Permit (162) C ITY OF TIGARD ERG
RESTRICTED ENERGY
� DEVELOPMENT H BMENa Tigard. SERVICES 639 -4171 DATE ISSUED: 4 24? 303 -00120
SITE ADDRESS: 16200 SW PACIFIC HWY Q � "b PARCEL: 2S115BA -00101
SUBDIVISION: TIGARD TOWNE SQUAFFE ' .- g,.7 ZONING: C -G
BLOCK: LOT: 001 JURISDICTION: TIG
Project Description: Installation of limited energy for HVAC.
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:
BIT HOLDINGS LTD PARTNERSHIP HVAC INC
BY FORUM PROPERTIES INC • 5188 SE INTERNATIONAL WAY
FIVE CENTERPOINTE DR STE 290 MILWAUKIE, OR 97222
LAKE OSWEGO, OR 97035
Phone: Phone: 503 462 - 4822
Reg #: LIC 50897
ELE 26 5710EP
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 4/24/03 $75.00 Elect'I Final
[TAX] 8% State Tax 4/24/03 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to ertlow'�esa 'opted by i - Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 throuc
A.
Iss ed by . i o. , k . , , IL t / • Permittee Signature SS AZ;)(Ot (71/1
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
C NTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N )� DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
•
4:, - r: Electrical Permit Application
Date received: 5e Al 65 Permitno.:EL,A
4 ,i. .' 1 1 ., City of Tigard Project/appl. no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: - By: I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: t n .Pao vR — t%105S
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory Q- Commercial/industrial ❑ Multi- family ❑ Tenant improvement
ESI'New construction ❑ Addition/alteration/replacement ❑ Other. ❑ Partial
JOB SITE INFORMATION
Job address: / (p 0 0 Stu Po.t.44-c_ 1 Bldg. no.: A Suite no.: O Tax map /tax lot/account no.:
Lot: 'Block: I Subdivision:
Project name: jl,0, , _ _ . „ 6 _g , — Description and location of work on premises: • 0 /1 4 , , t , , , , . t J sC i o/ , s 4-
Estimated date • ' completion/inspection:
CONTRACTOR APPLICATION FEE SCIIEDU.,E
Job no: Fee Max
Business name: ,� j(t � Description Qty. (en.) Total no. ins
New residential - single or multi - family per
Address: Sig$ SE (A) dwelling dwelling unit Includes attached garage.
City: iil(�,'wat.c.ku State: ZI q 7�aa Service included:
Phone: t. cgo,a I Fax: a- 6 I E -mail: 1000 sq. ft. or less 4
5 g 9 (o - 57 /er E� Each additional 500 sq. ft or portion thereof
CCB no.: 7 Elec. bus. lie. no: o� _ Limitedenergy,residential 2
oZ
City /metro lie. no.: t off 1 (2 Limited energy, non- residential 2
t . k � ) yL� `-I i Q” Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print)( • , ,, i f License no: s- " _ -- Services ° l o —Installation,
alteration or relocation:
PROPERTY OIVNER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
Mailing address: 401 amps to 600 amps 2
g 601 amps to 1000 amps 2
City: I State: 'ZIP: Over 1000 amps or volts 2
Phone: 'Fax: 1E-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 am .s 2
ENG IN EER Branch circuits - new, alteration,
Name: or extension per panel:
A. Fee for 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
Phone: Fax: E -mail: of service or feeder fee, first branch circuit: 2
Each additional branch circuit:
PLAN REVIEW (Please check all that apple) MLsc. (Service or feeder not included):
❑ Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps- rating of l &2 ❑ Hazardous location Each signor 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* / 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description: /y Vii
0 Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other. Per inspection
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 $ '75. C
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ o
Credit card number: • / / within 180 days after it has been State surcharge (8 %) $ �O . oG
Name of cardholder as shown on credit cars accepted as complete. TOTAL $ S! • • ,
Cardholder signature $ Amount i— 1C/ / _ // 914C./ 440-46I5 (6/00ICOM)
•
1 o5
'Electrical Permit Fees: - , Limited Energy Fees: •
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
/� Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 4, Check Type of Work Involved:
Residential - per unit .
1000 sq. ft or less $145.15 4 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ Burglar Alarm •
Limited Energy $75.00
Each Manul'd 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
201 amps to 400 amps $106.85 2 . ❑ Vacuum, Systems`
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 • -
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less - $66.85 2 (SEE OAR 918 -260 -260)
201 amps to 400 amps $100.30 2 •
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see "b" above. ❑ Audio and Stereo Systems
Branch Circuits ❑
New, alteration or extension per panel Boiler Controls
a) The fee for branch circuits
with purchase of service or ' ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑
or feeder fee. Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous ❑ Instrumentation ,
(Service or feeder not included) •
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 i ❑ Landscape Irrigation Control`
Minor Labels (10) $125.00 •
Each additional Inspection over El Medical
the allowable in any of the above
Per inspection $62.50 ❑ Nurse Calls .
Per hour $62.50
In Plant $73.75 . ❑ Outdoor Landscape Lighting`
Fees: ❑ Protective Signaling
Enter total of above fees $ ❑ Other •
8 % State Surcharge $ • .
. Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ " No licenses are required. Licenses are required for all other installations
front of application.
Fees: •
Total Balance Due $
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
. Total Balance Due $
i :\dsts\forms elc- fees.doc 10/09/00 •
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 - 4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Re uested U AM PM BUP
Location i &' —O� 4) ,4 t- ' Z-v Suite Z MEC
Contact Person K Ph d7 2_ PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
g Access:
Ft Drain ELR 3 / - 2
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
' r
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
P S PART FAIL
Service
Rough -In
UG/Slab
Low Voltage
F' = Alarm
(rte
ART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
�-� ❑ Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line /
ADA �p
Approach/Sidewalk Date V Inspector •. — i ►�o � 1 - Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL