Permit (76) xe C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00141
T[GA 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/15/2007
PARCEL: 1 S 136DD -04100
SITE ADDRESS: 11850 SW 67TH AVE 100 ZONING: MUE
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT: 007 JURISDICTION: TIG
PROJECT: AMERICAN FAMILY
Project Description: Low voltage signal circuits for data /voice and security (see other).
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: SECURITY X
TOTAL # OF SYSTEMS:
Owner: Contractor:
LEISER, ANNE TRUSTEE BROADWAY ELECTRIC - COCHRAN INC
6009 SW PENDLETON CT 626 SE MAIN
PORTLAND, OR 97221 PORTLAND, OR 97214
Phone: Contact #: PRI 503- 234 -6564
FAX 503- 238 -2098
FEES Reg #: ELE 37 -546C
LIC 72942
Description Date Amount SUP 3447S
[ELPRMT] ELR Permit 5/15/2007 $150.00
[TAX] 8% State Surcha 5/15/2007 $12.00 REQUIRED ITEMS AND REPORTS
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 or 1.800.332.2344.
Issued B, . %I " j L // 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: DATE:
LICENSE NO:
Call 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.
I
N. ...,. . •
. .
Electrical Permit Application FOR OFFICE USE ONLY • .
•
City of Tigard V n ' wr
C n Permit No: N
i g . 111MM PermitNo.: . .
Date/B : J A,or
13125 SW Hall Blvd., Tigard, OR 97223 Received —
Plan Review
Phone: 503.639.4171 Fax: 503.598.1MM 1 5 2007 ilf Af.11 4 / D:/B, Other Permit:
Inspection Line: 503.639.4175 A,.. 0 . Date Ready/By: ISM El See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: Supplemental Information
..t' ':',.., ' gl ,q.;.::;;: - 1 11%..,,40.41!,,(nzi...i. ) , ., : ,,,: ;:j,F4,?,::::,:ki;..a,:v.T, , , , ,,,,-- ; , : ,, , ,.,,,, ,, .. : :i,,,, ,, y..,,, ,‘‘,.-.;, ,•::.,,, ,:-.,
e , ,f/t.1".....>., , :t,. ,,, ' ,,,,,, :; i 4:: -7, -, 0 ',..;,-,,,,,,,: .4 . , - - 7.:., , , . .--,, .;:t: ,;;,,:::-., ,.. ,.:v i .,, i: -:
0 New construction 0 Addition/alteration/replacement Please check all that apply:
0
OService over 225 amps, comrn'l 0 Hazardous location
Demolition 0 Other:
S. . , 0 ervice over 320 amps - rating OBuildng over 10,000 sq. ft.,
;-= :' .::-' . : :: : ' : U 2 :4 ; t : ' . '; :- ..1 : . , ratidiiiii43i 1: ]tiiii - f§it.ijeT105114 1 ,06 :4, W . `" 1:6 ''''i''''''' of 1- and 2-family dwellings 4 or more new residential
0 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building DSystem over 600 volts nominal units in one structure
DBuilding over three stories ['Feeders, 400 amps or more
0 Multi 0 Master builder 0 Other:
['Occupant load over 99 persons ['Manufactured structures or
4013i'r §1"Ty:'.04MATION,ANR 10 qiNpoN ,•-.. f ; ElEgess/lighting plan RV park
Job no.: 0 MCI 2_1 Job site address: k g5 E (0--/ti--. DHealth-care facility ['Other:
Submit 2 sets of plans with any of the above.
City/State/ZIP: — Iv,. 0, G 7 2-23 The above are not applicable to temporary construction service.
Suite/bldg./apt. no.: Project name: r
. . '''"'''&'.:' ik ,
F:§611E
I )4.1)e/LECA-k, ' • - - Descript ' ' . — ' ' . '
ion Qty. I Fee. Total .*
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
Limited energy, residential 75.00 2
Tax map/parcel no.:
Limited energy, non-residential 75.00 2
E401 L . , '' .'-'1 '. Ng. Each manufactured or modular
• VO Cel 6ta3LL .cf,C,t,tii,k(i dwelling, service and/or feeder 90.90
Services or feeders installation, alteration, and/or relocation 2
200 amps or less 80.30 2
106.85 2
..;IF . , ?' . .. , ':-' , 3 . ,: - .: - ..- , .• .;i-.:::',1= 401 am to 600 amps 160.60 2
Name: 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
: .AiitieAwf.5. ,,. ,: la : .E c iii, i ,t6i, , ;i4ii s ,Is f ., : - :-.J.:-.-7., - : : - A. Fee for branch circuits with
service or feeder fee, each
6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
each branch circuit
Address: Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( ) Sign or outline lighting 53.40 2
E-mail: Signal circuit(s) or limited-
,.- . V . ■ :. i .ii,),T ,. V, ..40iN , 1 .f:tt.:- energy panel, alteration, or
' extension. Describe: Page 2 /511„.....-- 2
Business name: "?. 0... \.) ,_ \ sr ' c...
