Permit CITY OF TI GARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
At DEVELOPMENT BMENT Tigard. 2004 -00056
2CES (503) 639 -4171 DATE ISSUED: 3/5/04 R
13125 SW
SITE ADDRESS: 06650 SW REDWOOD LN 200 PARCEL: 2S112DA -01400
SUBDIVISION: PP1996 -048 ZONING: I -P
BLOCK: LOT: 002 JURISDICTION: TIG
Project Description: 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:
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
[ELPRMT] ELR Permit 3/5/04 $75.00 Elect'I Final
[TAX] 8% State Surchari 3/5/04 $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
Issu d by A 4 ' / I sf ) 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 DateBy: D Permit No.: z , .._az
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 �� ° : ". ' Date/By:
Other Permit:
Inspection Line: 503.639.4175 1 � Date Ready/By: luris: 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
. TYPE OF WORK - ''PL REVIEW, '
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
El 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 .In Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
El Multi ❑Master builder El Other: ['Building over three stories ['Feeders, 400 amps or more
['Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting RV park
Job no.: Job site address: ❑Health - care facility ['Other: �oGr Ia/ ��� 0�0 Submit 2 sets of plans with any of the above. g a ii City/State /ZIP: 7 ,T' / The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: . FEE* SCHEDULE`,,= .
�o� C A e>:ot. 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
Limited energy, non - residential 75.00 2
DESCRIP -TION OF WORK . Each manufactured or modular
dwelling, service and /or feeder 90.90 2
7-` 5J 727 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
v 401 amps to 600 amps 160.60 2
Name: / 7z a 5 - 5 —
1I 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: (5 a )��ac i l -6,'3 o 0 Fax: ( ) 0
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,
each branch circuit 46.85 2
Address:
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 a
extension. Describe: 7 Page 2 2
Business name:
-= p
Address: 97 .a-... 1 7 Aide Per additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: pcm QU.O a C 7aaa Investigation per hour (1 hr min) 62.50
Industrial plant per hour 73.75
Phone: (nty3) 3 _ e_ Fax: (45 -V3) 3 7 . 97C ELECTRICAL PERMIT FEES* ,..
CCB Lic.: 8 SBGs Electrical Lic.. -i06...5 eee Suprv. Lic.: Subtotal - 040
Suprv. Electrician signature, required: Plan review (25% of permit fee) rr,
Print name: Date: State surcharge (8% of permit fee) W • 0'0
' TOTAL PERMIT FEE
Authorized signature: Q ( L This permit application expires if a permit is not obtained within 180
vw f days after it has been accepted as complete O�
je, y �
Print name: N7 Date: • , /J /D • Fee methodology set by Tri- County Building Industry Service and
•• Number of inspections per permit allowed.
is\ Building \Permits\ELC- PermitApp.doc 12/03 440 461 Sr(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
El Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
El Vacuum Systems*
El 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
El Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
El Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
is. Buildineemtits \ELC- PemtitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
\ INSPECTION DIVISION Business Line: (503) 639 -4171
/ / BUP
\eceived Date Requeste 2 3 ,v AM PM BUP
Location 57) j d--1-- /T Suite p MEC
Contact Person Ph ( ) ( - 5/9 — lo ! 9 c f PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner r?) C,C-(jet ELC
Footing
Foundation ELC
Access:
Ftg Drain T,
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
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
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, EART FAIL
zg ECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
etrft � �i PART FAIL � Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SI C 0 Please call for reinspecti',n RE: 0 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date — - Ins Ext
Other:
Final • DO N • T REMOVE this inspection record fr m the J site.
PASS PART FAIL