Permit I
CITY O F TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
Y
l�
DEVELOPMENT SERVICES PERMIT #: ELR2004 -00077
Air./ 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/25/04
SITE ADDRESS: 11365 SW TIGARD ST PARCEL: 1S134DC -00700
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
Project Description: Fire Alarm
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:
BAPS TEMPLE A & E SAFE & ALARM CO
PO BOX 41160 PO BOX 179
SAN JOSE, CA 95160 MCMINNVILLE, OR 97128
Phone: 408 - 453 -6464 Phone: 408 - 453 -6464
Reg #: E40-45331 34CLE
L$63-472654993
FEES Required Inspections
Description Date Amount Ceiling Cover
[ELPRMT] ELR Permit 3/25/04 $75.00 Wall Cover
Elect'I Final
[TAX] 8% State Surchart 3/25/04 $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 throuc •
Issued by Permittee Signature „1Ji /
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
Jlec.tric'a1 Permit Ap 1 '_-.I. ' v. FOR OFFICE USE ONLY
I k
City of Tigard k 1-% % Received - 'D OD
O Date/B . Permit No: / 7
13125 SW Hall Blvd , Tigard, OR 97223 ykta Plan Review • „' " y
Phone: 503.639.4171 Fax: 503 598 1960 S`G P.A" 'I t� T
� 1 Date/B Other Permits _ _,0000 , ez)
Inspection Line: 503.639 4175 \�v OF O`v \- ------ , . el W Date Ready/By. Juro ® See Page 2 for
Internet: www.ci tigard.or.us G I G Notified/Method Supplemental Information
.Ii!'" t'c`. ?'i t =" - ;i l'�-�`' •t6rY - �F' y - e :.: �' >fn _ "'''''' , - i t t - r�u e �• -
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ew construction ❑ Addition/alteration/replacement Please check all that apply
U llemolition ❑Other:
Service over 225 amps, comm'l ❑Hazardous location
l: e r d cr h 2�_ ,,, rr, w �,,: ,: ❑Service over 320 amps - rating ❑Bwldng over 10,000 sq ft.,
A<< R '� X,r.'''` q 'CA 'TEGORY= OF'C01�FSTRUC�T_ION: "'z r;' ` ' ''
«, r,.� �i`- �4,'.- '��."'` �� of 1 -and 2 -family 4 or more new residential
L
. _�: �' ._,. _.. , :�:..��2S,�• St��•. _ .- .y�. ...-. _ .. .-.. 9:, �uf ^;�.r a- �:�z.,aL `u�'s" �:5�6�. Y dwellings
❑ 1 - and 2- family dwelling ,Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ['Feeders, 400 amps or more
❑ Multi faintly 0 Master builder 0 Other:
+�, .. c r/ �. F ['Occupant load over 99 persons ❑Manufactured structures or
i?e. il' : : tJCi ,JOBSITE N4a+ �+;i x ' ! ,,t park
RV
- .. , O AND.�OCA ; �'�;;' r ; ,tr, .,r`�::.:. = _, ❑ Egress /lighting plan P
Job no.:6 I Job site address: ,/ L- r T e l _ ' ❑Health -care facility ['Other
` t0� Submit 2 sets of plans with any of the above
City/State /ZIP• / 1,366.Y. "r. a above are not applicable to temporary construction service
no.: I Project name:
Suite/bldg./apt. ; . ' `' `FEE *YSGFIEDi}L'E`"
v r'" ; :; ";"' :
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'I 500 sq. ft. or portion 33 40 1
Tax map /parcel no.: Limited energy, residential 75 00 2
Y c" f ,, ,- r4 -y .. i, - J` Limited energy, non - residential 75 00 2
' .,'F" ,? , ' 4, < . • ; r �- ',. DESCRI,P 'WORK. -tr . :i . . . r �5'^ ' fi r : - t
�. r / ', :, h4a, - , . „2 , .. , .. - C-.,....: to .t' . .r r- g-t•,itre • . Each manufactured or modular
64,Z"172-,1 r dwelling, service and /or feeder 90.90 2
'�-, Services or feeders installation, alteration, and/or relocation
200 amps or less 80 30 2
V ,.,. V s : 3; .>- . n r . '3I, u r .,. ,,, 0. a 9� 201 amps to 400 amps 106 85 2
a E R 1'VPTER r ,".. ,,.,� ;' b
;_;� "'�!= � ®rBRO � TY ,O ' °.� ':v,_ )'a%-�� ,?-. Y;�l ®�TEIV ` :`�� ,_ t u`, .
