Permit `.. CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00293
DATE ISSUED: 7/23/2007
TIGA 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 7/23/2007
SITE ADDRESS: 09735 SW SHADY LN ZONING: C -G
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: TIGARD MEDICAL MALL
Project Description: Low voltage for HVAC wiring.
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:
Owner: Contractor:
HAZEL INTERNATIONAL, INC AND WILLAMETTE HVAC
HIGASHIYAMA HIGHLANDS CO, LTD PO BOX 23334
BY NORRIS + STEVENS REALTORS TIGARD, OR 97281
PORTLAND, OR 97204
Phone: Contact #: PRI 503- 628 -6841
FAX 503- 848 -2597
FEES Reg #: ELE 34- 346CRE
LIC 56951
Description Date Amount
[ELPRMT] ELR Permit 7/23/2007 $75.00
[TAX] 8% State Surcha 7/23/2007 $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 .. II other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started wit r 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopt: • •y the Oregon
Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0100. u may obta;� opies of these
rules or • ect ques i• qs to • - C at 503.246.6699 or 1.800.332.2344. /
Issued y: k $ ` � _ / 7 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.
x ,r. st, ; > `'PM 7t~�Y . .^a ' l�-yji:'if" w :,. .a,:
Electrical Permit Application c,,,,._ ' < p er ; FORK of FILE+ E o f
j r
'Ci Received ty of Tigard Date /By: '7 2 , a 7 Permit No.: L ,4j7 ^. t ?5
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
w _ Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit:
�'`k'r .'' k y Inspection Line: 503 639 4175 Date Ready /By: tort ® See Page 2 for
TICARD'
3i"' o g Internet: www.tigard - or.gov Notified/Method: 1G. Supplemental Information
•TYPE OF WORK • . PLAN REVIEW •
❑ New construction ❑ Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
• CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ['Fire pump. ❑ Installation of 75 KVA or
. JO SITE INFORMATION AND' LOCATION ❑Emergency system. larger separately derived system.
. �j���QQ / - El Addition of new motor load of ❑ °A ", "E ", "I -2 ", "I -3 ",
Job no.: Job site address: .F' 3 51.) C i451_ ,4 100HP or more. occupancy.
/1. ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 3c 4, Project name: ❑ Service or feeder 600 amps or more.
. FEE. SCHEDULE '
Cross street/directions to job site: Description 1 Qty. l 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'I 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
IR @ Co has t: /W e C/Y. residential (with above sq. fi ) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
. . ❑ PROPERTY .OWNER ❑ '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: ( ) Fax: ( ) 200 amps or less 66.85 I
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
.. ' ❑ ' APPLICANT ❑ CONTACT PERSON ' above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee,
first branch circuit 46.85 2
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 ..1- 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR.. • Sign or outline lighting 53.40 2
•
�/ Gtr ��� Signal circuit(s) or limited-
Business name:
1y1 ti energy panel, alteration, or
Address: ... / .. O 2,3o X ,2 333 9 extension. Describe: Page 2 2
City /State /ZIP: /iQ a ✓� T?t9 $1! Each additional inspection over allowable in any of the above
V Per inspection 62.50
Phone: ( ) 62e & LI I Fax: ( ) 8i $ -a -Q ' Investigation per hour (1 hr min) 62.50
CCB Lic.:,57crr 3' . Electrical Lic.'O.2,SZ a uprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, '
gnature, requiredi� Subtotal:
Print name:/ q, f, j
K e.,. g ,i✓l Date: 'f___2 3 at_ Plan review (25% of permit fee):
State surcharge (8% of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print naineV1, ke, 6� ./ Date: 2-2 ■17 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\ Building \Permits \ELC- PermitApp.doc 05/23/06 440 4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information " (
LIMITED ENERGY PERMIT FEES:
RESIDENT WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
❑ Other:
j COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n 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
I:\ Building \Permits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION 0 _ _ PERMIT #: ELR2007-00293
aaa3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/230007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/8/280€3 TIME: 7:aaAM PAGE: 17
SITE ADDRESS: 09735 cad{ SHADY L_.N CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TIGARD MEDICAL MALL
DESCRIPTION: Low voltage 9or HVAC wiring.
OWNER: PHONE #:
HAZEL INTERNATIONAL, INC AND,
CONTRACTOR: WILLAMETTE HVAC PHONE #: 6n628-6941
Inspection Request Scheduled For: Date: 8/8/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 073962-07 603422 -1991 Y
Corrections /Comments /Instructions: VW I
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0 /1n .l
—kid, G\
di \
01 PASS n PARTIAL APPROVAL n CANCEL I NO ACCESS
CALL FOR INSPECTION 1 1 ADDITIONAL FEES ASSESSED
Inspector: C- OSe) l Date: t la t Phone #: (503) 718- .,1i41,9
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007•00293
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 712312( �0/
Phone: (503) 639 - 4171 +U''!
Inspection Requests (24 Hrs.): (503) 639 - 4175 ° �I�
INSPECTION WORKSHEET FOR DATE: 10/17/2007 TIME: 7:02Am PAGE: 19
SITE ADDRESS: ()913f. SW SHADY LN CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TIGARD MEDICAL MALL
DESCRIPTION: ow voltage tor HVAC wiring.
(„ .
OWNER: HAZEL INTERNATIONAL, INC AND, PHONE #:
CONTRACTOR: WILLAMETTE HVAC PHONE #: M - 628 - 6841
Inspection Request Scheduled For: Date: 10/17/2007 Pour Time:
Code # Inspection Description Confirm Contact # Message
1 99 Elec.:tric:al final 057780 -01 503 -762 -4985 Y
Corrections /Comments /Instructions: I \ R1A� ( \Au j 15) � IV wEcl1;
WeeL `6 . - 1 S . 7 4T (-1..E- A 1 ,1 uNb�. uo .3(A)
X c.)&b.ocir ES am-d-artis It fiNgdr\ NNW f oLitz Er (WI 0 e 00 01%0 Al
Patov a Ab'N► 1, v► ?.x CANS V S v
Pal' 11 p ,i 5N) , ,
O( 1
• n PASS PARTIAL APPROVAL I 1 CANCEL n NO ACCESS
A FAIL KCALL FOR INSPECTION LI ADDITIONAL FEES ASSESSED
Inspector: % 1 V 6 VG Date: 1 1 67 Phone #: (503) 718- L"i-F