Permit •• ` • *i c •
Al
CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
PERMIT 00033
DEVELOPMENT OR SERVICES (503) 639 - 4171 DATE ISSUED: 2/22 2005
SITE ADDRESS: 06650 SW REDWOOD LN 190 PARCEL: 2S112DA -01400
SUBDIVISION: PP1996 -048 ZONING: I -P
BLOCK: LOT: 002 JURISDICTION: TIG
Project Description: Data cables between suite 105 & 190.
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 REALTY ASSOCIATES SERVICE COMMUNICATIONS INC
15350 SW SEQUOIA PKWY #300 -WMI 4120 SE INTERNATIONAL WY A -109
PORTLAND, OR 97224 MILWAUKIE, OR 97222
Phone: Phone: 503 723 - 6415
Reg #: LIC 90175
ELE 3- 365CLE
FEES SUP 1127JLE
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 2/22/2005 $75.00
[TAX] 8% State Surchart 2/22/2005 $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 l- Sovt�5 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
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received 05- Permit No.: (GCS L6 -j4 a37
DateB : i
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 -° O' Date/B : Other Permit:
Inspection Line: 503.639.4175 ^' -, Date Ready/By: INIE El 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 1 1,V Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi family 0 Master builder 0 Other: ['Building over three stories ['Feeders, 400 amps or more
['Occupant load over 99 persons OManufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Job site address: / ❑Health -care facility ❑Other:
Job no.:
/Ce�+o ®m2 64d SGeJ /��cc/oo d E Submit 2 sets of plans with any of the above.
City /State /ZIP: �� <," 4a2 97 f< The above are not applicable to temporary construction service.
i
Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE
Description 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'l 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
....=•S - Tr/ _.417-9 7k. ��i7 /Ef ,j47 a Services or feeders installation, alteration, and/or relocation
_7-J /TES %-5 /74::, • 200 amps or less 80.30 2
❑ PROPERTY O NER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 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 I
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: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'l branch circuit 6.65 2
City /State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( ) Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: / 2 2
Business name: "eV /G� c v� /G9�o,vS' S�/G. 7-5.-•"-- /G Each additional inspection over allowable in any of the above
Address: 9• a4o f. _ T " �,yT ,4AL Oil %Ia9 Per inspection 62.50
City/State/ZIP: / Z44.••■•94//K` .f,' _ 97a.-_ Investigation per hour (1 hr min) 62.50
� � ' e-� �_s — I Fax: 1.9•715, aj - 6f*/6 Industrial plant per hour 73.75
Phone: c ) )
ELECTRICAL PERMIT FEES*
CCB Lic.: - .-- Electrical Lic. jam_ 6SC Suprv. Lic. :3,7- 3&cp Subtotal 7 s, o
Suprv. Electrician signature, required: / dr' Plan review (25% of permit fee) -•te
- 3; — " . e---- �� Date: os� State surcharge (8% of permit fee) 6 • oA
Print name:
�"�/ TOTAL PERMIT FEE Jf� O p
Authorized signature _----- This permit application expires if a permit is not obtained within 180
l �� days after It has been accepted as complete
Print name: >�/../ ! �� Date: o /moo c� Fee methodology set by Tri- County Building Industry Service Board
! Number of inspections per permit allowed.
i:\13uilding \Permits \ELC- PermitApp.doc 12/03 440-461 (10 /02/COM/WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection LL!: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested ° ' 3 AM PM BUP
Location cZ) - �'�" Suite 796 MEC
Contact Person Ph ( PLM
Contractor �P Ph ( ) 'a 3 - (�- /S SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Access:
Ftg Drain ELR O AS - O 2 33
Crawl Drain
-Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Ina Sheath/Shear
Framing
Insulation PA- J J VP F'_ Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL � I
PLUMBING
Post & Beam
Under Slab
Water he
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
Fire Alarm
PASS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
El Please call for reinspection El Unable to inspect — no access
Fire ADASupply Line Z � ,�j �✓ / 661 4 j � p
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL