Permit CITY O T 1 G A R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
� DEVELOPMENT SERVICES PERMIT #: ELR2004 -00099
Al- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/13/04
SITE ADDRESS: 06650 SW REDWOOD LN 180 PARCEL: 2S112DA -01400
SUBDIVISION: PP1996 -048 ZONING: I -P
BLOCK: LOT: 002 JURISDICTION: TIG
Project Description: Limited energy for HVAC wiring.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATAITELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: • HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
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 Low Voltage Inspection
[TAX] 8% State Surcharl 4/13/04 $6.00 Elect'I Final
[ELPRMT] ELR Permit 4/13/04 $75.00
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 fo Inw rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 throuc
Iss ed 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
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received ,/ , tt V �� perm No. .
B % J / . .✓ i �. i
Date
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 / 4 '14 - fi Date/B : Other Permit:
Inspection Line: 503.639.4175 P -- I .. Date Ready/By: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: IMI, Supplemental Information
._ TYP OF WORK ' - "PL AN .RE VIE'W. '- '
❑ 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 / Master Commercial/industrial ❑ Accessory building OSystem over 600 volts nominal units in one structure
❑ Multi - family builder ❑ Other: ❑Building over three stories ['Feeders, 400 amps or more
' JOB SITE - INFORMATION AND LOCATION ['Occupant load over 99 persons ❑RV atured structures or
0Egress/lightingp1an park
0Healt2 care facility ['Other: no.: Job site address: 0 �N , ' - 1) l0p2) above.
Submit 2 sets of plans with any of the above.
City/ State/ZIP: / / 5.0, o •>►It • The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: / so Project name: 23/09/F7- 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
Tax map/parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK Limited energy, non - residential 75.00 2
Each manufactured or modular
• �01/€ • T xr 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 ❑. TENANT, 201 amps to 400 amps 106.85 2
_ Y 401 amps to 600 amps 160.60 2
Name: ?SAC • / P d/ s/ 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
Phone: ( ) 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: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'I 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: 1?4 OTm p
Address: 9 7$� SE / 7� `A Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: peNerz.Qa.o ex. c 7a02Q Investigation per hour (1 hr min) 62.50
Phone: ( )0? 33. 4 1 /1 Fax : (�3) a 3 & .. 7G 7 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: ' Electrical Lic.: iv ez cz E Suprv. Lic.: Subtotal
Suprv. Electrician signature, required: Plan review (25% of permit fee) 7S, °v
es4, v ,„' 7 ' Date: "a/ / 3 State surcharge (8% of permit fee) 6r,
Print name: j
/ �� y TOTAL PERMIT FEE g i • eQ
Authorized signature: This permit application expires if a permit is not obtained within 180
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.
is\ Building \Pennits\ELC- PennitApp.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: • ~' t
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
❑ 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 1BuildinglPertni tclELC- PmnitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received // Date Reque d �2 Z 6 AM PM p BUP
Location [' I' 57)_ d S uite ( rt n MEC
Contact Person Ph ( ) 9 j PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access: �j
Ftg Drain EL 5" — <
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler ib
Fire Alarm II
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
ELECTRICAL
Service
Rough -In
UG/Slab
'Low Voltage
Fire Alarm
ART FAIL El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE [ Please call for r- inspection ' E • Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date - Inspecto L Ext
Other:
Final DO NOT REMOVE this Insp Ion record f om the job = = .
PASS PART FAIL