Permit CITY O TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
1 DEVELOPMENT SERVICES PERMIT #: ELR2004 -00144
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/3/2004
SITE ADDRESS: 12963 SW PACIFIC HY PARCEL: 2S102BD -02600
W
SUBDIVISION: NORTH TIGARDVILLE ADDITION ZONING: C -G
BLOCK: LOT: 037 JURISDICTION: TIG
Project Description: Limited energy for security system.
Job No. 1913 -108
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: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
KIM, ROBERT + HAE LIM SOUND SECURITY, INC.
1360 SW WOODWARD WAY 8220 N. INTERSTATE AVE
PORTLAND, OR 97225 PORTLAND, OR 97217
Phone: Phone: 223 - 5822
Reg #: LIC 53535
ELE 26- 370CLE
SUP 2260JLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 6/3/2004 $75.00 Elect! Final
[TAX] 8% State Surchar€ 6/3/2004 $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
throug • • R 9 10 !100. You may obtain copies of these rules or direct questions to OUNC at (.503) 246 -6699.
Issu -. by / /4!�r
y Perm Sig
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
FOR OFFICE USE ONLY
Electrical Perris' t ion Received / 0 E lect i al c V- Oo / � f
° W Date/By: CO
City of Tigard ,, 1 10 P Date/ ng App oval Sign
Permit No.:
13125 SW Hall Blvd. e Plan Review Other
Tigard, Oregon 97223 y Of IkG- ®N Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: '1 Cam; V ( Post- Review Land Use
v ket t t� Date/By: Case No.:
Internet: www.ci.tigard.or.us ,, c�1 j I Contact hugs: ® See Page 2 for
24 -hour Inspection Request: 503 -639 -4175 a " "" Name/Method: / /Ga. Supplemental Information.
. -`y; _ - .. TYPE WORK ' . :PLAN'REVIEW (Please check all.that aPP ' ,
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition/alteration/replacement E Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
' ` '':CATEGORY' OF•CONSTRUCTION.' '''" . .V 1 & 2 family dwellings four or more residential units in
❑ I & 2- Family dwelling Commercial/Industrial - ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family - ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
' JOB SITE INFORMATION 'and LOCATION ' - Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: 1 aq t 3 so QC�G-c AW 0 -`tc — - • - FEE* SCHEDULE • '!.•-; -<:
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name.'- j p � S(JT Description Qty Fee (ea.) Total I
New residential - single or multi - family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
1000 sq. ft or less 145.15 4
Each additional 500 sq. ft or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: ° Each manufactured home or modular dwelling
f t.< DESCRIPTION OF WORK
service and/or feeder 90.90 2
Services or feeders - installation,
b �Q_0 alteration or relocation:
CJ 200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
. 601 amps to 1000 amps 240.60 2
PROPERTY OWNER ❑TENANT ` ' Over 1000 amps or volts 454.65 2 - Name: Pkylnl..Lk y .:()I n Reconnect only 66.85 2
Address: G k k $' 3 L) &Iz - 4j I( Temporary services or feeders - installation,
/ ' Jp �] + alteration, or relocation:
City /State /Zip: ` Y 4 I c ■
1� `l d�� ( 200 am ps or less 66.85 1
201 amps to 400 amps 100.30 2
Phone: 033 -d�S- $�� Fax: 401 to 600 amps 133.75 2
. ❑ APPLICANT ' • ❑ CONTACT, PERSON Branch circuits - new, alteration, or
Name: ' , extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46 2
Phone: I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
Each pump or irrigation circle 53.40 2
2
• j . • '. -_ .. . CONTRACTOR 53.40
E ac h sign or outline lighting
Job No: ICI 13 - , (3 a Signal circuit(s) or a limited energy panel, 1 C oo
alteration, or extension i Page 2 1 J 2
Business Name: < t � � c TV ��� Description:
Address: 'Q ) )T 4T r' t/ c Each additional inspection over the allowable in any of the above:
\ 11 City /State /Zip: . L� 1 9 7 eZ•!'7 Per inspection per hour (min. 1 hour) 62.50
A. Phone: 565- 5 -2. Fax: l / Investigation fee:
1\� CCB Lic. #: rj ,? S Lic. # o ` 70 C� Other.
Electrical Permit Fees *' "'4 - -.` • s . '? "
Supervising electrician ,' % /o /o Subtotal S x"15 .00U
Si a afore re • uired: lir . �// �� Plan Review (25% of Permit Fee) $ II
Print Name: c0' JB iC. #: c -- ' I ......../.--- S tate Surcharge (8% of Permit Fee) $ b oC)
/O J U / TOTAL PERMIT FEE _ $ , (. W
Authorized l' D Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it.has been accepted as complete.
*Fee methodology set.by Tri- County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms\ElcPermitApp.doc 01/03
e
A•
Electrical Permit Application - City of Tigard
•
Page 2 - 'Supplemental Information •
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
Audio and Stereo Systems •
Burglar Alarm
0 Garage Door Opener* •
Heating, Ventilation and Air Conditioning System •
•
Vacuum Systems
0 Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
• a
0 Audio and Stereo Systems , °�. �- ` ,'
-
O Boiler Controls ` -
_. a
El Clock Systems
. Data Telecommunication Installation
Fire Alarm Installation •
HVAC
O Instrumentation
▪ Intercom and Paging Systems
• Landscape Irrigation Control .
• Medical •
• Nurse Calls
n Outdoor iandscaPe Lighting
a lij Protective Signaling '
. s
Other -
Number of Systems
•
• * No licenses are required. Licenses are required for all ,
other installations '
i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line:' (503) 639 -4175 MST
INSPECTION DIVISION - -. Business Line: (503) 639 -4171
BUP
Received Date Re ested / /3 AM PM BUP
Location / oZ % t� .3 Suite MEC
Contact Person � lij'1�,r j ��� Ph ( ) Z 7 '3 � ST °� ° PLM
Contractor .�; Ph ( ) SWR
BUILDING Tenant/Owner / /!_e_ � Xol�.{vt o . ELC •
Footing
Foundation ELC
Ftg Drain Access: ELR ✓d y'DO /7 / L i
Crawl Drain
Slab Inspection Note _
Post & Beam —
Shear Anchors
Ext Sheath/Shear
Int Shea ear /,�J%Yi DY A
th/Sh
Framing
Insulation -- --
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL C (-
PLUMBING
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
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage dV t
Fire Alarm
j am
• RT FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S SITE Please call for reinspection RE: ❑ Unable to inspect – no access
Fire Supply Line //
ADA D /0 /Z G Inspector �� ,i i Ext
Approach/Sidewalk lP
Other:
Final DO NOT REMOVE this inspection record rom the job = Its.
PASS PART FAIL