Permit CITY T I G A R D ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2006 - 00064
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 2/22/2006
PARCEL: 2S 113AD - 01700
SITE ADDRESS: 16920 SW 72ND AVE ZONING: C -
SUBDIVISION: ROSEWOOD ACRE TRACTS LOT: 030 JURISDICTION: TIG
Project Description: Security 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: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
BRIDGEPORT LAND LLC VISION SECURITY SERVICE
3939 NW ST HELENS RD 10874 SW ROLAND CT
PORTLAND, OR 97210 WILSONVILLE, OR 97070
Phone: 503- 224 -2676 Contact #: PRI 503- 682 -6713
FEES Reg #: LIC 152497
ELE 3- 544CLE
Description Date Amount
[ELPRMT] ELR Permit 2/22/2006. $75.00
[TAX] 8% State Surcha 2/22/2006 $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 by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: , ; e �� 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.
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Electrical Permit Application .; . '... l . .� - , „1.0 t`01. Icwl lutil,()iN / • A t •
��
' City of Tigard il) .,«; ci,..- ,. d R ece i ved / � �.. 7 _�/� / `J g ; i ) _ Date/By: V N /I Permit No.:t ( .1c 4 lNr 9( /
13125 SW Hall Blvd., Tigard, OR 972.x: $ "- Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 /4 " ,0 - y ? } f ``' Date/ Other Permit:
Inspection Line: 503.639.4175 _' ' l imo Date R eady/By: Jeri ®See Page 2 for
Internet: www.ci.tigard.or.us FEB 22 2?:-.:- • Notified/Method: tr.. Supplemental Information
TYP 1(11I�1� PLAN REVIEW
El New construction Ad ��1 Please check all that apply:
❑ Demolition ❑ _,Ly �� ❑ Service over225 amps, comm'l ❑Hazardous location
❑Service over 320 amps - rating ❑Bulldog over 10,000 sq. ft.,
CA E� GORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling mercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑ Other: ❑Building over three stories El Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress lighting plan RV park
Job no.: Job site address: 1 ( t �
G/ 1 -O -2
&E. ❑ Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City /State/ZIP: T 4D �- l g The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name:�w 5+-)is . FEE* SCHEDULE
Description 1 Qty. I Fee. I Taal I ••
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. 11 or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
5 • -- , _ �.-. 1 ¶ - )�� 1 C'� - A dwelling, service and/or feeder 90.90 2
��(f `� J��IAJ- �t/r�t q v J l G!1" \ Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
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❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps 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
› APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
� , 1 7 branch or feeder fee, each
Business name: K/'t " 1 ' V IQE branch h circuit it 6.65 2
B. Fee for branch circuits
Contact name: � without service ithout servicic feeder or feeder fee,
' 1 first branch circuit
46.85 2
Address: l !�� `T 5u,„) ht7
Each add'I branch circuit 6.65 2
City /State/ZIP: I )SO -VJwf d2 c im v 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-
C ONTRACTOR energy panel, alteration, or
extension. Describe: I 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: ( ) Fax: ( ) Industrial plant per hour 73.75
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� ELECTRICAL PERMIT FEES* ,
CCB Lic.: �� � Electrical Lic.: u,
; Srv. Lic. Subtotal • .
Suprv. Electrician sign ature, required: „ / ,// Plan review (25% of permit fee)
1'
Print name: N j Date: State surcharge (8% of permit fee) 60
�' _� p � �• TOTAL PERMIT FEE / e
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 \Pennits\ELC•PcrmitApp.doc 12/03 440-4615T(10 /02/COMM'EB
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:
I ,COMMERCIAL WORK ONLY: . }
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation •
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❑ HVAC
El Instrumentation , .
❑ Intercom and Paging Systems '
❑ Landscape Irrigation Control*
❑ Medical .
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
Protective Signaling . .
❑ Other
Total number of commercial systems: J .
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Pennits\ELC- PetmitApp.doc 04/03
- CITY OF TIGARD E`'R•
BUILDING DIVISION PERMIT #: 606 - 060 G cf
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639-4175 ±i 6 'I ...
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: /, 9 2.0 7 a CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
7
Inspection Request Scheduled For: Date: .3f 7 Or" Pour Time: 0-_ , 44 J
Code # Inspection Description Confirm # Contact # Message
/ L - `b 769 /3i z
Corrections /Comments/ Instructions:
(---(............
i
1/ / Tei\
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A 1-7 PASS PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
FAIL n CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: tJ NZA 0 661-1/4
Date: _ 3
1
t7 6‘ Phone #: (503) 718 - -2446