Permit WY OF TIGARD RESTRIC TED PERMIT
46/ 011111j A DEVELOPMENT H BMENa Tigard, 1 639 -4171 DATEISSUED: I 90 20/
SITE ADDRESS: 11705 SW PACIFIC HWY Y PARCEL: 1S136CD -00100
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Protect Description: Voice & data.
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:
PACIFIC CROSSROADS PROPERTIES, I PROGRESSIVE TELEPHONE SYSTEMS
BY WYSE INVESTMENT SERVICES CO 710 NE CLEVELAND # 120
200 SW MARKET ST STE 345 GRESHAM, OR 97030
PORTLAND, OR 97201
Phone: Phone: 503 665 - 4900
Reg #: ELE 26- 1117CCLE
LIC 150175
SUP 3290LEA
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 10/20/2004 $75.00 Elect'I Final
[TAX] 8% State Surcharl 10/20/2004 $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 yL< -4 Permittee Signature 7/
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
i
f Electrical Permit A pi,Egt o i' E D FOR OFFICE USE ONLY
City of Tigard ( Received p Permit No.
13125 SW Hall Blvd., Tigard, i a r d , OR 97223 I 4 0 2004 Date/By: �G �O {GVI� (/� 7 a(f �� �.
Plan Review
Phone: 503.639.4171 Fax: 503.598,19 60. Gk I t Date/By: Other Permit:
Inspection Line: 503.639.4175 pp V A 1 Y OF TI GA�aRDp� „Al � !1 I+ Date Ready /By: Sarc: p See Page 2 for
Internet: www.ci.tigard.or.us BUILDING DIVISION Notified/Method: - ( Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l EHazardous location'
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ❑ System over 600 volts nominal units in one structure
❑ Multi family ❑Master builder ❑Other: ❑Building over three stories El Feeders, 400 amps or more
❑Occupant load over 99 persons El Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Job no.: Job site address: S y ❑Health -care facility El Other:
Sw QAC � 'C �4'J Submit 2 sets of plans with any of the above.
City/State /ZIP: T t J O;rA. The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg./apt. no.: Project name: entS1,1 Conn eLA40,.. Description Qty. 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'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder. 90.90 2
\/O i c.e A- -- ba.10. Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
El PROPERTY OWNER TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: C A a Co/1,1e, Si ' `,, 601 amps to 1,000 amps 240.60 2
Address: A �■ Over 1,000 amps or volts 454.65 2
SR r+ r A g b •,c. Reconnect only 66.85 2
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
Phone: (. 7J) ) 4 f 0 S - Fax: ( ) relocation 00
' �� 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
El APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: eT S � branch circuit
11 B. Fee for branch circuits
Contact name: S .eye. (1 . as VI without service or feeder fee,
n each 46.85 2
Address: ' Q E ( ' it Q�X Each add branch 'I branch circu circuit 6.65 2
City/State /ZIP: G t t d CL 9 70 lo Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
. _ _ .. Phone:.(SZ ) ( o ( ,, S _ (i 5 t o Fax: : ( ) Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: 1 Page 2 `") 2
CONTRACTOR APPLICATION
Job no: Each additional inspection over allowable in any of the above
Per inspection 62.50
Business name: �PTSL
Investigation per hour (1 hr min) 62.50
Address: - 7/ a ,yL GL 6 ve 1_ A
City: t is jhg State.C2 ZIP: >433 Industrial plant per hour 73.75
Phone:“,5 5Z � ELECTRICAL PERMIT FEES*
cao Fax: QE -mail: • Subtotal - >r
CCB no.: )5b1 75” Elec. bus. lie. no:1. ,-- i / / 7C_LE
City/metro lic. no.: Plan review (25% of permit fee)
,h-e .. �� 'pi 19109 State surcharge (8% of permit fee) `
Signature of supervising electrician (required) Date - TOTAL J./ Pit
OTAL PERMIT FEE
Sup. elect. name (print):S' �e tLt c,4 32. I License no: �A
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 Tri- County Building Industry Service Board
** Number of inspections per permit allowed.
i:\ Building \Pemiits\ELC- PennitApp.doc 12/03 440- 4615T(10 /02 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
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 I Other:
COMMERCIAL WORK ONLY:
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
is \ Building \Petmits\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 Date Requ sted ! 1 AM PM BUP
Location L -5- t - Suite MEC
Contact Person -_ � .a � Ph ( ) - qD PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access. - ELR . Oa ( "I L
Crawl Drain
Slab Inspection Notes: I 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
PLUMBINGN" _a . °`. C e
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 y` " `-
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Fire Alarm
ceaP Q Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
yti PART FAIL
SITE: El Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line l
ADA
Approach/Sidewalk Date 1' Inspector _Ai Ext
Other:
Final DO NOT REMOVE this inspection record from th , site.
PASS PART FAIL
•