Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
4 DEVELOPMENT SERVICES PERMIT #: ELR2003-00326
r � I II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/20/03
SITE ADDRESS: 06900 SW SANDBURG ST PARCEL: 2S101 DD -00702
SUBDIVISION: SALEM FREEWAY SUBDIVISION ZONING: I -P
BLOCK: LOT: 004 JURISDICTION: TIG
Project Description: Instal Protective signaling.
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: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
J + K PROPERTIES CORP SONITROL PACIFIC
6900 SW SANDBURG RD 8220 N. INTERSTATE AVE.
TIGARD, OR 97223 PORTLAND, OR 97217
Phone: Phone: 223 - 5822
Reg #: LIC 53535
ELE 26 370CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 10/20/03 $75.00 Elect'I Final
[TAX] 8% State Tax 10/20/03 $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 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699.
Issued by i % — J /f Permittee Signature ?)--k p ca it vZ
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
, FOR OFFICE USE ONLY
Electrical Permit Application Received Electrical J�--
RECEIVED Planning r o v 1 Permit No o 3 ot) to
Plannin A'rov 1 Sign
City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 OCT 2 0 2 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 CITY OFT !Mil Post - Review l Land Use
� Date/By: Case No.:
Internet: www.ci.tigard.or.us _ , Contact Juris.: ® See Page 2 for
3�W-
24 -hour Inspection Request: 504019 �'' Name/Method: Supplemental Information.
- . -: TYPE OF WORK :.,-. ,.- . ., , ` PLAN check all that.aPPly) ''.. •. - , i , '' - .
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility •
commercial ❑ Hazardous location
[I Addition/alteration /replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
' `:CATEGORY OF- CONSTRUCTION . 1 & 2 family dwellings four or more residential units in
❑ I. & 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 ❑ Other: ❑ Egress/lighting plan ❑ Other:
Submit _ sets of plans with any of the above.
_ JOB SITE- INF ORMATION and LOCATION --- ' The abo ve are not applicable to temporary construction service.
Job site address: Co c�� 0t-+ FEE* SCHEDULE ''-:. '--_. y , '_�
Suite #: Bldg: /Apt. #: Number of inspections per permit allowed
Pro
j ect Name: ll�r : t i3r �t r n � TY i " Cs , z , De scription Qty ' Fee (ea.) Total
New residential - single or multi - family per y
Cross street/Directions to job site: dwellin unit. Includes attached g arage.
Service Included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: Lot #: 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
-> Services or feeders - installation,
alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
601 amps to 1000 amps 240.60 2
El -PROPERTY. OWNER ; ' ❑TENANT" = ' Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: • Temporary services or feeders - installation, •
alteration, or relocation: 66.85 1
City /State /Zip: 200 amps or less
201 amps to 400 amps 100.30 2
Phone: Fax 401 to 600 amps 133.75 2
. ❑ APPLICANT' = . ❑ CONTACT PERSON Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of 6.65 2
Address: service or feeder fee, each branch circuit
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
Each pump or irrigation circle 53.40 2
- - T 7 -.. CONTRACTO - . 53.40 2
" Each sign or outl lighting
Job No: 4 ■'a-c - ' �6 Signal circuit(s) or a limited energy panel, tit 0`
_ \
h alteration, or extension Page 2 ■ 5' 2
Business Name: 3 W? \ Ci C- Description:
Address: tga. 6 13 - KAri atrial(
(�Q Each additional inspection over the allowable in any of the above:
City /State /Zip: POY lard t v ._. 1 �17 Per inspection per hour (min. 1 hour) 62.50
Phone: 5(‘ 3- a a 3 -5'a), - - . 7 11 Investi ation fee: —
Other:
CCB Lic. #: 53s3 5 Lic. #: a(4, - 3�0 Electrical Permit Fees*' . .: . . - -,:,:. i -- , -
Supervising electrician AS4 - Subtotal $ t CZ
signature required: Plan Review (25% of Permit Fee) $
Print Name' I Lic. #: u(00 c-f-ri-- State Surcharge (8% of Permit Fee) $ . C�S
TOTAL PERMIT FEE $ \ . A C)
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit FormskElcPermitApp.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
O Burglar Alarm
❑ Garage Door Opener
❑ Heating, Ventilation and Air Conditioning System
Vacuum Systems
O Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Boiler Controls
El Clock Systems
0 Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
0 Instrumentation
n Intercom and Paging Systems
El Landscape Irrigation Control
0 Medical
El Nurse Calls
Outdoor Landscape Lighting
al Protective Signaling
•
Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations '
i:\Dsts\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 /2-17 AM PM BUP
Location G Q 'c ��K�bw✓O STS • Suite MEC
Contact Person Ph ( ) a� — ' PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner kle.s k• 'Y ELC
Footing
Foundation - ELC
-�--- �� -- - 1.-12_,
Ftg Drain Access: t () ' s - 003a -tom
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
_FA SS P RT FAIL
LECTRIC
Service
Rough -In
UG Slab
o
ire arm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
,_i4TJ PART FAIL
ITE El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA !,
Approach/Sidewalk Date bEC., jO l r3 Inspector iV • ` - Ext
Other: V
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL