Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 -00198
a,re '!1'�I'. DATE ISSUED: 7/20/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2 S 110 B B -01100
SITE ADDRESS: 12408 SW DUCHILLY CT ZONING: R -1
SUBDIVISION: AMES ORCHARD LOT: 014 JURISDICTION: TIG
Project Description: All encompassing low voltage. •
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: X AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: X BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: X CLOCK: MEDICAL:
HVAC: X DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: X FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: ALL ENCOM : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
REDDICKS, JEFFERY E + SIMPLE SECURITY
KATHY L 4702 SW SCHOLLS FERRY RD.
12408 SW DUCHILLY CT #196
TIGARD, OR 97224 PORTLAND, OR 97225
Phone: 503 -524 -2408 Phone: 503 -574 -2254
Reg #: ELE 34- 603CLE
LIC 152019
FEES •
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 7/20/2005 $75.00
[TAX] 8% State Surchar€ 7/20/2005 $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
through OAR 952 You may obtain copies of these rules or direct questir s to OUNC at 503 - 246 -6699.
Issued By; i.Gct�� /��2- 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.
ermit Ap pica i t < � ,
� `� Mr., r R r P ,;IOR(DTIItwuu,sl OiNin « r - ri i k 9... V E � " ) r 3 , . , . • 3� 5k4i iv t . w '
Jrd Date/By: � 1 t52 /,/ � Permit NoSi� — � 4,
islvd., Tigard, OR 97223 Plan Revi w
. =39.4171 Fax: 503.598.1960 J " *l flp .a r 1, Date/BY: . Other Permit:
iht4 JUL z 0 2005 u...10.3`._11,a, � �t y
r?' ine: 503.639.4175 J Date Ready/By: haisj c ®See Page 2 for
! . =s c. gar.or.us
CITY OF TIGARD
www.ci.tid Notified/Method: C O Supplemental Information
PLAN REVIEW
New construction t, Addition/alteration/replacement Please check all that apply:
ID Demolition ❑ Other: ❑Service over 225 amps, comm'l El Hazardous location
❑Service over 320 amps – rating ❑ Buildng over 10,000 sq. ft.,
• CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
El. 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building El System over 600 volts nominal units in one structure
ID Multi - family ID Master builder ❑Other: ❑Building over three stories ['Feeders, 400 amps or more
DOccupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION , RV park
❑ Egress/lighting ighting plan P
❑Health -care facility ❑Other:
Job no.: Job site address: i '. y o g y, W. Dti �� c
Submit 2 sets of plans with any of the above.
City /State/ZIP: Tr&R R D The above are not applicable to temporary construction service.
Suite/bldg./apt. no.: Project name: D _0n. Dn FEE* SCHEDULE
{�eOWcG tf2V►�AdCIJL- Description I Qty. I Fee. .1 Total •.
Cross street/directions to job site: K i l viii Rd , 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
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90.90 2
s¢ C. yTty P kt -t , 7'V (-a f3 (Q Services or feeders installation, alteration, and/or relocation
i
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
i Name: Cat 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
I 2_`-(0 S l,C) r l� Q Reconnect only 66.85 2
City /State/ZIP: Temporary services or feeders installation, alteration, and /or
Phone: ( S (- 7 _ y Go Fax: ( ) relocation 00 a
\ \ \\ 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 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
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: S t Vt,, Q t: txr►T r C branch circuit
r to S y B. Fee for branch circuits
ontact name: 4 ./(/1. .P y without service or feeder fee, 46.85 2
Address u /- each branch circuit
4 7 0 2 . $ 1.0 - 5 4,14-o its CeYtry 2 2-to Each add'I branch circuit 6.65 2
City /State /ZIP: r T LA k d x 2 R 7.- - Z Miscellaneous (service or feeder not included)
�/J� Pump or irrigation circle 53.40 2
Phone: (o 3) 5 _ Z !) !� Fax: : ( ) Sign or outline lighting 53.40 2
1 E -mail: ! Signal circuit(s) or limited-
C ONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name:
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ) 2 / Fax: ( ) 1 -, / --O Industrial plant per hour 73.75
J �� ELECTRICAL PERMIT FEES *.
CCB Lic.: `� Zp 1 Electrical Lic.: 3ti- 6O3 Suprv. Lic.: }!k Leo Subtotal
Suprv. Electrician signature, required: y / Plan review (25 %ofpermit fee)
"f> <� " State surcharge (8% of permit fee) °
Print name: «l4 M t `/ e ✓ Date: 2 , Lov f`
( Y TOTAL PERMIT FEE i .
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.
is\ Building \Permits\ELC- PermitApp.doc 12/03 440-46 15 T( 1 0/02/COM/W EB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDkNTIAL WORICONIN:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
111 Audio and Stereo Systems*
El Burglar Alarm
, .
0 Garage Door Opener*
111 Heating, Ventilation and Air Conditioning .
System*
f •
El Vacuum Systems*
El Other:
COMMERCIAL WORK ONLV:
Fee for each commercial system $75.00
(SEE OAR 918-260-260)
Check Type of Work Involved:
▪ Audio and Stereo Systems
fl Boiler Controls
El Clock Systems
El Data Telecommunication Installation
O Fire Alarm Installation
El HVAC
El Instrumentation
111 Intercom and Paging Systems
LI Landscape Irrigation Control*
D Medical
El Nurse Calls
O Outdoor Landscape Lighting*
1=1 Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
\Buildmg \Permits \ELC-PennitApp doc 04/03
CITY OF TIGARD 44 ' s'. 5- 9 9
BUILDING DIVISION PERMIT #: ELR2005 -00198
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/20/2005
Phone: (503) 639 -4171 al Requests (24 Hrs.): (503) 639 -4175 ' I :.
INSPECTION WORKSHEET FOR DATE: 7/25/2005 TIME: 7:12AM PAGE: 86
SITE ADDRESS: 12408 SW DUCHILLY CT CLASS OF WORK:
SUBDIVISION: AMES ORCHARD LOT #: 014 TYPE OF USE:
PROJECT NAME: REDDICKS
DESCRIPTION: All encompassing low voltage_
OWNER: REDDICKS, JEFFERY E +, PHONE #: 503 - 524 -2408
CONTRACTOR: SIMPL.. SECURITY PHONE #: 503 574 - 2254
Inspection Request Scheduled For: Date: 7/25r2Q05 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage i 1998.01 503-574-2254 N
Cored
Corrections/Com - /
A PASS ❑ PARTIAL APPROVAL ❑ CANCEL El NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 6- 1\ kt 1 V V `'.. Date: II 2S 0 5 Phone #: (503) 718 -14