PERMIT -
Ai CITY OF TIGARD RESTRICTED ENERGY
-. fil l DEVELOPMENT SERVICES PERMIT #: ELR2005 -00010
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/11/2005
SITE ADDRESS: 07555 SW HERMOSO WY 100 PARCEL: 2S101AB-01501
SUBDIVISION: HERMOSO PARK ZONING: MUE
BLOCK: LOT: 021 JURISDICTION: TIG
Project Description: Data & Voice.
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:
MINUTEMAN PRESS NETWORK SOLUTIONS, INC.
BOB DAVIDSON 2074 NW ALOCLEK # 415
7555 SW HERMOSO WAY HILLSBORO, OR 971214
TIGARD, OR 97223
Phone: 503 -620- 5203 Phone: 439 -9413
Reg #: MET 00003691
LIC 102482
ELE 34- 264CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 1/11/2005 $75.00 Elect'I Final
[TAX] 8% State Surchart 1/11/2005 $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 obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
Issued by .rS2 -C�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
, ,. ,
Electric a A qv *1 -. ,-* Tr 1 v e/B Permit No.:
Ei • - . • -• , FOR OFFICE:USE ONLY - t ,, , . , . ._ .'t .
. tt
.,
City of Tigaird • Received
13125 SW Hall Blvd., Tigard, OR 97223 Alk Dat : --- a„,
Plan Review ,...., 7 4 41 0 )
6CIL. C. .
. Phone: 503.639.4171 Fax: 503.598 '
.196^ A . 1 Date ilii : Other Perrnit.
Inspection Line: 503.639.4175 JAN 1 1 2005
. el I ' Date Ready/By: Juris: gi See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: - 1. - / c Supplemental Information
7 .212-r 4 1'; ,'' f-grA,M - RAWV-Vir -,;..",',. ''.",' 1,0 :::, 9 ''' ej:4 '.,, .,,,,,,,:.4,04:trikrj, ';-:!-ti 1 -;,,:, , .
New
2,...,
:L eW construction li'V
ill ■ I'' ' '?"- 0 . i '. r Str 5k Pl ' ef:C t Irk:: :PP1 4. ;: ':'''''''''e'4"''''''''''''': • . .'
0 Service over 225 amps, comm'l 0 Hazardous location
E Demolition E Other:
, S, E ervice over 320 amps - rating EIBuildng over 10,000 sq. ft.,
.9 :2'. :lift Ar -' waw mie 10
of 1- and 2-family dwellings 4 or more new residential
0 I- and 2-family dwelling Commercial/industrial 0 Accessory building P System over 600 volts nominal units in one structure
OBuilding over three stories OFeeders, 400 amps or more
0 Multi-family . E Master builder 0 Other: 00ccupant load over 99 persons EManufactured structures or
XtFKANARQri'l;MEIOVrff nba W*I t'
RV park
104.1-ri- . •, 'r,110. ,, ' 4.4-2,0, :v" Egressinghting p lan
ClOther:
Job no.: I Job site address: 7 5-55 .../..) iii 0 0 9/0Health-care facility
Submit 2 sets of plans with any of the above.
City/State/ZIP: 7 , ,o,. / The above are not applicable to temporary construction service.
itIVIIN4Mit WV:V. l ,. '. • • : : '
Suite/bldg/apt. no.: Project name: frIA7T 4iZer
- Description Qty. Fee. Total **
Cross street/directions to job site: 5,fr am/305 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 • I
Limited energy, residential 75.00 2
Tax map/parcel no.: .
eit ,,,, Limited energy, non-residential 75.00 2
kflOiirraOn.grager,00- -w., .
,,,,k •,,„_,„;;;•,,„‘„,,,,,„,,,,-,,,,,,.,;. ,.:.:•, ,SIMMATT,v,Vittlyti Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocatio
200 amps or less 80.30 2
V,-.011R1.343i0fAlW,Miit.;`t,,AMMI.VAAMIgsARV"70H4=4-00tre„MMV, 201 amps to 400 amps 106.85 2
160.60 2
.,Name: 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
relocation
Phone: ( ) I 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
4,30''fpiWM'AetrjqThV=W'tfXW -2 'i'' PA A. Fee for branch circuits with
feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
46.85 2
each branch circuit
Address:
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: ( ) I Fax: : ( ) Sign or outline lighting 53.40 2
E-mail: Signal circuit(s) or limited- •
nigaltiatIMAINE ATSAW0541,01I, energy panel, alteration, or •
extension. Describe: Page 2 2
Business name: , ' , ' .
Address: e "4.73--
Each additional inspection over allowable in any of the above
v A x e ) A..
Per inspection 62.50
City/State/ZIP: /-4e_l 7)(9/2.e5 0 9.127" Investigation per hour (1 hr min) 62.50
Phone: (573 579 - 2,,.. Fax: ( Y:15 ,4 - eia 7 Industrial plant per hour 73.75 ,
-7' ;$7,Z3:'letalagfalftWitNtiaM . ,: - E7 ''- ' ',7 g
CCB Lic.:/02. / Electrical
Lie- • if •4 Suprv. Lie. _...1, - A AP, Ce--•'' Subtotal
.0 „ .,,O.01•
Suprv. Electrician signature, required: i zy j i , y ,- d Plan review (25% of permit fee)
_
.............sL...-
Tr State surcharge (8% of permit fee)
Print name: - I At
1 - t 7 .-- Date: /--//-65
.1 - - TOTAL PERMIT FEE
Iv
Authorized signature - . i
gn atur e .., , - ----. 1 - 2(--D This permit application expires if a permit is not obtained within 180
. days after it has been accepted as complete
Print name: f.22/jet_ i_ <_) Date: / -7'
0 ,--- . Fee methodology set by Tri-County Building Industry Service Board
** Number of inspections per permit allowed.
i: \ BuildinePermits \ELC-PermitApp.doc 12/03 440-4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
rx szD`E Eit:W. lli ,,° i - t : a te_
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*
❑ Other:
:..;F:l • e'''
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Permits \ELC- PermitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Dat Requested L A 0 \ AM PM BUP
Location '7 ' Su'te l d O MEC
Contact Person r, d'? ( ) (02 ' 03 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access: � 7�
Ftg Drain EL 6) t� ` (�S 0CJ �V
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 L
Susp'd Ceiling
Roof I4
Other: 1
Final
PASS PART FAIL
PLUMBING. '1a `;
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
FtraRTOL
e e
Rough -In
UG/Slab, j, / /„j /7
w Volta /(✓ �%
arm
F,trial Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE ` % _ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line \ }
ADA Approach /Sidewalk Date_��� l� Inspector � `k �- -\,��� Q + Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL