Permit •
CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
Akt, DEVELOPMENT SERVICES PERMIT #: ELR2005 -00250
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/25/2005
PARCEL: 2S112BA -10400
SITE ADDRESS: 14491 SW PENNYWORT TERR ZONING: R -12
SUBDIVISION: BONITA TOWNHOMES LOT: 040 JURISDICTION: TIG
Project Description: Security.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: X BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
JLS CUSTOM HOMES AZIMUTH COMMUNICATIONS INC
16280 NW BETHANY P.O. BOX 508
BEAVERTON, OR 97006 WILSONVILLE, OR 97070
Phone: 503 -533 -4006 Phone: 503- 639 -0110
Reg #: ELE 36 -94CLE
SUP 2312LEA
FEES LIC 145828
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 8/25/2005 $75.00
[TAX] 8% State Surcha 8/25/2005 $6.00
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 may obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: ,� Permittee Signature: Q3 L--
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 roll orrich: ush: oNLY
City of Tigard
�`�\ ° nae/B . ; d "..--..C., Permit No.: JO l 11.7) 13125 SW Hall Blvd., Tigard, OR 9 rt'TLG Plan Review
Phone: 503.639.4171 Fax: 503.59810 h �o1S� '"747. � Date/B . Other Permit: •
• Inspection Line: 503.639.4175 r . 1 _ J_ _ +i Date ReadyBy: ® See Page 2 for
Internet: www.ci.tigard.or.us ki Notified/Method Supplemental Information
.,n
TYPE OF ( WO - ftI k S PLAN REVIEW
❑ New construction ❑ Addifib ( t tm kreplacement Please check all that apply:
❑ Demolition ❑ Othe'V` ❑Service over 225 amps, comm'l 0 Hazardous location
❑ Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
. CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building OSystem over 600 volts nominal units in one structure
Multi- famil ❑ Master builder ❑Other: ❑Building over three stories ['Feeders, 400 amps or more
DOccupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: Job site address: 4L4C 1 S iJ pewApit,30gT 1S' ❑Health care facility ❑Other:
Submit 2 sets of plans with any of the above.
City / State/ZIP: - T - 1 . 64,2.0 o K.- The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: 1 Project name: ': N ,t ?LACE Description
FEE* SCHEDULE
on I Qty. I Fee. I Total I
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential q° 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
S C - (LtTy dwelling, service and/or feeder 90.90 _ 2
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
401 amps to 600 amps 160.60 2
Name: fL,S CU.S)`dM I-I-OM ES 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 I I CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: A 2-1 rtu, coA CA 7 »J branch circuit
��., B. Fee for branch circuits
Contact name: ' Q ICJ (.1. G without service or feeder fee, 46.85 2
/� each branch circuit
Address: O, 1J D� 5 o& /� Each add'l branch circuit 6.65 2
City/ State/ZIP: L) 1 - 5010) Lit. , 0(2 4i 0-]D Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
• Phone: (5Q )1OJ 3 - zg 1.e- Fax: : ( S0 63r .0 ! I S Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: A 2 t4 . (( ,.D. 4 . COrbt M u Nt c,4T o tv S
Address: R () - 0 Sod, Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: (3( I-So ki J ( LLE , 0(2 ei 7076 Investigation per hour (1 hr min) 62.50
7 Industrial plant per hour 73.75
Phone: (56) ( 3e1 _6 I t D Fax: (rjo3) Co 39 (,l I ELECTRICAL PERMIT FEES*
CCB Lic.: ( N 5 S 2S Electrical Lic.: 3 b [ iii c LE Suprv. Lic.: .130 LE}4 Subtotal
Suprv. Electrician signature, required: l al---y Plan review (25% of permit fee)
•
Print name: 2, Qcl u t-gea6 Date: g / OS.--- State surcharge (8% of permit fee)
TOTAL PERMIT FEE
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.
is\ Building \Permits\ELC- PermitApp.doc 12/03 440.4615T(10/02/COMIWEB
Electrical Permit Application - City of Tigard
• Page 2 - Supplemental Information w •
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
El Audio and Stereo Systems*
❑ Burglar Alarm
El Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
•
Check Type of Work Involved:
El Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
El Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
❑
•
Medical
El Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Pamits\ELC- PamitApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION , , A PERMIT #: ELR2005 -00250
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/255/2005
Phone: (503) 639 -4171 1
Inspection Requests (24 Hrs.): (503) 639 -4175 I �..
INSPECTION WORKSHEET FOR DATE: W29/2005 TIME: 7:13AM PAGE: 76
SITE ADDRESS: 14491 SW PENNYWORT TERR CLASS OF WORK:
SUBDIVISION: BONITA TOWNHOMES LOT #: 040 TYPE OF USE:
PROJECT NAME: BONITA TOWNHOMES
• DESCRIPTION: Security.
OWNER: JLS CUSTOM HOMES, PHONE #: 503 -533 -4006
CONTRACTOR: AZIMUTH COMMUNICATIONS INC PHONE #: 503 - 639-0110
Inspection Request Scheduled For: Date: 8/29 /2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 014465.01 503 - 209-6038 Y
Corrections /Comments /Instructions:
, ---)
/ '
/ (r_
I
IA PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
/❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 5-:-7-Q � Phone #: (503) 718-