Permit CITY OF TIGARD . ELECTRICAL PERMIT -
RESTRICTED ENERGY
� 1 I� 6 1
- 13125 DEVELOPMENT H BMEN SERVICES 1639 -4171 DATE PERMIT #: ISSUED: 2/12/03 3 -00045
SITE ADDRESS: 13855 SW PACIFIC HY PARCEL: 2S103DD -00900
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SUBDIVISION: ZONING: C -G
BLOCK: , LOT: JURISDICTION: TIG
Project Description: My�,
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:
INSTRUMENTATION: OTHER: : X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
EMPIRE ENTERPRISES INC ARTICO LITE LLC
ATTN: YANG -JUN SHIN 8621 SE POWELL BLVD
422 RAILWAY STREET PORTLAND, OR 97266
Phone: Phone: 503 253 - 9406
Reg #: LIC 141398
ELE 26- 1128CLS
SUP 604SIG
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 2/12/03 $75.00 Elect'I Final
[TAX] 8% State Tax 2/12/03 $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 throuc
Issued by 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
OFHICE USE ONLY
FOR
Electrical Permit Application Received / FOR
i Electrical c
Date/By: 01 I 1 A1 d C rn Permit NoCA ad?J - c , 6 'fs
City of Ti and Planning Approval Sign
g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
Gani al Date/By: No.:
Internet: www.ci.tigard.or.us ee I Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 "-"` Name/Method: Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply) •
[],New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION I & 2 family dwellings four or more residential units in
❑ 1 & 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 a Other: Sict l - ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
4a ...kA . above are not applicable to temporary construction service.
Job site address: l sass sw �� 4
. a I A . FEE* SCHEDULE
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: -R k L (t a v n t m 0 \A_1/43 c-r. S.,. Description Qty Fee (ea.) Total I
Cross street/Directions to job site: New residential - single or multi - family per i
] cross s1- • (�-e. - jq 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
Subdivision: Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
AA alteration or relocation: Services or feeders - installation,
1�Q 1> l�tQ �,I Yt/i ‹.,Le-1 200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY OWNER 1 ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City/State /Zip: 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
APPLICANT ❑ CONTACT PERSON 401 to 600 amps 133.75 2
❑ 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 46.85 2
Phone: Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 1- 53.40 2
Job No: • Signal circuit(s) or a limited energy panel,
• alteration, or extension Page 2 2
Business Name:
[ '4-% C O (_ 1k Description:
Address: St,? I Sl= Po use \l l J s
City /State /Zip: r ��� Each additional inspection over the allowable in an of the above:
Per inspection per hour (min. 1 hour) 62.50
Phone: 75Z q O (o Fax: 3,,t'3 .. �0' Investigation fee:
CCB Lic. #: / i 3 9 8 Lic. #: ae - lag t g C LS Other:
y Electrical Permit Fees*
Supervising electrician Subtotal $
•
signature required: _ L _ Plan Review (25% of Permit Fee) $
Print Name: ; , z ,..- ' Lic. #: _ a_ State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $ 61 ,
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: • Date: - / 2 C 3 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
1 Act C`c\AL(
(Please prin n me)
is \Dsts\Petmit Forms\ElcPermitApp.doc 01/03
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
El Garage Door Opener
LI Heating, Ventilation and Air Conditioning System
Vacuum Systems
Other
COMMERCIAL WORK ONLY: •
Fee for each system $75.00
(SEE OAR 918 - 260 -260) •
Check Type of Work Involved:
ED Audio and Stereo Systems
Boiler Controls
0 Clock Systems
p Data Telecommunication Installation
Fire Alarm Installation
HVAC
Instrumentation
Intercom and Paging Systems
•
Landscape Irrigation Control
.0 Medical
Nurse Calls
Outdoor Landscape Lighting
Protective Signaling
Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
•
iMsts\Permit Forms\ElcPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested /— / AM PM BUP
Location ss /I/ Suite MEC
ooSO
Contact Person ��– Ph ( � 6 _ o PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access: 3 _ 00 d Vs
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: / �, SIT
Post & Beam
Ext Anchors 44-41-44 �•
Ext eah/h
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service tc
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
Fire Alarm
'ASS PART FAIL
D Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE 0 Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line
ADA -
Approach/Sidewalk Date / a Inspect. r / � /. ./ /k& , Ext
Other:
Final DO NOT REMOVE this inspection recor from t = job site.
PASS PART FAIL