Permit w
CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
A ll itti DEVELOPMENT SERVICES PERMIT #: ELR2004 -00376
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/14/2004
SITE ADDRESS: 15820 SW UPPER BOONES FERRY RD BLD.B PARCEL: 2S112DD-00701
SUBDIVISION: OREGON BUSINESS PARK II ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Proiect Description: (2) thermostats.
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:
INSTRUMENTATION: OTHER: THERMOSTAT X
TOTAL # OF SYSTEMS: 2
Owner: Contractor:
PACIFIC REALTY ASSOCIATES PROTEMP ASSOCIATES INC
15350 SW SEQUOIA PKWY #300 -WMI 9788 SE 17TH AVE.
PORTLAND, OR 97224 PORTLAND, OR 97222
Phone: Phone: 503 233 - 691 1
Reg #: EbfB- 23876063CRE
LIC 38868
SUP 2613LEP
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 12/14/2004 $150.00 Elect] Final
[TAX] 8% State Surchart 12/14/2004 $12.00
Total $162.00
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 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
Issued by .cam 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 J� DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Permit Application •. FOR OFFICE USE ONLY
City of Tigard
Date Received By /� /Y I7 Permit [ No . �2aci e.0,7 7.,k
13125 SW Hall Blvd., Tigard, OR 9722 f1 Plan Review
Phone 503 639 4171 Fax 503 598 1 �� , L J i i , Date/BY Other Permit
u"u" � Date/BY Notified/Method Fin 1
P r Date Ready /By
Inspection Line 503 639.41 75 ' J 0 See Page 2 for
www ci tigard.or us 200k �— Supplemental Information
TYPEM61 W ' • - ,'PLATY,4REVIEW ",•_: . ' : "
❑ New construction j 'Addtta Please check all that apply
❑ Demolition
Oth ['Service over 225 amps, comm'I EHazardous location
FIlIiLDING DIVISION
Service over 320 amps - rating ❑Buildne over 10 sq ft ,
• ` , • _ • 'CATEGORY OF CONSTRUCTION .. of 1- and 2- family dwellings 4 or more new residential
❑ 1 - and 2 - family dwelling Comercial /industrial E] Accessory building ❑System over 600 volts nominal units in one structure
. m
EBuilding over three stones ❑Feeders, 400 amps or more
I=I Multi - family E Master builder El Other.
DOccupant load over 99 persons Manufactured structures or
- 'JOB `SITE•INFORMATION AND" =LOCATION:• , ❑Egress /lighting plan RV park
/3 ❑Health -care facility ❑Other:
Job no Job site address.
,./ /! / `,
/
�
(rive/ L. �4Af- Submit 2 sets of plans with any of the above
City /State /ZIP / 4. J, ORe5 6"i 7'7 r- The above arc not applicable temporary b e to tempora construction service.
