Permit (62) ` - v ���� ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00248
TIGARD. 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/22/2008
PARCEL: 1 S136DD -05300
SITE ADDRESS: 11850 SW 67TH AVE 100 ZONING: MUE
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT: 013 JURISDICTION: TIG
PROJECT: TIGARD TRIANGLE COMMONS
Project Description: Moving (1) fire alarm system.
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: X OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
LARSON, IRVING UJENNIE E TRS FIRE PROTECTION SERVICES
BY JUDY L STROJNY 5573 SW ARTIC DR
555 CHESTERTOWN ST BEAVERTON, OR 97005
GAITHERSBURG, MD 20878
Phone: Contact #: PRI 503 -590 -3732
FAX 503- 628 -6214
FEES Reg #: ELE 34- 488CLE
LIC 154333
Description Date Amount SUP 4120LEA
[ELPRMT] ELR Permit 8/22/2008 $75.00
[TAX] 12% State Surch 8/22/2008 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
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 or 1.800.332.2344.
Issued By: ,-- 7A / iie. Permittee Signature: �_� ��'/ ,e�
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:
CaII 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
h
Aug 21 2008 3:57PM Fire Protection Services 503 628 -6214 p.1
ApplicationRECEIVED 1 � ��
Electrical Per)t ApAhcati0 ' l l 1 u n h;' l r , 1 1 w\ 1 a
_^ r
City of Tigard R r1. - �� 3 . Permit No i r- sck)o !
i . 1312 SW -lull Blvd., Tigard, OR 97223 AUG 1 2008 plan Review Other pmt,
t4 Phone: 502.639.4171 Fax: 503.598.1960 Date ; :
Inspection Line: 503 CITY OF TIGARD Date Ready/By: S7 See Pose 2 for
. t } L} NotifiedIMethod 1 a-- Supplemental Information
Internet vt bgazd of gry a 1 1 1 1 ■
.:,�. i c •x, cry ra S ..4.75 e° d s e.t t..> Iii i - V, , st G 11 f? .:a ,�? Ri 1/r ifs . , t+ x '• S ffr. i
tia t f i I 11;xt.� 3 x-- , y . i r } a t it r
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❑ New construction j ® Addition/alteration/replacement Pty c dr apply (submit 2 lans wiitems cbeckea below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition 1 ❑ Other: where the available fault current ❑ Marinas and boatyards.
"" .. 4 :i img 1r ��x } a •; tr +•,: 5 '' t t. -' • 1) ' '. exceeds 10000 amps at 150 unite or ❑ Floating buildings.
w 1.•,:.- , ::Tail }. -t i
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..' _,$,.=.4:. .:p tz.. Si.ou.rue rathu tz.7: 6 - n.a.a , y- .m.:..._ ..I.44..,rY
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loss to ground, or exceeds 14,000 ❑Commercial -use agricultural
CI 1 - and 2-family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pump. 1:1 Installation of 75 KVA or
S i.. h , , N x• . .. t -4. z,f.:ly'iii3 ii>• a tt5 r r i i , Erg a {+ . _. ❑ Emageny system. larger separately derived system.
xx f 1 : i' a + e s t. t s ' E..+?i1 1 5 ,ix, . Addition of new motor load of 'A", "E" "1.2 ", "1 -3 ",
....,7 e -- rx4.n:4:i � - ..c:. ,n, ■..sf s�F�ii s,.i ;..d, 3-., ai`.. r: �c _.Cr+l.",a. ' .....:k�9� ❑ 0
Job no.: 1352 _ Job site address: 11850 SW 67 Ave. 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks
City / State/ZIP: Tigard;OR ❑ Health -care facilities. ❑ Supply voltage for more than
1 ❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: 100 I Project name: Triangle Commons ❑ Servrceorfeeder600ampsormore
' r c f r ,tf a L. r i I i i t ,,
�'t.�1..�a Vs�' +... _'ka°�`� -:3' sn.�.n:elo . .zn�, � }Y�������li'Sls�' �! ?.':;
Cross street/directions to job site: Description Oty Fee. Tow
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft or less 145.15 4
Ea. add'l 500 sq. ft. of portion 33.40 1
Tax map /parcel no.: Limited energy, residential
n ,,, , n r x-711 ri svg. .,. ._.i1 •�SZnxrvTE . tFlix• �7iii2 'I. itt' ( 1: ?f 2;:r : ( a9 ) 75.00 2
5l4 # #c •aW- _a iii.i L:_#as�:§%i^. tr :wcri0-...5,,, . :: ,? ,. : 3 4 - n1.. ...}`r�.iki:::i '_? with above . ft.
