Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT #: ELR2000 -00247
�I -- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/24/00
SITE ADDRESS: 12286 SW SCHOLLS FERRY RD PARCEL: 1S134BC-00300
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Burglar Alarm
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: X BOILER: LANDSCAPE /IRRIGAT:
• GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS: •
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
BURNHAM PACIFIC ADT SECURITY SERVICES, INC
10135 SE SUNNYSIDE RD 2815 SW 153RD DR
SUITE 250 BEAVERTON, OR 97006
CLACKAMAS, OR 97015
Phone: Phone: 503469 -7100
Reg #: LIC 0059944
ELE 26- 209CLE
FEES Required Inspections
Type By Date Amount Receipt Elect'I Final
PRMT CTR 10/24/00 $75.00 2720000000
5PCT CTR 10/24/00 $6.00 2720000000
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:
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
Datereceived: Permit , u.
—0 2
, ,•, , City of Tigard Project/appl. no.: Expire date:
City ofTigard Address 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: i Mr, av By: Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no,: Payment type:
Land use approval:
TYPE OF PERMIT.
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
• JOB SITE INFORMATION
•
Job address: 1 , Q 6) I S 129 Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name:ja Description and location of work on premises: j ��) „ RAW
Estimated date o ' mpletion/inspection:
.-4 (;O T ZA T:OR_A.P.PLLCA3.10.Ni , a_: ,..�:._-� ,._ D
.._ FIT .0 LE _
Job no: ' T rr Fee Max
H' � , 1J • CCS Desc ription Qty. (ea.) Total no. insp
Business name:
2815 S.W. 153RD Dr. New residential - single or multi- family per
Address: dwelling unit. Includes attached garage.
City: Beaverton, OR 1 91.®06 I ZIP: Service included:
Phone: L i -2 I Fax: yM - �C, E -mail: 1000 sq. ft. or less 4
CCB no.:5 t !
�_ Each additional 500 sq. ft, or portion thereof
U I Elec. bus. lic. no: (DU [�:E, Limited energy, residential 2
City /metro lic. no.: Limited energy, non- residential 2
`� VI , l / Lti, Each manufactured home or modular dwelling
S gnature of supervising electrician required) Date ��11 Service and/or feeder I 2
Sup. elect. name (print): � License o: lro Services or feeders— installation,
t
alteration 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: I Fax: I E -mail: Reconnect only 1
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
20
ORS 447, 455, 479, 670, 701. 201 1 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENG IN EER Branch circuits - new, alteration,
or extension per panel:
Marne.' F e f r ,
A. °_ _or 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 REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps - rating of 1 &2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* t 2
O Building over three stories 0 Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egreess/lightingplan ❑ Other. Per inspection I I 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 $ 1 (
❑ Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) $ WWI
Expires p accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6/00 /COM)
RECEIVED
Electrical Permit Fees: • our 18 7000 Limited Energy Fees: `
Complete Fee Schedule Below: COMMUNITY DL LuilviLIV PE OF WORK INVOLVED - RESIDENTIAL ONLY
/� Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total y 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 n Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular ❑ 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 a
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation •
200 amps or less $66.85 . 2 Fee for each system ' 1 '' '' ". — ; • $75.00
201 amps to 400 amps $100.30 2 (SEE OAR 918-260-,2601. ;
401 amps to 600 amps $133.75 2
Over 600 amps to 1000 volts, Check Type of Work In4olvei,r. ( c , ,-
see "b" above. .
❑
Branch Circuits Audio and Stereo Systems
New, alteration or extension per panel ❑
a) The fee for branch circuits Boiler Controls
with purchase of service or
feeder fee. ❑ Clock Systems
• Each branch circuit " $6.65 2
b) The fee for branch circuits ❑ Data Telecommunication Installation
without purchase of service
or feeder fee. • ❑ Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6.65 • n
HVAC
Miscellaneous
(Service or feeder not included) ❑ Instrumentation
Each pump or irrigation circle $53.40 ,
Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00
Minor Labels (10) $125.00 ❑ Landscape Irrigation Control
Each additional inspection over ❑ Medical
the allowable in any of the above
Per inspection • $62.50 ❑
Per hour $62.50 _ Nurse Calls .
In Plant $73.75 ❑
Outdoor Landscape Lighting
Fees: •
❑ Protective Signaling
Enter total of above fees $
8% State Surcharge $
Ti Other
Number of Systems
25% Plan Review Fee
See "Plan Review" section on $
front of application. * No licenses are required. Licenses are required for all other installations
Total Balance Due $ Fees:
El Trust Account # Enter total of above fees $
• 8% State Surcharge $
• Total Balance Due $
•
i:\dsts \forms \elc- fees.doc 10/09/00
CITY,OF TIGARD BUILDING INSPECTION DIVISION
MST-
24-Flour Inspection Line: 639 -4175 Business Line: 639 . 71
BUP
Date Requested n — AM PM BLD
Location / /.Z6 Sv S GT( F -6/ / Suite MEC
Contact Person Ph 03 £( PLM
Contractor Q Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR �LV .O Z y 7
Footing Access:
Foundation 9a-wi FP S
Ftg Drain SGN
Crawl Drain Inspection Notes: ��
Slab � i) ? //t,' Ar�� `" SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling / ,fir
Roof
Misc:
Final
PASS PART FAIL
PLUMBING &C)
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
t t r7ii C ce rRICk
Rough In
UG /Slab
Low Voltage
Fire Alarm
•S' PART FAIL
E
Backfill /Grading
Sanitary Sewer
Storm Drain [ I 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 Date /1
Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.