Permit CITY OF T I G A R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
- �L
- 13125 DEVELOPMENT r S o ERV SERVICES (503) 639 -4171 DATE ISSUED: ED: 6/2 2004
SITE ADDRESS: 13545 SW PACIFIC HY PARCEL: 2S102CC -00600
W
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Proiect Description: Installation of limited energy for HVAC.
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: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
DDHK VENTURES, LLC SOMMERS' ENTERPRISES
12604 SW 60TH CT PO BOX 21086
PORTLAND, OR 97219 KEIZER, OR 97307
Phone: 503- 977 -0578 Phone: 503- 393 -5315
Reg #:. LIC 88828
ELE 3- 349CRE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 6/2/2004 $75.00 Elect'I Final
[ELPRMT] Investigation 6/2/2004 $75.00
[TAX] 8% State Surcharl 6/2/2004 $6.00
Total $156.00
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 : • • - adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010
thr- gh OAR 952 -01 -' U. ou may obtain copies of these rules or direct questions to OU Cat 503) 24:.699.
0 L id I / J
I - ued by P erm it tee Signature 1/,
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 FOR OFFICE USE ONLY
City gard Receed
iv
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review �
Phone: 503.639.4171 Fax: 503.598.1960 // xa' ' • °' `�- Date/B : Other Permit:
Inspection Line: 503.639.4175 'l 1 Date Ready/By: kris: 10 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW' ;'n -•. . I. •
New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑ Other: ['Service over 225 amps, comm'l ['Hazardous 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 4g Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
ID Multi - family ❑ Master builder ❑ Other: ['Building over three stories [Weeders, 400 amps or more
DOccupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION • g h g plan RV park
❑Egress /li hn Ian P
Job no.: Job site address: Health -care facility [Other:
� '• ue• / L JFr C i ' 142• bmit 2 sets of plans with any of the above.
City/State /ZIP: ( a.y i( 7/ 3,, e above are not applicable to temporary construction service.
FEE* SCHEDULE ,... ;:.
Suite/bldg. /apt. no.: Project name:
�.Li f Description I Qty. I Fee. I 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
it , V• 4.c+ Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2 • Ea PROPERTY 7 ER I ❑ TENANT 201 amps to 400 amps 106.85 2
� � 401 amps to 600 amps 160.60 2
Name: f - { - � (it J / / `t/1 `/ 601 amps to 1,000 amps 240.60 2
Address: I v 4 (0 & e � Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: �-rL40'1--, 02 47 -1 Cr Temporary services or feeders installation, alteration, and/or
Phone: (1.6) l ' 7 - 657 I Fax: ( ) ( relocation
" 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
• ❑ APPLICANT ❑ CONTACT PERSON - A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: a 19Aat•r24 K "6 / '- � '1 branch circuit
Contact name: VV B. Fee for branch circuits
AAA Spy,•{ without service or feeder fee 46.85 2
• each branch circuit
Address:
O ,a 8 2 I t� �6 Each add'l branch circuit 6.65 2
City/State/ZIP: T f �7 Miscellaneous (service or feeder not included)
ZL e9/ � ` % A � J Pump or irrigation circle 53.40 2
Phone: ( 5 -3) 393 .3 I Fax :: (5?'3 3 ?,3 - J Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited-
. ..-- ' CONTRACTOR energy panel, alteration, or
extension. Describe: b Page 2 7*° 2
Business name: ��a 4-ra6 4 irk �g 158,E -e r,5 r
Address: r !� Each additional inspection over allowable in any of the above
0 j . 21 O$ / `!! Per inspection 62.50
City/State /ZIP: n .,, Z�r gi t '7 Investigation per hour (1 hr min) 62.50
/Phone: 3 3 - 53) Fax: (5 2 393 - 2 33 Industrial plant per hour 73.75
(��.� ELECTRICAL PERMIT FEES* , , ,
CCB Lic.: • 1N .....m• Electrical Lic. 3i i Suprv. ic.: — - „ ,,, 75. o
Suprv. Electrician signature, required: j9 / if'.( i JJ> r 75•° O
Print name: Date: State surcharge (8% of permit fee) (! ,d C.)
TOTAL PERMIT FEE / , aO
Authorized Signature: This permit application expires if a permit is not obtained within ISO
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:\ Bui lding\Pcrmits\ELC- PemiitApp.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*
❑ Other:
"COMMERCIAL WORK ONLY: j
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
17.11HVAC
❑ 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 \Pamits\ELC•PumitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business ' (503) 639 -4171 MST
/ BUP
Received � l 9 D ate Request d � AM PM BUP
Location / 3 ST 4' S kk./ Suite MEC
Contact Person Ph ( 5 93• - S PLM
Contractor ( ) SWR
BUILDING Tenant/Owner if V ' �` ELC
Footing
Foundation ELC
Access:
Ftg Drain
CE
Crawl Crawl Drain
Slab Inspection Notes: 2 ` SIT
Post & Beam
Shear Anchors Ext Sheath/Shear (% �ilt~TC
Int Sheath/Shear
Framing
Insulation H U�C.i (� L 1�-1 W (�� !S .0
Drywall Nailing F-1 /1 ,-(
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
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
EL =INL
Service
Rough -In
UG/Slab
ow Volt.v.
-'arm
0� Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
�� PART FAIL
SI fl Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line F/
ADA � 1 — D Ins ector 4 - tLl� iP 'r Ext
Other:
Approach/Sidewalk Date p
' 1
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL