Permit :' Ia CITY Y F TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 -00268
ca ��' DATE ISSUED: 9/19/2008
Tt
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4174 PARCEL: 2S102CB - 00100
SITE ADDRESS: 12850 SW GRANT AVE ZONING: R -
SUBDIVISION: CF TIGARD ELEMENTARY LOT: 041 JURISDICTION: TIG
PROJECT: BROADWAY ROSE THEATRE
Project Description: Low voltage for HVAC. Job No. 3200
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:
TIGARD - TUALATIN SCHOOL DISTRICT #23 ARROW MECHANICAL
6960 SW SANDBURG ST 10330 SW TUALATIN RD
TIGARD, OR 97223 TUALATIN, OR 97062
Phone: Contact #: PRI 503- 692 -1565
Reg #: ELE 34 -47CLE
FEES LIC 5193
Description Date Amount
[ELPRMT] ELR Permit 9/19/2008 $75.00
[TAX] 12% State Surch 9/19/2008 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
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 may obtain copies of these
rules ( r o direct question o OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: &_tg . Permittee Signature: '
OWNER INSTALLATION 0 ,
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.
n ��aF� , * 11'�''� .rK'�12'�` ,;11.440p sC�Y n �i ''+�I � $ n i7 �+ i�j M r'i t ,t: 'rc.
�+'leet>�ical Permit Application , , .F� SFO OFFI ONLY d ' rt -L
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71 Received � / 9 p � k,,, CXJ g „fa 0
City o f Tigard 7 Permit No.: js (O
° 13125 SW Hall Blvd., Tigard, OR 9722 Plan Review
' ';, Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit:
l
' "
Inspection Line: 503.639.4175 Date Ready /By: Jeri El See Page 2 for
IC A P
?: In www.tigard or.gov Notified/Method: ft > Supplemental Information
TYPE OF. WORK PLAN' REVIEW
❑ New construction (A 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 2 Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ","I - ", "I - ",
Job no.: 30po Job site address: 'j Z O &a/ 64640 47-, 10OHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: �t yat ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: t, "pAjx„GA/ P4,617 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I 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'I 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK .. (with above sq. ft.) 75.00 2 •
,+ Limited energy, multi - family 75.00 2
1 .0,4 Vev 6/},-/ v/r,t A:0-10 '7'57'117-5 residential (with above sq. ft.)
7 I Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
0 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 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, • er 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 it
Contact name:
without service or feeder fee, 46.85 2
.. tai. „0�c first branch circuit
i Each add'I branch circuit 6.65 2
!d
Address: 3?7e9 P �A 1/�77� Al Miscellaneous (service or feeder not included)
City/State /ZIP: 1 em 1.7062 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (60 eLye,_ g‘ -6 6 -- Fax:: (/93) 641— ) 7e( Reconnect only 66.85 2
E - mail: Pump or irrigation circle 53.40 2
CONTRACTOR • Sign or outline lighting 53.40 2
B Signal circuit(s) or limited -
Business name:
beet„,,,,,, rte► L`G Hot Al i . f b / energy panel, alteration, r ( Page 2 2
Address: &,'3- , . ,,,t,-7-01.14;714 Rd extension. Describe: \ \, I
City/State /ZIP: •7 0b /,�..n. o 47, 6 7 Each additional inspection over allowable in any of the above
/ Per inspection 62.50
Phone: (i )S) 4,4,z —/t ,r `� Fax: (C73 ) Gag r Investigation per hour (1 hr min) 62.50
CCB Lic.: 4143 Electrical Lic.: 3 L4 Suprv. Lic.: c, g Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES .. .
