Permit . •
CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
4 DEVELOPMENT SERVICES PERMIT #: ELR2006 -10001
' ll 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 2/28/2006
PARCEL: 1S134BC-00200
SITE ADDRESS: 12192 SW SCHOLLS FERRY RD ZONING: C -G
SUBDIVISION: GREENWAY TOWN CENTER LOT: JURISDICTION: TIG
Project Description: Limited energy 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: 1
Owner: Contractor:
ELLIOT ASSOCIATES HUNTER DAVISSON
50 SW PINE ST SUITE 200 1800 SE PERSHING
PORTLAND, OR 97204 PORTLAND, OR 97202
Phone: 503- 972 -7192 Contact #: PRI 234 -0477
FEES Reg #: LIC 26-682CLE
Description Date Amount
[TAX] 8% State Surchart 3/31/2006 $6.00
[ELPRMT] ELR Permit 3/31/2006 $75.00 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 . ' :: says of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you • follow rules a0.5 e. by e Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 - 0010
thr • ugh OAR 952 - 0100. •u may obtain copies of these rules or dire .uestions to OUN - at503- 246 -6699.
Is ed By: / / ! Permittee Sig at , J�;�' , . •
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.
Electrical Permit Application ® �� " � , 4,5 4 -g 1 � I I �c 1 1 ' I ( I) r r
y •+r�Y w �'} , . M 1 -;a r..:�.....a� ar.`',.__ , wVi �, ,. , 1 ,1:,T..,:',,
City of Tigard • \,- GE's 4,0,6 Permit xa: f .,24/40o– loop /
. 13125 SW Hall Blvd., Tigard, OR' °`,r Plan Review
Phone: 503.639.4171 Fax 503. 98.1960 0 6 J , Date/ . Other Permit:
Inspection Line: 503.639.4175 r �g 2 a 20 r 4 !!? Date Ready/By. ®See Page 2 tar
Internet: www.ci.tigard.or.us f Notified/Method: WI Supplemental Information
r p in t t . S S i � iu `' ` -. t 8 1
<3 {' -. „� . '+;' «.+..sdt y y �'` y �S �''�, , a ` r, a C„ r..,, 0•44, '# �`° ' r " - �` " . any.. ?
❑ New construction ; i 00. 'latI. on/replacement Please check all that apply:
❑ Demolition ❑ Other ['Service over 225 amps, comm'I ❑Hazardous location
N „,� ❑ Service over 320 amps – rating ❑ Buildng over 10,000 sq. ft.,
.
It , u C T itsfo O `._ ;a ;',k-�,�:c ~ of 1- and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling Commercialfmdustrial ❑ Accessory building ❑ System over 600 volts nominal units in one structure
❑ Multi family ❑ Master builder ❑ Other: ❑Building over three stories ❑Feeders, 400 amps or more
_ ❑Occupant load ova 99 persons ❑Manufactured structures or
al-,,,,,,„ �
GL�CAiION ''.3f �JO. B `S�T,�`�., .' �. ,,,�„ -., �.�.x�T�N�»n� � ��- ' ❑ Egress/lighting Plan RV park
Job no.: I Job site address: 1 Z l (f� 5h) S f,A�, / / l re /✓ ,f f w ❑Healthc d
are facility ❑er:
Submit 2 sets of plans with any of the above.
City/ State/ZIP .C;0,,`J M t� 72 The above are not applicable to temporary construction service.