Each additional inspection over allowable in any of the above
Address: C„ 2. (= 5 E. iN
Per inspection 62.50
City/State/ZIP: - 1 c5 _AA OR c k - 7 2 A Li' Investigation per hour (1 hr min) 62.50
Phone: (563 ) 2_3(k -( t-k Fax: (563) 232,, -7_,ccutg Industrial plant per hour 73.75
CCB Lic.: 7 2_4= Electrical Lic.: 31-5 i Suprv. Lic.: 3 Lick - f 5 Subtotal
Suprv. Electrician signature, required: V Plan review (25% of permit fee)
State surcharge (8% of permit fee) /
/d- ----
Print name: V_ ArN V....6-0 Date:
TOTAL PERMIT FEE 1 , : )- ------"
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: . Fee methodology set by Tri-County Building industry Service Board
** Number of inspections per permit allowed.
i: \Building TennitsELC-PerrnitApp.doc 12/03 440-46157(10/02/COM/WEB
CITY OF TIGARD
• BUILDING DIVISION PERMIT #: ELR2007 -00141
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/15/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 g.-1 11.
INSPECTION WORKSHEET FOR DATE: 8/27/2007 TIME: 7:OOAM PAGE: 14
SITE ADDRESS: 11850 SW 67TH AVE 100 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE:
PROJECT NAME: AMERICAN FAMILY
DESCRIPTION: Low voltage signal circuits for data/voice and security (see other).
OWNER: LEJSER, ANNE TRUSTEE, PHONE #:
CONTRACTOR: BROADWAY ELECTRIC COCHRAN INC PHONE #: 503.234 - 6561
Inspection Request Scheduled For: Date: 8/27/2007 Pour Time:
Code # Inspection Description Confir . Contact # Message
135 Loan voltage 054673 -01 971-219-9278
` Y
Corrections /Comments /Instructions:
v
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: r' '1\1()° Date: 'A 27 01 Phone #: (503) 718 - Z`I'
CITY OF TIGARD - - -
BUILDING DIVISION PERMIT #: ELR2007 -00141
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/15/2007
Phone: (503) 639 -4171 (1
Inspection Requests (24 Hrs.): (503) 639 -4175 ��:
INSPECTION WORKSHEET FOR DATE: 7/27/2007 TIME: 7:03AM PAGE: 88
SITE ADDRESS: 11850 SW 67TH AVE 100 CLASS OF WORK: '
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE:
PROJECT NAME: AMERICAN FAMILY
DESCRIPTION: Low voltage signal circuits for data/voice and security (see other).
OWNER: LEISER, ANNE TRUSTEE, PHONE #:
CONTRACTOR: BROADWAY ELECTRIC - COCHRAN INC NIli J nc o PHONE #: 503
Inspection Request Scheduled For: Date: 7/27/2007 Pour Time:
Code # Inspection Description Confirm #N Contact # Message
135 Low voltage 052830.01 971- 219 -9270 Y
Corrections /Comments /Instructions:
KR 1
\PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G _ N■8 Date:1 ' /.1' ' 01 Phone #: (503) 718- 1.44Azt
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007- 00141
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/15/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 _I.�
INSPECTION WORKSHEET FOR DATE: 7/11/2007 TIME: 7:01AM PAGE: 63
�.`Q ��` v CLASS � � V6fa OF RK:
SITE ADDRESS: 11850 SW 67TH AVE 10 tokcaril
SUBDIVISION: TIGARD TRIANGLE CO F�9MONS LOT #: 007 TYPE OF USE:
PROJECT NAME: AMERICAN FAMILY
DESCRIPTION: Low voltage signal circuits for data/voice and security (see other).
OWNER: LEISER, ANNE TRUSTEE, PHONE #:
CONTRACTOR: BROADWAY ELECTRIC-COCHRAN INC
INN\Y, (Z0k130 PHONE #: 503 - 2346564
Inspection Request Scheduled For: Date: 7/11/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage (c- t N 051761 -01 971 - 219 -9278 Y
Corrections /Comments / Instructio
2 �� L� V cc k� k
❑ PASS '/ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: &- ' (N) Oe5 Date: , • 11• 01 Phone #: (503) 718- 2-411b