Suprv. Electrician signature, required: a (/d- Subtotal: 7c
Date: Plan review (25% of permit fee): r
Print name:
�i �it4 �/� /b /o'� State surcharge (12% of permit fee): 4
Authorized signature: • . TOTAL PERMIT FEE: di� /t
, A This permit application expires if a permit is not obtain d within 180
Print name: ,� - i / l9xC Date: V ` days after it has been accepted as complete. Il 4i
11'' / • Number of inspections allowed per permit. � b c
1:\ Building )Permits\ELC- Permit.4pp.doc 05/23/06 440 -4615T(11 /05 /COM/WEB
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*
n Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.0
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
❑ Other
Total number of commercial systems: j
*No licenses are required. Licenses are required
for all other installations
I:\Building\Permits\ELC- PermitApp.doc 03/23/06
CITY OyGARD •
BUILDING DIVISION 1 PERMIT #: ELR 2008.OU 2t;f3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/19/2(}(}13
Phone: (503) 639 -4171 - h' +
Inspection Requests (24 Hrs.): (503) 639-4175 ,_.41.1t
INSPECTION WORKSHEET FOR DATE: 12/222008 TIME: 7:0(1AM PAGE: 23
SITE ADDRESS: 12850 SW GRANT AVE CLASS OF WORK:
SUBDIVISION: OF TIGARD ELEMENTARY LOT #: t341 TYPE OF USE:
PROJECT NAME: BROADWAY ROSE THEATRE
DESCRIPTION: L voltage for HVA(. Job No. 3200
OWNER: TIGARD- TUALATIN SCHOOL DISTRICT #23, PHONE #:
CONTRACTOR: ARROW MECHANICAL PHONE #: W3
Inspection Request Scheduled For: Date: 1202008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135
1.ow voltage 070672 -01 503- 692 -1565 Y
Corrections /Comments/ Instructions:
1
. 1
tig PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
1 1 FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: KRY644 Date: Phone #: (503) 718- *____:___. _
.
F T :
CITY OGARD `
BUILDING DIVISION PERMIT #: ELR2008 -00263
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6 ,1.19/2008
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 1 L :
INSPECTION WORKSHEET FOR DATE: 11/26/2.008 TIME: 7:00AM PAGE: 10
SITE ADDRESS: 12850 SW GRANT AVE CLASS OF WORK:
SUBDIVISION: Cl: TIr ARD ELEMENTARY LOT #: Go TYPE OF USE:
PROJECT NAME: BROADWAY ROE THEATRE
DESCRIPTION: L..GVa voltage for HVAC. Job No. 3200
OWNER: TIGARD- TUALATIN SCHOOL DISTRICT #23, PHONE #:
CONTRACTOR: ARROW MECHANICAL PHONE #: 503 - 692 -1666
Inspection Request Scheduled For: Date: 11/26/2008 Pour Time:
Code # Inspection Description Confirm # Contact- # —_ Message
136 Low voltage {; tAc4 1 07856 ;3-01 r� ,, 3.692 -1565 Y ,/
Corrections /Comments / Instructions:
L
fro I. et;•6� 1 4 u,..„..� 4-u r s lf-e- --
T1 P. -S PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
_�.. AIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: , •� 4 Date: 11-16 . Phone #: (503) 718-
4
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CITY n m�pN— °r ' '
BUILDING ��UN��� ��U��U��U���� ' PERMIT ~�~""~~~�""°~= ~°" ° "~~"~~"~ � ELR2O0�O02G8
13125 SVVHaUB�d Tigard, ORQ72�3 DATE|SSUBl
` ~ . 911912008 Phona: (503) 83A~�171
Inspection Requests (24Hmj:(5O3)G3Q~4175 A-14
INSPECTION WORKSHEET FOR DATE: TIME: PAGE: � 10/29/2.008 � ?:O0Ah4 � 34
SITE ADDRESS: CLASS OF WORK:
SUBDIVISION: � 1 2850 S�/GF��N�[ AVE �
LOT #� TYPE OF USE:
� CF: TlGARD ELEMENTARY . 041 �
PROJECT NAME: � BR()ACWAY ROSE THEATRE
DESCRIPTION: � Lww vo|ioBo for HVAC. Job No. 3200
OVVNER PHONE #:
� llGAR(�TUALAT|N SCHOOL DISTRICT #23
CONTRACTOR� PHONE #: � /�RR0yVhAECHAN|{>AL � G03692'15,65
Inspection Request Scheduled For: Date 10f29/2008 Pour Time:
Code # Inspection Description Confirm-I Contact # Message
(7729Ioi\ 1J6 Lmmw�tagm 5O3'692'1665 �~ Y
-.~- -`
Corrections/Comments/Instructions:
\ / V - f\ OoN C�.�i
/
!
PASS 0 PARTIAL APPROVAL [1] CANCEL ri NO ACCESS
[11 FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
[�_, � |��/�/ «�-- �
Inspector: �� ` �,������� Date: ,LK�'�\�� Phone #: /603\ 718' )--
. ` . " ,
.