Suite/bldg. /apt no.: Project name: lk/ �t..3 ; .� _. a :: l , 1 & ^ '
Description Qtr Fee. Total
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. it or less 145.15 4
Subdivision: I Lot no.: Ea. add'I 500 sq. R or portion 33.40 1
Tax map /parcel no.' Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
: a AROjt r i, -')'4A.- ! B1 i. ... QNT bit �VOR1t , r �b`' ' . ' .,' Eac manufacdued er modular
A / �" dwelling, service and/or feeder 90.90 2
200 amps or less 80.30 2
/T tr�G/ i vi "Le /Il?d �` hCl / {�Pr � � f �ti� Services or feeders installation, alteration, and/or relocation
',t / (14--- , j �r�� v � I r /.- y
. i ., mp, ,, '1 ' A ��.. =u < _ we , r ® t, b 201 amps to 400 amps 106.85 2
,_': .,.,r. a" -'''' h to ` " 4: .nip _ .., .b . , < s "�. : 401 amps to 600 amps 160.60 2
Name: / I , - 6 , 14,7 ' J f' 601 amps to 1,000 amps 240.60 2
Address: Co Sbtz ( pip e sr— SG.i�� z..€ o Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/ State/ZIP: "j )G , f1 / a q7 2, y Temporary services or feeders installation, alteration, and/or
Phone: (5 )J ) 6/7. — 7/92.,. I Fax: ( ) relocation
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
NtagMjK ,Pg rtA'i `i , - ' ^` 3 tlreO1�Td'ACk' PERS !N ift i A. Fee for branch circuits with
� ,�_ service or feeder fee each
Business name: 7 i / -t�e Y ?e 1 c c O� „11AC . branch circuit 6.65 2
/ B. Fee for branch circuits
Contact name: 4/ti 2'h without service or feeder fee, 46.85 2
each branch
Address: /$ ° S 7ese t 1/1 ra ncch h circuit circuit \ J Each a dd'1 branch 6.65 2
City/State/ZIP: pdy 4-' c ,, vt CI 672 7 Q 7 Z O Z Miscellaneous (service or feeder not included)
Phone: ( ) Z i t ••• 6 1 Fax: • (SO3) 5 ' Z - 3 L ( Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
r`� ; �,t e '"' r ''< ener el, alteratio O
��' ,.��':xy��" . �.,�'` "`s��,i.CO s � . �..r.�. _ � ��, -;r�� gY Pan � r �
n
extension. Describe: 1. Page 2 i7 2
Business name: WI L° T'� s P , � , . , 4 4.,
v Each additional inspection over allowable in any of the above
Address: $ A
Per inspection 62.50
City/State/ZIP: I w/ � Investigation per hour (1 hr min) 62.50
Phone: ( ) ` yt �
l G g I Fax ( ) 0-
lY Industrial plant per hour 73.75
�
€ ITItt rl ELECTR I AI 'Pfit1�T11 *,a—
CCB Lic.: D /.,(Z I Electrical Lic.: Zia -( a " uprv. Lic • Subtotal 75 Oct
Suprv. Electrician signature, required / ` " ll� Plan review (25% of permit fee)
State surcharge (8% of permit fee) Da
Print name: , 9c? v,i�, , '. _ l te: 2- -2,7_ 64'
,
TOTAL PERMIT FEE CO
Authorized signature: / 1 , / This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: (2t /t. r ������ —
L/ Date: Z 7 -dot • Fee methodology set by Td -Canty Building Industry Service Board
• • Number of inspections per permit allowed
i:l BuildingTennits \ELC- PermitApp.doc 12/03 440- 4615T(10/O2ICOM/WFB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
EM .1:=74= itrietaMMX
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:
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
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
i: BuildingTemiits \EL,C- PennitApp.doc 04/03
CITY OF TIGARD (=ZC
BUILDING DIVISION PERMIT #:a7066, dit/
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 ° ���,����«�11ijk
Inspection�iequests (24 Hrs.): (503) 639 -4175 _�. °:
INSPECTION ORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: / oZ ( Ci F Z��y _, CLASS OF WORK:
SUBDIVISION: LOT #: a TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Schedule. For: Date: 3 - - 0 Pour Time:
Code # Inspection Des iption Confirm # Contact # Message
19 9 • : 0 6 93 - 6 e'a
Corrections /Comments /Instructio , s: 91 Q' I o v
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1
AB gL iLEs
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PASS Li PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL 1 I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G . • WO � `'■ � Date: l�0 Phone #: (503) 718- 1-