1. Limited energy, multi- family 75.00 2
Move (1) Fire Alarm Device to accommodiate Tenant Improvement residential (with above sq. ft)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 � 2
--' ,s . 6 -71I ,,r 1 a'*' - h r -c �. x .,.z Al iii ` F : -' e r..ua t. - s S c- '- 1 * Ear
- "' esr . „ii2 e=xit "L ":x° as 4 ..'-'.fifiiiii3tt. -t". 6n.s > l"Yt -: Fef l .. l` i1. 201 amps t 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or Tess 66.85 I
Owner installation: Titus installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, leasoi, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, r panel
Owner signature: Date: A. Fee for branch circuits with '
s:h-vri c. 7 1 f }tfv .r,,,m ir:;.x.' -ImI Igo ial Dz-r st9vs= ,m .ace.: &
1,= b _4Y " ail i Y } i, r firt{I ° ¢ 3' ,k '� ,. 'x. igm ••}., above service O
- r feeder fee,
w,.,a,9t.t _ ._._�. � _. s_�m a 4 c . �.1�:,.x.xt,ar, ". ..ar each branch circuit 6.65 2
Business name: Fire Jrotection Services Inc B. Fee for branch circuits
without service or feeder fee,
Contact name: David X41 Phipps first branch circuit 46'85 2
Address: 5573 SW At}ctic Dr Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City / State/ZIP: Beave ton Or 97005 Each manufactured or modular
dwelling, service and/or feeder 90.90 I 2
Phone: (503) 590 -3732 I Fax: : (503) 628 -6214 Reconnect only 66.85 2
E -mail: phippst fpsnw.com Ptunp or irrigation circle 53,40 2
t 1 .. t i ! 1 '°.. 2 .0TI i fi i1 i 4 A t� e r -113 Ir �i;I:Lt9 R 2F,' a
. l i.I . q t .,r11 - , r z T Si gn or outline lighting 53.40 2
n�.mf,,. _�lxe^_ . >.. kr S.� .., ua."'�.i x:x..u,*h t #. 1 _,.. , �,�sR�Oi_r.. ...
Business name: Fire protedtion Services Inc Signal circuit(s) or limited
energy panel, alteration, or
Address: 5573 SW Arctic Dr extension. Describe: 1 Page 2 75.00 2
City /State/ZIP: Beav Or 97005 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 590 -3737 Fax: (503) 6286214 Investigation per hour (1 hr min) 62.50
CCB Lie.: 154333 Electrical Lic.:. 1 88 Suprv. Lic.: 4120LEA Industrial plant per hour 73.75
P IVI
Suprv. Electrician siglature, required: / : "' ',.. Subtotal 75.00
" Plan review (25% of permit fee):
Print name: David M Phipps' ate: 08 -21-08
State surcharge (12a /0 of permit fee): 9.00
Authorized signature'l TOTAL PERMIT FEE: 84.00
ae
This permit application expires if a permit b not obtained within 180
Print name: David M hipps Date: 08 - 21 - 08 days after it bat been accepted as complete.
Number of inspections allowed per permit.
MBuildingV.Per mils\ELC- PermitApp.dac 05/23/06 440-4615T(11/05tx1MAVEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2008- 00248
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/22/200f3
Phone: (503) 639 -4171 "
Inspection Requests (24 Hrs.): (503) 639-4175
WORKSHEET FOR DATE: 9/19/2008 TIME: 7:O0AM PAGE: 27
SITE ADDRESS: 11850 SW 67TH AVE 100 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 013 TYPE OF USE:
PROJECT NAME: TIGARD TRIANGLE COMMONS
DESCRIPTION: Moving (1) fire alarm :system.
OWNER: LARSON, IRVING 1 /JENNIE E TRS, PHONE #:
CONTRACTOR: FIRE PROTECTION SERVICES PHONE #: 603- 590 -3732
Inspection Request Scheduled For: Date: 9/19/2008 Pour Time:
Code # Inspection Description _ Contact # Message
199 Electrical final 075670 -01 503 -3732 N
Corrections /Comments / Instructions:
,pS AL a EJ f b ,
t. 'Nob ispeczokkikt, ig6 vi11>1 �4
6 qe&.. CJ
S ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
QA
FA ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Cr Noe Date: Si 19(1 Phone #: (503) 718 -1-4�
1