" f., mP mP
401 amps to 600 amps 160 60 2
Name: i . _ P S l f��� n � r 2( 2 /J v`/ J 601 amps to 1,000 amps 240 60 2
Address: / 1 y 3 S e d -7 � • / � Over 1,000 amps or volts 454 65 2
;L Reconnect only 66 85 2
City/State/ZIP: T� etzA A t (22 Temporary services or feeders installation, alteration, and/or
Phone: ( ) �" I Fax: ( ) relocation
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 r. � ` ® PLICANT F ti qr'' '''' 'i . "1. '�' ', - r' ®,,'C N• A "4'.' A ranch circuits with
. ,i . Fee for branch " ';. . � +I P U T, CTPEASON^e ' - � ; ,
�E +.i : -�dr�' t� ut_ ..M ., .,,� • _ . ,. A service or feeder fee, each
Business name: branch circuit 6 65 2
Contact name: B Fee for branch circuits
without service or feeder fee, 46 85 2
Address: each branch circuit
Each add'I branch circuit 6 65 2
City/ State/ZIP: Miscellaneous (service or feeder not included)
Phone' ( ) I p er:: ( ) Pump or irrigation circle 53 40 2
Sign or outline lighting 53 40 2
E -mail: Signal circuit(s) or limited-
• : :.a 2 ;J 4: �'"b'(i� Iii i; :f E - :f 'i� p a4 4i•�• - _�1r4` •l. 14 . energy •...� 1 � w � a�s,' � '° COIY,T[iAC'TOR �� F hey; =.::. � �i � . •->,'`- %��'�) gY anel, alteration, or
P
.� e e �4.0. s. •u _ - dtk�n�'! rj '�rli -l'- �:., r•
Business name: extension Descnbe Page 2 2
Address. / D / Each additional inspection over allowable in any of the above
/ Per inspection 62 50
City /State /ZIP. J �- /�� - /A 7 7 /,)-g Investigation per hour (I hr min) 62.50
Phone: / "� 7 Fax: ( 70 Industrial plant per hour 73 75
y7� ��I �� /7/7,22 3 S Y "! ,i1f €ik `r *.CTI07:4Z4:P 'FiE_ lA;TT,T:_... ,:; t
CCB Lic.: r Electrical ` Su rv. Lic d
���� y � El l Li � ( p ,3�/[�LC p J p I21 Cl R Subtotal �/ �.
Suprv. Electrician signature, required: e Plan review (25% of permit fee) / —
Print name: /41/ / kE I- /S e e , e R Date. _ State surcharge (8% of permit fee) LB _ 61--°
/ TOTAL PERMIT FEE V / „a-0
Authorized signature: i This This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: �1 kE / / ' b e.e R41- Date: 3_ 4 3 • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed
i \Buildmg\Permits\ELC- PermitApp doc 12/03 440- 4615T(10 /02/COMIWEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection nine: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received I Date Requested _ lS AM PM BUP
Location I I -2 ) (e .S 1 Suite MEC
Contact Person r /wite Ph ( q 7/) -3s- 71? PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR 1
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
/C/t
Shear Anchors :
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation I t� , ^ /� , lA �n , / �IG(l 2 /� ,� V
Drywall Nailing I �7LJl/ I t G
Fire wall
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
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fi - larm
;-� 111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
L" .�7 PART FAIL
Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line I / KA/1. �!
ADA Approach/Sidewalk Date 6 - 1 8 - o tt Inspector E ✓ Pnj2pL 4& Ext
k Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL