Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
,rk DEVELOPMENT SERVICES PERMIT #: ELR2001 -00040
r �I ! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/15/01
SITE ADDRESS: 06825 SW SANDBURG ST PARCEL: 2S101 DD -00400
SUBDIVISION: SALEM FREEWAY SUBDIVISION ZONING: C -P
BLOCK: LOT: 001 JURISDICTION: TIG
Project Description: Voice and data cable
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:
TOC MANAGEMENT SERVICES RIEKS COMMUNICATIONS
6825 SW SANDBURG STREET 1704 N MERIDIAN
TIGARD, OR 97223 NEWBERG, OR 97132
Phone: 620 -1710 Phone: 538 -8852
Reg #: LIC 74386
ELE 36 -49c1e
•
FEES Required Inspections
Type By Date Amount Receipt Ceiling Cover
PRMT CTR 2/15/01 $75.00 2720010000 Wall Cover
Elect'I Final
5PCT CTR 2/15/01 $6.00 2720010000
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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
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:
CON RACTOR INSTALLATION ONLY
i
—
SIGNATURE OF SUPR. ELEC'N: % / /, /I� DATE:, - / $ - T` /
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
• Electrical Permit Application
Date received: /�' /V i Permit no.: a00 /-Cao c 90
4,. \,ii City of T •
�,L ;.� I Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171 •
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERA'IIT
❑ 1 & 2 family dwelling or accessory gCommercial/industrial 0 Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement 0 Other: ❑ Partial
JOB SITE INFORMATION
Job address: ' P :j3''S 0 $ / /fj3 U/e 1 % Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: (Subdivision:
Project name: I Description and location of work on premises: %g) /4 .2z 7 -, e . f 1/0/CE'
Estimated date of completion/inspection: -- 0 '-CJ eAt = _
CONTRACTOR APPLICATION FEE SCI IEDUCE
Job no: Fee Max
Business name: /'/ eD/�,/1e!(J�y/e,„gr /D/' Description Qty. (ea.) Total no. insp
'/ New residential - single or multi- family per
Address:, 'O ig 3 .a 6( dwelling unit. Includes attached garage.
City/y6 & t I State 'ZIP: 97/3 L Service included:
Phone�3 f, 8'fgf*Fax: 5,407 I E -mail: _ 1000 sq. ft. or less 4
I r Each additional 500 sq. ft. or portion thereof
CCB no.: 7 Y3 8'6' Elec. bus. lic. no:3G Y e
9 L energy, residential 2
City /metro lic. no.: Limited energy, non- residential 7( 2
Each manufactured home or modular dwelling 1
Signature of supervising electrician (required _ 7A11.2 %ate , • ' 0 Service and/or feeder 2
Sup. elect. name (print) 0 , 1 r _ License no rvicesorfeeders — installation,
a lteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: 'Fax: I E -mail: Reconnect only i
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: • I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E -mail:
Each additional branch circuit:
PLAN REVIEIV (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps- commercial 0 Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps- rating of 1&2 O Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories • • 0 Feeders, 400 amps or more *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lightingplan O Other: Per inspection I 1 I
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee $
O Visa O MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 (6100/COM)
Electrical Permit Fees: Limited Energy Fees:
Complete Fee Schedule Below: • TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total `' Check Type of Work Involved:
- Residential - per unit
1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular n Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation
200 amps or less $80.30 2 Vacuum Systems
201 amps to 400 amps $106.85 2
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918 - 260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 _ 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see "b" above. n Audio and Stereo Systems
Branch Circuits I I Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or n Clock Systems
feeder fee.
Each branch circuit $6.65 2 01.. Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65
Miscellaneous n Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control
Minor Labels (10) $125.00
Medical
Each additional inspection over
the allowable in any of the above Calls
Per inspection $62.50
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting .
Fees: n Protective Signaling
Enter total of above fees $ n Other
8% State Surcharge $ Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $ -7 -
Enter total of above fees $ / � • (
/
❑ Trust Account # 8% State Surcharge $ lP ` e,7-7
Total Balance Due $ V i OT/
i:\dsts \fortes \elc- fees.doc 10/09/00
17 P
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
// BUP
��%
Date Requested ' 7 G AM PM BLD
•
Location ]ue COJ' Z s Suite MEC
Contact Person Ph 7 Z/ 7r PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR 2!Y >G -(U Z97
Footing Access:
Foundation I°PS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear �{/� �j
Framing t� /V 00 — CJl J� O 0
Insulation
Drywall Nailing / —0 0
Fire wall i% If 2C)/ a O 0
Fire Sprinkler
Fire Alarm
Susp'd Ceiling / /�
Q of v — G s
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
r — / ■III■■•
Post & Beam
Under Slab
Top Out
Water Service Ca P p, q i i z
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas
Smoke e Dampers
Final
PASS PART FAIL
LECTRI
- Service
Rough In
UG /Slab
Sow Voltag>
Fire Alarm
F•
ART FAIL
S
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other D ate q- / Inspector ..!J, _ iv _'� Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.