Suite/bldg. /apt. no ?a �si'.r e ;. P= *i .7° : A � .4 -
'
Project name. J ;; �, c;s ?sFEE fiSC HE D l1LE: F s , , ;: :
vA"T� l.�/G n•. % C� Descnptlon I Qty. I Fee. I Total 1
Cross street/directions to job site: ie.5 ..&,," A)arl /,o+ --st 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
t ,. „- „ .,. Limited energy, non - residential 75.00 2
a' i < O ORK _;';, n �¢ -tr. ,': l
;:�i= .,:av� -: �:: , • �� " :4$.-" FEW ..i,�s; .,,• r.�� e� 5w :� =`
. �,.. ... , , . _ , -w "�,..t °;,p;�n, � v.t��, =: - Each manufactured or modular
dwelling, service and /or feeder 90 90 2
- a e4 '40:0 l'✓' 7 4 J / 4 . 1 /4 Services or feeders installation, alteration, and/or relocation
200 amps or less 80 30 2
t.:' ® PRORERTY OWNER. 5,1 t:•.•; +'. ,;i s icer ,TENAT >;; :a,' ``Ri 201 amps to 400 amps 106 85 2
401 amps to 600 amps 160.60 2
Name:
y..5,."111: 9 -r-C /},Q p V..C---- 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
' r; M ; W 'A,PELIGAN;t7, r „; { n,,. " s:fift' ; ` 1 „OiYFL eg.if R SONti �.. ` n A Fee for branch circuits with
.'k.,1,.S?.:A_ ... s . - .�,.- n...�.., -th iFi'1 =_.... a:.T- +.. ".. . , •..tom.... J,., ..Ya "a- ....c:...S'
Business name: 1-;,,A.7 1 A, �. y - service or feeder fee, each 6.65 2
'> i „... /25,,S
7. S /.0-1-i ei- - j."...7,4-0c.;.: branch circuit
B. Fee for branch circuits
Contact name. /
J 9 < i ,) k r i / /Z-h— without service or feeder fee, 46 85 2
o each branch circuit
Address: ' /7 / 1 y'� _ Each add'I branch circuit I 6.65 2
City/State /ZIP: �� ` , , r
tY�? /� i - L el-i--i--,L) �7/��� - n,� -- �% 7.42-,Z 2 Miscellaneous (service or feede not included)
Phone' (�;` -3 ) 5 -) z) - , GG Fax : (J j 5 ) �) ‘ Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: 4j /C Li fe. r ! - qtr / p ,.O Cv i Signal circuit(s) or limited -
,T '?rt'' 4i -,rf„� =; ; CONTRA • T'a kit- "e;'t•' �, .,�*-`. ;.r< energy panel, alteration, or
lc ,_ ,� t�i: , -ti•F'. "`i�.!
- - ,nd;.�'w'�t - <i, Fa, �..., ...... _ � OR
, ,. . , .:. eatrV�J- I :-r�'�<'z•;�?. s �:.l -.f;, ,_-s, �a` energy P
extension. Describe Page 2 2
Business name: S✓'d -'n e AS "9/31.7 S
Address: Each additional inspection over allowable in any of the above
Per inspection 62 50
City/State/ZIP. Investigation per hour (i hr min) 62 50
Phone. ( ) Fax
( ) Industrial plant per hour 73 75
., C RICAL ° DMI',I;v FEES* /. i ,' . - ty f''�.. ,
) s. �; Fifi: ... =:.i ' -.- � ... .. �1 `.:,`.••.T�:. . " ice_
CCB Lie J ,..5 a r Electrical = .2crt�,s(:1 . Supry Lic.., 9 "
.� f y:� LfG'��a Subtotal
Suprv. Electrician signature, requtr - ' lZ Plan review (25% of permit fee)
Print name i State surcharge (8% of permit fee)
Q .
6 r " ' �� / rr " '' ' �� D a te / / ..—or TOTAL PERMIT FEE / 62 a
Authorized signature: /�
' ) ��` a � - This permit application expires if a permit is not obtained within 180
r) `, days after it has been accepted as complete
Print name. , LJco `y '/ f -'�,,, / Date: /2 L,,.._d, ' Fee methodology set by Tn- County Building Industry Service Board
` pP ” Number of inspections per peniut allowed
1 \Buddmg\Permns \ELC- PermitApp doc 12/03 440 - 4615x(10 /O2/COM/WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: 003) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 1 3 AM PM BUP
/ Location r 5 R .� P Suite MEC
Contact Person . l�lJ` -ems Ph ( ) , 3a 1 - 86 o ( PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access: _ / -� u
Ftg Drain /,�LZ m CG r-e)), .,p - Dl`F N ELR d � d [ - 0 6 3 740
Crawl Drain
Slab Inspection Notes: —b °oo
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
/ Ay
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.
' - + -PART FAIL
SITE El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Date 13 - 0 LA U ` l �_UC Ext
Approach/Sidewalk Inspector
Other:
Final DO NOT REMOVE this Inspection record fro the job site.
PASS PART FAIL