Permit CITY TIGARD ELECT' RICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 -00256
c 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/31/2005
PARCEL: 2S112BA -11700
SITE ADDRESS: 07883 SW PICKLEWEED LN ZONING: R -12
SUBDIVISION: BONITA TOWNHOMES LOT: 053 JURISDICTION: TIG
Project Description: ALL ENCOMPASSING low voltage
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: X AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: X BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: X CLOCK: MEDICAL:
HVAC: X DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: X FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: ALL ENCOMP : X 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 -53 -4006 Phone: 503- 639 -0110
Reg #: ELE 36 -94CLE
SUP 2312LEA
FEES LIC 145828
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 8/31/2005 $75.00
[TAX] 8% State Surchari 8/31/2005 $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 ar t orth in OAR 952 - 001 -0010
through OAR 952- 1 -0100. You may obtain copies of these rules or direct questio s U Ca t 3- 246-6699.
Issued By: 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.
Electrical Permit AppI C,,IEIVE ismof•rlcl.: USE ONLY
City of Tigard D Received
atemY D 31 Permit No.��= �+ / J ....00,A.
13125 SW Hall Blvd., Tigard, OR 97223 AUG 31 200 Plan Revie
Phone: 503.639.4171 Fax: 503.598.1960 a' -, : I ' Date/By Other Permit:
Inspection Line: 503.639.4175 CITY OF TIGA':.: -:� . I . Date Ready/By: June: ® See Page 2 for
Internet: www.ci.tigard.or.us BUILDING DIVISION Notified/Method: Tid Supplemental Information
TYPE OF WORK PLAN REVIEW
El New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l 0 Hazardous location
['Service over 320 amps - rating ['Bulldog over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1 - and 2- family dwellings 4 or more new residential
❑ 1 - and 2 family dwelling ❑ Commercial /industrial ❑ 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 over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: Job site address: • 7983 Siu pale,, ; ❑Health -care facility ❑mar
Submit 2 sets of plans with any of the above.
City /State/ZIP: 1 0 i2- The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name: B 0%01TPc Q LAN CE Description I Qty. Fee, I Taal 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.: 53 Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 1 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
AUDIO dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
I® PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 3 C uSTo t ►A 0 O'■E 5 601 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
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 Et CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: A 2.1 r"_Th C+ N c 4TLONS branch circuit
B. Fee for branch circuits
Contact name: 2, (3 uLJ f., without service or feeder fee, 46.85 2
((��
each branch circuit
Address:
P.0 • Bc 50e Each add'I branch circuit 6.65 _ 2
City / State/ZIP: ( I LSOfv di L L E , og_ C7 7 V Miscellaneous (service or feeder not included)
Phone: (5b) '7 q -2:37 Fax: (S 3) 63 4 - 6 u / 5
Pump or irrigation circle 53.40 2
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- ( / r -i Cc) MM LAA) 1 CA 7) d rJ S -
Address: P0- g D v !, 0 O Each additional inspection over allowable in any of the above
'. Per inspection 62.50
City /State/ZIP: W 1 I L S 60,4 L L LE o e '( (� 707 ! Investigation per hour (1 hr ' ) 62.50
Phone: (5 ) 1 Fax: (� 639 _a�i� Industrial plant per hour 73.75 _
6� - 0 /�p ELECTRICAL PERMIT FEES*
CCB Lie.: 1 LI 5 g - I Electrical Lie.: 36- It a Suprv. Lie.: Z3 i 2 LC-ick Subtotal
Suprv. Electrician signature, required: RAji Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Print name: Re, 7 , aLe ,26 ate: g13 16s--
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: • Fec methodology set by Tri- County Building Industry Service Board
• • Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PemlitApp.doc 12/03 440.4615T(10/02/COM/WEB
Electrical Permit Application City of Tigard . •
Page 2 - Supplemental Informatio
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
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:
COMMERCIAL WORK ONLY:
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:\ Building \Pcrmits\ELC- PcmitApp.doc 04/03