Permit r M6
R
CITY OF TIGARD ELECTRICAL ERG
RESTRICTED CTED ENERGY
PERMIT 00206
•
— 13125 a• � 1 ��
DEVELOPMENT H BMEN R V SERVICES 639 - 4171 DATE ISSUED: 7% 4/2004
SITE ADDRESS: 15055 SW SEQUOIA PKWY 120 PARCEL: 2S112DA -00800
SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Proiect Description: Voice and data cabling.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATAITELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC REALTY ASSOCIATES STEELHEAD TECHNOLOGIES INC
15350 SW SEQUOIA PKWY #300 -WMI 1520 NW 6TH CT
PORTLAND, OR 97224 GRESHAM, OR 97030
Phone: Phone: 503 492 - 2119
Reg #: LIC 159346
ELE 26- 1205CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 7/14/2004 $75.00 Elect'I Final
[TAX] 8% State Surcharl 7/14/2004 $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 n •
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon la , •r ires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -4 • 9
through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions • OUN! : t (503) 4''-6 •9.
Issued by Permittee Signa - Ai,/ . , :I
OWNER INSTALLATION ONL
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
£ltrical Permit Application FOR OFFICE USE ONLY
City Received i ' / 4'
�J Of Tigard g Received �� Permit No � —�()-
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Ui so-' d "rr�y' 1 Date/B : Oth Permit
Inspection Line: 503.639.4175 - ■ r' Date Rea See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental information
. ' 'TYPE OF WORK - :,; PLAN
y t 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 Ja Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑ Master builder ['Building over three stories ❑Feeders, 400 amps or more
❑ Other: DOccupant load over 99 persons ❑Manufactured structures or
•
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
�,/ ❑Health -care facility ❑Other:
Job no.: Job site address:
/�' 5-5—Su) ��U O lc1 , �I . y Submit 2 sets of plans with any of the above.
City/State /ZIP: 7 7 y ,1 Ole_ ( The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: / p Project name: traps i ht i r e fe-76 )~EE* 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
Limited energy, non - residential 75.00 2
DESCRIPTION - OF WORK Each manufactured or modular
• k /�,Q�} N /�� dwelling, service and /or feeder 90.90 2
VC /�� e / /�/ ��T(7 / /Jv� Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
El PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 644 77U5 T 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: ( ) Fax: ( )
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 1 ❑ 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
each branch circuit
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
/ , s " extension. Describe: Page 2 2
Business name: Sr� 10� 6 x ) � / � S
cc - a ? (
Address: � M Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: ag' ° / /gib o 9 )' V3 d Investigation per hour (1 hr min) 62.50
Phone: g ) 9/ Z - a// Fax ($CJS) y� 6� � p S Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES* . -
CCB Lic.: Lic.: C .rv.
/s�� y 6 Elect rical a� - ao� - �� Su ‘,2y >3A 00 Subtotal Suprv. Electrician signature, required: .. / Plan review (25% of permit fee)
[ // State surcharge (8% of permit fee)
Print name "IA /7/ /G AT Date: 7-/V-0 TOTAL PERMIT FEE
51
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.
i:\ Building \Pemtits\ELC- PermitApp.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:'
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
El Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY: 7
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
El Clock Systems
0 -Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
El 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 \ Building \Pemiits\ELC- PertnitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection LIncr (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
q BUP
Received Date Requested ! — 3 AM PM BUP
Location Suite / ZU MEC
Contact Person H40A1-- Ph ( ) —, PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
r/
Ftg Drain ELR O07 — D 0,
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation .
Drywall Nailing L
Firewall Fire Sprinkler '`°� V l�►� ir'
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 PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• ART FAIL
Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Dat 'D Inspector r /6(1 A Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL