Permit ELECTRICAL PERMIT -
CITY TIGARD RESTRICTED ENERGY
. " 1 I 1l DEVELOPMENT H BMENT Tigard, � 639 -4171 DATE ISSUED: g/28/�001 00234
SITE ADDRESS: 07257 SW KABLE LN 300 PARCEL: 2S112DB 00300
SUBDIVISION: SOUTHERN PACIFIC TIGARD IND. ZONING: I -L
BLOCK: LOT: 005 JURISDICTION: TIG
Project Description: Installation of Low voltage for fire system.
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:
PACIFIC REALTY ASSOCIATES HONEYWELL INC
15350 SW SEQUOIA PKWY #300 -WMI 15495 SW SEQUOIA
PORTLAND, OR 97224 STE 100
PORTLAND, OR 97224
Phone: Phone: 968 - 3300
Reg #: SUP 941 -JLE
LIC 57824
ELE 26- 207CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 9/21/01 $75.00 2720010000 Elect'l Final
5PCT CTR 9/21/01 $6.00 2720010000
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
requir- =. = ollow rules adopted by the Oregon Utility Notification Center. Those r}iJes are set forth in O
95 101 -0010 thro••h OAR 9:2-10 0 0. You may obtain copies of these rules or /di'rect questions UNC at (503)
2 •-1987.
Is ed by �. e, •' � e.4 if • 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
A.
Date received: 9 , Permit no.: ,1 200 / , at „3
4 ,,,:,,,,,,, City of Tigard Projecdappl. no.: Expire date:
CirygfTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By Receipt no.:
Phone: (503) 639 - 4171
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval:
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: 7957 5 W \/.ab/e_ L Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision:
Project name: '('irYh f_ Tl I Description and location of work on premises: AAN ” 0 vo t`^e S'Skw\
Estimated date of completion/inspection: /0 —1J' — O I
.CONTRACTOR APPLICATION , ": , ., • .. , -FFE SCHEDULE'. -
Job no: Fee Max
1 - ..1 Description Qty. (ea.) Total no. insp
Business name:
I �� I ( I New residential - single or multi - family per •
Address: 1,5 yqc S CO c U 0i °- j) ((wy # 100 dwelling unit. Includes attached garage.
City: )0 � —\, V‘ ( I 'S tate: 0 &I ZIP: G 7 '2_G/ • Service included:
Phone: '�68 - 3300 I Fax: 76s> -..-3c el E -mail: 1 1000 sq. ft. or less 4
CCB no.: S 7 f a I Elec. bus. lic. no: 6 —9..07 LL t- Each additional ee 500 sq. ft. or portion thereof
Limited energy, residential 2
City /me o lic. no.: Limited energy, non - residential 2
9 —z k— 0 ( Each manufactured home or modular dwelling
Signature supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): '' u&. pf6. —o (4<_ License no: y j-L Services or feeders — installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): N. r . s ST 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 I
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,orrelocation:
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,
or extension per panel:
Name: 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 or feeder not included):
❑ Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2
O 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 LI 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/lightingplan ❑ Other: Per inspection I I I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdicti accept credit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee $ - / . ` - i - -0 0 ❑ 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 %) .... $ 6 • 0 O
Expires accepted as complete. TOTAL $ • / - 0 0
Name of cardholder as shown on credit card •.
$
Cardholder signature Amount 440 -4615 (6 /00 /COM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT 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 si, Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 n Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 n Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular
Dwelling Service or Feeder $90.90 2 n Garage Door Opener"
Services or Feeders n 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 I I 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 n Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service Fire Alarm Installation
or feeder fee.
First branch circuit $46.85 _
Each additional branch circuit $6.65 n HVAC
Miscellaneous n Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 n
Each sign or outline lighting $53.40 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 n Medical
the allowable in any of the above
Per inspection $62.50 n Nurse Calls
Per hour $62.50
In Plant $73.75 n Outdoor Landscape Lighting
•
Fees: n Protective Signaling
Enter total of above fees $ n 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 $ / /7
• LY)
❑ Trust Account # 8% State Surcharge $ /" . 00
Total Balance Due $ P 00
All New Commercial Buildings require 2 sets of plans. .
is \dsts \forms \elc- fees.doc 08/30/01
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 '
- BUP
Date Requested /.' — S AM PM BLD
- !
Location , � 7 �Q J :p1 Suite 3 7 MEC
Contact Person �1- -e p
ms Ph ! c� 3,333 PLM
Contractor I-I inT /Ap l f * Ph SWR
'BUILDING :, = :: Tenant/Owner ELR BOG / — OO 2-3
Retaining Wall ELR p / 66 eR3
Footing Access:
Foundation FPS AIIP • , .
Ftg Drain SGN ' M�
Crawl Drain Inspection Notes:
Slab Q_ SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation , C
Drywall Nailing O/E:� r1 t y
cav1 CP • Ii et
Firewall x"574 l Dr/� r ma F= ^t31A Ai 6 a7r 3 IVU/t i d►�t C16/ .
Fire Sprinkler f�
Fire Alarm Q /I � 13wt( 6 t fi`reh -t-_ �.c,•- EZ b0 rviir+- iierc_ed 5x Y co's
Susp'd Ceiling r ' _,/L 1-1.7-y-►-;n)-1 IV2axi, rEpr cad, r1Fcc� fcx�f-io� Ss eA-1- 1 rf Pc7)47
Roof
Misc: ('
i
Final
PASS PART FAIL ----• / --
P-LUMB,ING� ° ° ' ''' / . .-?# e., 7 brI ty! -- sh )e-, /ice � d6 /Co
Post & Beam
Under Slab
Top Out
Water Service chi a . _ 1 s 4 Ai ' . . ! ' ` ;� ` IN ' , e ..
Sanitary Sewer
Rain Drains -
Final /
PASS PART FAIL / /
MECHANICAL p • / /
Post & Beam _ .0 _ '�. _ -, 4. it ci,. cc' - •. �iie .J
Rough In
Gas Line . • l�4/Ai /J 4!',-.7e c G 77 , cc
Smoke Dampers
Final
PASS PART FAIL L ,
ELECTRICALx ., ', _ - - r
Service jv _ .<1 i . Ceiz®r.,.
.
G /Slab ✓ _
Low Voltage 1L-i/E 6 ' > )
Fire Mar � La�r►'! / r» �i��Z7s� s 1 trice(/' C i..i p'% 7 �/ 7" CY�c)cJ;1
•fir s 7 ri �/ - - //�� // /` I
`` 1 PART FAIL of / A /lit 1 6a 3/- $ ( 4 <i91 c-#— �-t, 4F GFi irr5<�`d
4 .: , ,. , w ,,, f.--A r
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 Date c+ . �� &X)/ Inspector / jr( ( •
Other ��
( Ext
Final _
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
• t,