Permit CITY OF TIGARD
SERVICES ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SER PERMIT #: ELR2006 - 00253
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/18/2006
PARCEL: 2S 104BB -07900
SITE ADDRESS: 14350 SW BARROWS RD 002 ZONING: C - C
SUBDIVISION: RUSSELL'S SCHOLLS FERRY SUB LOT: 002 JURISDICTION: TIG
Project Description: Low volt for stat.
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:
ALBERTSON'S INC #576 WILLAMETTE HVAC
PO BOX 20 PO BOX 23334
BOISE, ID 83726 TIGARD, OR 97281
Phone: Contact #: PRI 503- 628 -6841
FAX 503- 848 -2597
Reg #: ELE 34- 346CRE
FEES LIC 56951
Description Date Amount
[ELPRMT] ELR Permit 10/18/200f $75.00
[TAX] 8% State Surcha 10/18/200f $6.00 REQUIRED ITEMS AND REPORTS
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 2y the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain /pies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Or Issued By: Permittee Signature: I
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.
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EleCtrical Permit Application
. . .
f161 1 City of Tigard Received
Permit Nofi...R a 0 —c9 eld
. tilii•- ° 13125 SW Hall Blvd., Tigard, OR 94GT 1 8 2006 Date/By / 0/1 Sfrgo. i-, 6
Plan Review
Phone: 503.639.4171 Fax: 503.5981960 Date/By. Other Permit:
Inspection Line: 503.639.4175 • - . :,.., ,. ' . ,_ . : ; • Date Ready/By: Juris 63 See Page 2 for
Su
, . ,, 0, ; .1■1, 4,-, .; . ■ .
- I
Internet: www.tigard-or.gov ''''' L — " - -
`-' — `---" Notified/Method: pplemental Information
TTT Ter -r x rrri Ir.r•-.7-
' ' - • TYPE OF WORK . — • PLAN REVIEW . . ..
•
0 New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION • exceeds 10,000 amps at 150 volts or 0 Floating buildings.
' less to ground, or exceeds 14,000 0 Commercial-use agricultural
1:1 1- and 2-family dwelling Commercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
0 Emergency system. larger separately derived system.
. . " JOB SITE INFORMATION AND LOCATION - 0 Addition of new motor load of
" / 10ORP or more. occupancy.
$O
Job no.: Job site address: / Y 3 SC.,..) )3.,..v ot . J.:- Av 0 Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: 0 Health-care facilities. 0 Supply voltage for more than
CI Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: 2 Project name: 0 Service or feeder 600 amps or more.
• . FEE SCHEDULE ' • :,
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1 *
New residential single- or multi-family dwelling unit.
Includes attached garage.
•
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: Limited energy, residential
• • 75.00 2
. - :. • DESCRIPTION OF WORK (with above sq. ft.)
. .
Limited energy, multi-family
/VeL.,,,,.) -- at eAii-A 0 s'7 -/-4 Vkc...___ residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
. ..
0 PROPERTY OWNER . , I ' ' . 0 TENANT - ' 201 amps to 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 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 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
. •
• 0 APPLICANT 1 - - 0 CONTACT PERSON ' , above service or feeder fee,
6.65 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee,
Contact name: 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
90.90 2
dwelling, service and/or feeder
• Phone: ( ) Fax: : ( ) Reconnect only , 66.85 2
E Pump or irrigation circle 53.40 2
- ,• CONTRACTOR i • ' , Sign or outline lighting 53.40 2
Signal circuit(s) or limited-
Business name: 4 ..... .2 , e. 1.4 vA c
energy panel, alteration, or ....
Page 2 2
Address: Describe: .
• f /3
'o e31, 3 3 3 N
• City/State/ZIP: 7, c .. s. ,L 9 QV . Each additional inspection over allowable in any of the above
C.) Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (I hr min) 62.50
CCB Lic.: S76 et r" Electrical Lic.: 5 ci- J' •c Supr Lic.:5"02- t5Xe8 Industrial plant per hour 73.75
. ELECTRICAL PERMIT, FEES . • • ,
Suprv. Electrician signature, required: /74 Subtotal:
Plan review (25% of permit fee):
Print name:,y_..(, /... 3L, viol Date: /0 - / 3- 04
State surcharge (8% of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
IABuildingTemiits\ELC-PennitApp.doc 05/73/06 5 440-4615T(11/05/CONEWEB
. q.
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
°° RESIDENTIAL;WORK =ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other
COMMERCIAL ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
• ❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\ Building \Petmits\ELC- PemlitApp,doc 03/23/06
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~,~°,,~��,,~~= ~�,°,~°,~°,~ PERMIT #: ELR200G-00263
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/18p006
Phone: (503) 639-4171 Ai t11/4
Inspection Requests (24 Hrs.): (503) 639-4175
^ INSPECTION WORKSHEET FOR DATE: 1211/2008 TIME: 6:513AM PAGE: 36
SITE ADDRESS: 14350EWBAAR0WSRQ002 CLASS OF WORK:
SUBDIVISION: RUSSELL'S SCHOLLS FERRY SUB LOT #: 002 TYPE OF USE:
PROJECT NAME: SPEC SPACE
DESCRIPTION: Lc volt for st:t.
OWNER: AL8ERTS0N'S INC #S76. PHONE #:
CONTRACTOR: WIL[Ah4E7-FEMVAC PHONE #: 5O3,628-684i
Inspection Request Scheduled For: Date: 2/ 1/2006 Pour Time: • Cod- ' °'' •" Description Confirm # Contact # Message
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Inspector: G-^ &\ 6 • Date: 12A- Phone #: (5O3)718'
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