Permit CITY T I G A R D ELECTRICAL RESTRICTED ENERGY PERMIT
AI DEVELOPMENT SERVICES PERMIT #: ELR2005 -00257
''` All DATE ISSUED: 8/31/2005
13125 S W Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S112BA -10800
SITE ADDRESS: 07886 SW PICKLEWEED LN ZONING: R -12
SUBDIVISION: BONITA TOWNHOMES LOT: 044 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 -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 8/31/2005 $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 et forth in OAR 952 -001 -0010
through OA 2490
01 -0100. You may obtain copies of these rules or direct ques'o to U C 5 46 - 6699.
Issued By: Permittee Signature: ` - i
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.
Electrie21 Permits ici ED
ecei
City of Tigard Date/B ved 103 U Permit �e2 P%67
13125 SW Hall Blvd., Tigard, OR 972tQ(iIy 2005 R 1 005 Plan Review
Phone: 503.639.4171 Fax: 503.598.1 ' " I ' • Date/By Other Permit:
Inspection Line: 503.639.4175 C TY OF TIGARD _.1,,� _�_I Date ReadyBy.. / ® See Page 2for
Internet: www.ci.tigard.or.us BU I LDING DIVISION Notified/Method Supplemental Information
TYPE OF WORK PLAN REVIEW
gi. New construction ❑ Addition/alteration/replacement Please check all that apply:
El Demolition ❑ Other: ❑Service over 225 amps, comm'I 0 Hazardous location
OService over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I - and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building OSystem over 600 volts nominal units in one structure
® Multi - family El Master builder ❑ Other: ❑ Building over three stories 0 Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION 0 Egress/lighting plan RV park
- 72 , g1, picat Wtr�1) '•. ❑He 2 car DOther:
Job no.: Job site address:
Submit 2 sets of plans with any of the above.
City / State/ZIP: ` a to A Q 1 o1-- The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: Q �� A � 1 C I. c Description
FEE* SCHEDULE
ll Descion I Qty. I Fee. I Total l -.
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.: t 4 Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential , 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular •
dwelling, service and/or feeder 90.90 2
UO I CFI U i oto / el u O1 n / .0 t .0 21 r 4 Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
IT PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 51.5 CtAS' 0 M 14 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 jai CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: Az mix-i--44 co MM u & i 6 4 'ad A) S branch circuit
B. Fee for branch circuits
Contact name: 30g � U5 t 2 6 without service or feeder fee, 46.85 2
Address: P.0_ (3o.. sob a
each branch circuit
Each dd'I branch circuit 6.65 2
City /State/ZIP: i4( LSOg ( IL F r n Q Q ? , Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: (S D3) -K3_ 2 61/ Fax:: (5b3 ) 6. -cm 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: A2iia.0 1-1- C OM Al 14 Aft eA no N S
Address: c U pie Sd 8 Each additional inspection over allowable in any of the above
Per inspection 62.50
• City/State/ZIP: (/0 1 L Soo J t L I. e , () 2 q 0V ]() Investigation per hour (I hr min) 62.50
Industrial plant per hour 73.75
Phone: (5 ) 6, 34 - 01/0 Fax: (5 63) 6 ? 9 - o i t S ELECTRICAL PERMIT FEES*
CCB Lie.: ( 4.58? g Electrical Lie.: 3b -9 yCLE Suprv. Lie.: Z3 /2 Leyl• Subtotal
Suprv. Electrician signature, required: / Plan review (25% of permit fee)
Print name: Z ee at 8 E Date: g/ 6 ., � St ate 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: I Date: • Fee methodology set by Tri- County Building Industry Service Board
•
Number of inspections per permit allowed.
i:\ Building \Pennits\ELC- PermitApp.doc 12/03 410- 461ST(10/02/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*
El Burglar Alarm
❑ Garage Door Opener* •
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum. Systems*
El 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
El Fire Alarm Installation
El HVAC
El Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
El Protective Signaling
•
El Other
•
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Pertnits\ELC- PermitApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005-00257
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/31/2005 •
Phone: (503) 639 -4171 4,
Inspection Requests (24 Hrs.): (503) 639 -4175 s' e7 I L.
INSPECTION WORKSHEET FOR DATE: 9/14 /2005 TIME: 7:09AM PAGE: 48
SITE ADDRESS: 07886 SW PICKLEWEED LN CLASS OF WORK:
SUBDIVISION: BONITA TOWNHOMES LOT #: 044 TYPE OF USE:
PROJECT NAME: BONITA TOWNHOMES
DESCRIPTION: ALL ENCOMPASSING low voltage.
OWNER: JLS CUSTOM HOMES, PHONE #: 503 - 533 -4006
CONTRACTOR: AZIMUTH COMMUNICATIONS INC PHONE #: 503 - 639 -0110
Inspection Request Scheduled For: Date: 9/14/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 015648 -05 503-209 -6038 N
Corrections/Comments/Instructions:
. t �
'5■1 .'ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CA FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: -1)5 Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005.00257
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/31/2005
Phone: (503) 639 -4171 i
Inspection Requests (24 Hrs.): (503) 639 -4175 .�'2� "'IL
INSPECTION WORKSHEET FOR DATE: 9/14/2005 TIME: 7 :09AM PAGE: 47
SITE ADDRESS: 07886 SW PICKLEWEED LN CLASS OF WORK:
SUBDIVISION: BONITA TOWNHOMES LOT #: 044 TYPE OF USE:
PROJECT NAME: BONITA TOWNHOMES
DESCRIPTION: ALL ENCOMPASSING low voltage.
OWNER: JLS CUSTOM HOMES, PHONE #: 503 - 533 -4006
CONTRACTOR: AZIMUTH COMMUNICATIONS INC PHONE #: 503-639-0110
Inspection Request Scheduled For: Date: 9/14/2005 Pour Time:
Code # Inspection Description - / Confirm # Contact # Message
199 Electrical final V 015648 -06 503-209-6038 Y
Corrections /Comments /Instructions:
1:d PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
, t4
, I �/
Inspector: Date: Phone #: (503) 718-