Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00179
.TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/27/2008
PARCEL: 2 S 102 C B - 00100
SITE ADDRESS: 12850 SW GRANT AVE ZONING: R -12
SUBDIVISION: CF TIGARD ELEMENTARY LOT: 041 JURISDICTION: TIG
PROJECT: BROADWAY ROSE THEATRE CO
Project Description: Installing (1) burglar alarm system and (1) fire alarm 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: X OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 2
Owner: Contractor:
TIGARD TUALATIN SCHOOL DIST. #23 PHILLIPS ELECTRONICS
6960 SW SANDBURG ST 1110 NW FLANDERS
TIGARD, OR 97223 PORTLAND, OR 97209
Phone: Contact #: FAX 503- 227 -4992
PRI 503- 222 -5083
Reg #: ELE 26- 2I3CLE
FEES LIC 125364
Description Date Amount
[ELPRMT] ELR Permit 6/27/2008 $150.00
[TAX] 12% State Surch 6/27/2008 $18.00 REQUIRED ITEMS AND REPORTS
Total $168.00
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 OA 952 - 001 -0100 You may obtain copies of these
rules or direct questions to OUNC at 503.246.6• " - 0.332.2344.
Issued By: ,L / 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.
. ctrical Permit Application eN FOR OH FICE USE ONLY 1
City of Tigard � Received
sateB : , "Ml�a<il�' /.�% permit No.: � 16.0 8` )I
- ° 13125 SW Hall Blvd., Tigard, OR 97223 an Review
• Phone: 503.639.4171 Fax: 503.598.1960 \ Y � Date Other Permit:
p
ection Line: 503.639.4175 , \`►
Ins ► y By: turh ® : See Page 2 for
TIGA q D ��
Internet: www.tigard- or.gov 1 � ' � \ od: Supplemental Information
G
TYPE OF WORK �� o PLAN REVIEW
❑ New construction Addition /alteration/replac�fA�\i� Please check all that apply (submit 2 sets of plans w /items checked below):
s 7"' ❑ 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.
Tess 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A "E ", "I -2 ", "I -3 ",
100HP or more. occupancy.
Job no.: Job site address:
E 0, ( t U t ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: – �)� % 72? 3 ❑ Health -care facilities. ❑ Supply voltage for more than
1 ( C1 { C / ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: al)CI.Gf (.UCti'f R. cAe 'ite ❑ 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'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.)
/ A Limited energy, multi- family
v G� 75.00 2
u"G i
g.dl i- /1-fa 4- F� ii �lfI 1P «pi residential (with above sq. ft.) _
J Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ 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, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ 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'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
`
/ //
Business name: Signal circuit(s) or limited -
p1 i 6 (. l t 2 L - y (0('&"O6t'c 1..L energy panel, alteration, or
r � / �, ��_ S / �L -- 2
Address: 1 ( l c; m., to, t c i T extension. Describe: 2 Page 2 7
City/State /ZIP: 1)L /`{{CC iti �� 0,,,97,e6-7 Each additional inspection over allowable in any of the above
f Per inspection 62.50
Phone: (S ) .2._.7--2- Fax: (Cg72_3 ) )27 -ef y 92 Investigation per hour (I hr min) 62.50
CCB Lic.: 1 k, 4 Electrical Lic.:�(243--CLi Suprv. Lic.: ? �3 Industrial plant per hour 73.75
! �/ ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: J14 e,a,„ Subtotal: Lr '
Print name: j t Date: Plan review (25% of permit fee): O
�� /27,h State surcharge (12% of permit fee): i
Authorized signature: TOTAL PERMIT FEE: /L7 7 r V
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.
I:\ Building \Permits\ELC- PcrmitApp.doc 05/23 /06 440 -4615T(11 /05 /COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT # 2Od8b OcWi
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 •
Inspection Requests (24 Hrs.): (503) 639 -4175 4
INSPECTION WORKSHEET FOR DATE: It. TIME: PAGE:
SITE ADDRESS: \ Z o,7 O 6 LA) G-tis S P 1 - CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: S I R.86
DESCRIPTION: f Q1 •
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: t-' 3 - Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments /Instructions:
1E41 N ; L i 6N 1143
PASS 1 1 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
14 VQ L3c Date: 2 3 Phone #: (503) 718 -Z„�`i
Inspector: r
CITY ��������������� ~ ^-- i � �.
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BUILDING DIVISION - • •
PERMIT u���ou~��xn��� ��o�o��n��o� #: ELA200800178
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/27/2008
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 ^all_t
INSPECTION WORKSHEET FOR DATE: 12/1/2000 TIME: 7:O0AM PAGE: 21
SITE ADDRESS CLASS � 1�860� SVV<�RANTAVE WORK:
SUBD|V|S(ON: CI: T|G/ D ELEMENTARY LOT #: 041 TYPE OF USE:
PROJECT NAME: BROADWAY ROSE THEATRE C0
DESCRIPTION: Installing (1) burglar alarm system and (1) fire alarm system.
OWNER: llQARDTUALATN SCHOOL CdST. #23. PHONE #:
CONTRACTOR: PHILLIPS ELECTRONICS PHONE #: 6O3_22��5O33
Inspection Request Scheduled For: Date: 12y1/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 07861I01 605'222-5083 N
Corrections/Comments/Instructions:
y�—C Cep-A L^, i\ 1^-'1` 4 4%_ V 12 /—J~'
ri PASS RARTALAPPRO\AL EI CANCEL Lil NO ACCESS
FAIL | 1 CALL FOR INSPECTION III ADDITIONAL FEES ASSESSED
/�
Inspector: L�--� c� '/ Date: /^� � / — � 0
~f
- ' Phone #: (503) 718-
�
/^�'
� . .
CITY OF TIGARD
BUILDING DIVISION r PERMIT #:
Et_R2008 -00 i 73
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/27/2.000
Phone: (503) 639 - 4171
Inspection Requests (24 Hrs.): (503) 639 -4175 �';`i "�__..
INSPECTION WORKSHEET FOR DATE: 10/3/2008 TIME: 7 :OOAM PAGE: 27
SITE ADDRESS: 12050 SW GRANT AVE CLASS OF WORK:
SUBDIVISION: C.f TIGARD ELEMENTARY • 041
#: 041 TYPE OF USE:
PROJECT NAME: BROADWAY R SE (Ht ATRE CO
DESCRIPTION: Installing (1) burglar alarm system and (1) fire alarm system.
OWNER: TIGARD TUALATIN SCHOOL D1ST. #23, PHONE #:
CONTRACTOR: PHONE #:
PHILLIPS ELECTRONICS 503-222 -5083
Inspection Request Scheduled For: Date: 10/3/2008
Pour Time:
Code # Inspection Description Confirm# Contact # Message
135 Love voltage 076252 -01 \ \ 503 -222 -5083 -- Y
Corrections /Comments /Instructions: f
i
� 1
v
— rwi f ELMO' '1 S IA Eb2 C2) Two Rov' ,14-1 Ki
+as G'10N5 mosL.. .
n PASS
XPAIRTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
1 1 FAIL • ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �� \ V U3 L Date:I/ 3($ Phone #: (503) 718- 2-41.117