Permit A. w CITY OF' TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
4I1� DEVELOPMENT SERVICES PERMIT #: ELR2004 -00258
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/13/2004
SITE ADDRESS: 15495 SW SEQUOIA PKWY 150 PARCEL: 2S112DD -01600
SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: Relocate T -Stat.
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 AIR RITE CONTROL INC
15350 SW SEQUOIA PKWY #300 -WMI 1623 SE 6TH AVENUE
PORTLAND, OR 97224 PORTLAND, OR 97214
Phone: Phone: 238 - 0388
Reg #: LIC 63302
ELE 26- 814CRE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 8/13/2004 $75.00 Elect'I Final
[TAX] 8% State Surchart 8/13/2004 $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 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 through OAR 952-001-0100. 1 y You mayobta Utility
of these rules or direct
questions to f in OAR 0 352 0 99 0 /
Issued by , _ 1 �� Permittee Signatu VAillialN,..1414
W. -
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
FROM :AIR RITE CONTROL FAX NO. :5032346749 Aug. 13 2004 01:01PM P1 •
. El ct i cal Permit A 1 w � ori FOR OFFICE USE ONLY
AD ,)L Received _ (� Electrical , r 7/J�)//_
/_` Date/By: �� D / if Pem No.: �!/I�o�V U7 � �
Y Planning Approval Sign •
City of Tigard j Cj c � �QO DatelDy: !�' • Permit No.: •
13125 SW Hall Blvd. V J Q Plan Review Other
Tigard, Oregon 97223 �' . ' Date/By: Permit No,!
A\1 Date/ y: Pe Land Use
Phone: 503 -639 -4171 Fax: 503 - ]�40 v ,
no" rr g0.-/1 't, Date/By: Case No,:
Internet: www_ci.tigard.or.us �_,..1 `` U,. t:;l I Contact Juris.: ® Sec Page 2 for •
24 -hour Inspection Request: 503-6 �_
Namc/Melho Supplemental Information. •
SI
.. ;•. , =� •- r', }: '• F W _ .:'; . :•' I' Y. A1q.111YdTVi+ ::( ple" ase'eii ?s'll „h'lital5ri10. `�•
New construction ['Demolition 01 Service over 225 amps- ❑ Hcalth -care facility
commercial 0 Hazardous location
Addition/alterationlreplaccment ❑ Other: 0 Service over 320 amps- rating of ❑ Building over 10,000 square feet,
' '' ''';�,'- 'C. if CQ�2 ':^ Qi` CONSIIVO :>:Tritgl r� ' •. - I & 2 family dwellings foul' or more residential units in
❑ 1 & 2- Family dwelling jgj 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:
i --- Submit sets of plans with any of the above-
_: _�o�rrrnlr�oara;z:oci ;:> .gi
'''='` `' � �' The above are not ap licablc to lern)rorag construction service,
lob site address: -.5 . i '
s � .. . ' _ .. °.':. ,; . �„hr• }
4,, rr .. ; ,:,,... .
i~/ tu e . > . .:r�_ '.� ^': L?! Jf'!'iL�•S'7���''�4'ri:4tii:... N' �d.�n�1�k�'i�:n:.
Suite #: Bld *. /A t#: Number of inspections per permit allowed
Project Nan e_ «� R to ,rC[r /T
as ei4'r 3-fOPe Description Qty Fee (ea.) Total
Cross street/Directions to job site: New residential-single
ng dc i t.a ncl de attached mul per
dwelling unit - Includes attached garrage.
Service included:
1000 so. ft or less 145.15 4
Each additional 500 sq. it or ponion Owrcof 33.40 l
Subdivision: r-� Lot #: - Limited clergy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
. , servico and/or feeder 90.90 2
`. Services or feeders - installation, •
G t o 'f -S i °r7T 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
=.[_,1P,•RO�2'ik' Ir. 100fint s $: :'.. ... m; .710 ? .:! y ...f -_. .. %f: •f,ti:; , 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: _ _ Reconnect only 66.85 2 .
Address: Temporary services or feeders • Installation,
alteration, or relocation:
City /State /Zip: 200 amps o r less 66.85 1
Phone: Fax: - 201 amps to 400 amps 100.30 _ 2
_ _ 401 to 600 amps 133.75 2
'�? a ' Branch circuits • new, alteration, or
.`- 'C��P.�'>� r " >' �. ° w � 4 . �. �' U ,N`'.Ir`A;�?''>i'�)`lSOZ7^1'#�, _s•••,
Name: Tip M 5 (o l2 ( extension per panel:
•
Address: !(o 2.3 54 , X! A i-6 A. Fee for brine circuits with purchase of
n Q service or feeder er fee, each branch circuit 6,65 2
City /State/Zip f0� .4114 / Q 1-1 2. l ct - B. Fee for branch circuits withoutpurchase of
service or feeder fee, first branch circuit 46.65 2
Phonc: 5 Z S -03 y5'1 Fax :.5d3 &3L1 - Col Fri Fach additional branch circuit 6.65 2
E-mail: Misc.(Scrvice or feeder not included):
� , Each pump or irrigation circle 53.40 2
ke ': : ,v+ ; :'- ? i CTfl fr . f f ; _ t.,:.:••1 " Each signor outline lighting 53.40 2
Job No: to y b Si gnal circuits) or a limited energy panel, •
job alteration, or extension j Page 2 2
O Business Name: At Pe.. �1.Te K. - F+bt_ vv}��on:
i Address: I to Z. 3 s, . - ,/ptld A4 v�°- e:4l ' S - -
1State /ZI 6 f ^ 1 Each additional inspection over the allowable in any of the above:
Clt
CCB ),IC. #: 4
y p A 0 D/'< ' 1 a I LI Per inspection ear hour (min. 1 hour) _ „^ _ 62.50 �_
IQ Phone; 3!/✓`2- $' V Fax: 7.'13 -03'-( GI Investigation fee:
j Other: .
Z G .01 �. Pei��iF�4�.z ti.. k �:,.:r� -� - .�ye. sr awLgia it : t may,.,_.._::::
.3� L ";1. :.r:. ` ��iectkl�rS� `�i.
Supervising electric an ' A I .1C. ><r: Z O / Subtotal S 9,x _
signature requir . G/ =• _ _ Plan Review 25% of Permit Fee) $
Print Name: ,f e f�Je Lic, .#: 2:11. L ( 3 _ State surchar�c (8% of Permit Fee) $ -,
• TOTAL PERMIT FEE $ 3j °-
Authorized _ Notice: Thie 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 Tn -County Building Industry Service Board.
' (Please print name)
i Msts\Permit Forms\ElcPermitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Lire: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
iQ BUP
Received � // Date pequ. ed �/� AM PM BUP
Location / 5(' � c ,1.0 - � Suite MEC
Contact Person =i��� Ph ( ) 3? 1/ PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner y �PiI��.J ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation '`:. L1 (0 ,` JN J
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm � 1
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 I I _ / v t ) y 6 7 _ fZ 7
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
e r C: u rF21 . 5L
Rough -In
UG/
ow Voltage
F� ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
S ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA q .� A o ff ( .. � f LE C ;
Approach/Sidewalk Date t Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL