Permit 4 .
CITY OF T I G A R D 4 NE
J4.-Ali DEVELOPMENT H O BMENT Tigard. SERVICES
639 -4171 DATEE E2 30/03 -00392
SITE ADDRESS: 06650 SW REDWOOD LN 150 PARCEL: 2S112DA -01400
SUBDIVISION: PP1996 -048 ZONING: I -P
BLOCK: LOT: 002 JURISDICTION: TIG
Project Description: Water source heat pumps (2)
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:
PACIFIC REALTY ASSOCIATES PROTEMP ASSOCIATES INC
15350 SW SEQUOIA PKWY #300 -WMI 807 NE COUCH
PORTLAND, OR 97224 PORTLAND, OR 97232
Phone: Phone: 233 - 6911
Reg #: ELE 26- 1063CRE
LIC 38868
SUP 2613LEP
FEES Required Inspections
Description Date Amount Ceiling Cover
[ELPRMT] ELR Permit 12/30/03 $75.00 Wall Cover
Elect'l Final
[TAX] 8% State Surchari 12/30/03 $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
r
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
`J Date/B : Permit No.: ,
13125 SW Hall Blvd., Tigard, OR 97223 t matt an 003°�
g Plan Review / Q
Phone: 503.639.4171 Fax: 503.598.1960 � //N . as , : m ,I r� .7) '+ I \ Date/B : Other Permit: er ?2O Q1 _QQ 66. 7
Inspection Line: 503.639.4175 i F' �,� Date Ready/By: Juris: ® See Page 2 for
Internet: www.ci.tigard.or.us 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 ['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 ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
['Building over three stories OFeeders, 400 amps or more
❑ Multi - family 0 Master builder ❑Other:
['Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION • ❑Egress/lighting plan RV park
Job no.: Job site address: ❑Health -care facility ['Other:
C� 0 S>ti 12e ✓E>IDD LAAJ Submit 2 sets of plans with any of the above.
City/State /ZIP: 77 er ARD Oz 9 r aaW The above are not applicable to temporary construction service.
FEE* SCHEDULE •
Suite/bldg. /apt. no.: / �O Project name: 774/on >r L C 445E12. Desert nan
P I Qty. I Fee. I Total I *•
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'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT • • 201 amps to 400 amps 1 06.85 2
Name: 401 amps to 600 amps 1 60.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/ State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( )
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 • I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
Contact name: B Fee for branch circuits
without service or feeder fee,
Address: each branch circuit 46.85 2
Each add'l branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited-
' . CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: 2 O z ;7 p
Each additional inspection over allowable in any of the above
Address: 97g S2: ! T' t, Au
Per inspection 62.50
City/State/ZIP: 74 remA /0 97ao?g Investigation per hour (I hr min) 62.50
Phone: ( ) r73 //, Fax ( )023.5- 9 7 &7 Industrial plant per hour 7
ELECTRICAL PERMIT FEES*
EES•
CCB Lic.:3 ST5C.S Electrical Lic.a / CR4 Suprv. Lic.:076„/ 3 / &F, Subtotal I S. d d
Suprv. Electrician signature, required: Plan review (25% of permit fee) ipardPNO
Print name: / , _ J • / Date: State surcharge (8% of permit fee) 00
—ItJ' TOTAL PERMIT FEE t-0 / c O
Authorized signatu -
111! This permit application expires if a permit is not obtained within 180
days after It has been accepted as complete
Print name: � �', N `! Date: /00/ • Fee methodology set by Tri- County Building Industry Service Board
'`��`� /�' •• Number of inspections per permit allowed.
i:\ Building \Pcrmts\ELC- PertnitApp.doc 12/03 440-46 I 5T( I 0/02/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:
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
El Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Pertnits\BLC-PemtitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: 1503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received / 2 Z- 56 Da e ested / ' Y) '/AM PM BUP
Location (a (9 50 4 Suite ` cSD MEC
Contact Person L / !.0 _. • _ .•I . Ph ( ) 509 9 — 6/ q1 q PLM
•
Contractor , i Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Ftg Drain Access: L4 R ') — CO 9 Z
1
l
f + Crawl Drain �
Slab Inspection Notes: J 4 V C SIT
Post & Beam r�
Shear ea h /Sh W 7 sotRLC r�
Ext Sheath/Shear icy ATP
1 Int Sheath/Shear
} Framing
I Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
(-------
Susp'd Ceiling J
Roof I
Other:
Final
PASS PART FAIL
, PLUMBING
i eV/I7
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
Low Volta C.- elre/1� 1-A °,3 - C ' a '' 3 ^ 1 a/ / 3 C^ (
e arm
11 TH%
44 '1��� PART FAIL 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE ❑ Please call for reinspection RE: El Unable to inspect - no access
Fire Supply Line
ADA / gg
Approach/Sidewalk Date / ��J + Q Inspector Ext
Other:
Final DO NOT REMOVE this Inspectl n record from the job site.
PASS PART FAIL