Permit l•
•t
ill n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00327
. TIGARD. 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/5/2008
PARCEL: 1 S136CD -00500
SITE ADDRESS: 08050 SW PFAFFLE ST 110 ZONING: C - P
SUBDIVISION: PACIFIC CROSSROADS CORP LOT: JURISDICTION: TIG
PROJECT: ACCOUNTAX
Project Description: Installing data telecommunication system.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PFAFFLE OFFICE LLC CONNECTIONS NW INC A WASHINGTON CO
915 NW TORREYVIEW LN 2501 NE 170TH CT
PORTLAND, OR 97229 VANCOUVER, WA 98684
Phone: 503- 619 -1040 Contact #: PRI 360 - 772 -0494
FAX 360 - 326 -1586
Reg #: ELE CLE143
• FEES
- LIC 179928
Description Date Amount .
[ELPRMT] ELR Permit 12/5/2008 $75.00
[TAX] 12% State Surch 12/5/2008 $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 or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: Q d , O Permittee Signature: Q O h
ApPli
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.
To: !Electrical Permits Page 5 of 6 2008-12-05 22:50:53 (GMT) 13603261586 From: Tom Jensen
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Electrical Permit Application GEN\IE I FOR OFFICE USE ONLY
111 ° City of Tigard
.5 - 0 9 Pennn " CI R 2
13125 SW Hall Hlvd., Tigard, Colt 9 _ Plan Review
Phone: 503 7 -t
.639.4171 Fax: 503.598.1960 • 5
■■ 8 Received r■
Date/By: tl_ C L.3
Dare/B 1 . 8 00327
Other Pcnnit: i ei s k o t p 2 OS .(3,a345
TIGARD Inspection Line: 503.639.4175 • % te Ready/By:
Internet: www.tigard-or goy (Ai. ItGR . 'ci ' ted/Nlethod: 1-1 Q., I Sup f t:formation
V NO" ' • • ,iset
761Tpf.)viati' , -.t.,tAmiv._:,„L.,‘::r . :=,:- . . ,,, : :,,,,:i,:
Z New construction 0 Additinn/alteM ement
Please check all that apply (submit 2 sets of plans writems checked below):
0 Service 01 feeder 400 amps or more 0 Building over three stories.
El Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
,. ...: '.. .-..?7;, - .':. i.- :: , cONgrapt:IION:' ,':•";', T. ..'" . .1 . 4 ,1:.:. exceeds 10 amp: at d 1 s 50 14 v 00 olt o s or E c Floatin e g:tti i ldings b . ,
ricultinal
0 1- and 2-family dwelling El Commercial/industrial 0 Accessory building amps for all other installations. buildings.
I:I Multi-family 0 Master builder ID Other: 0 Fire pinup. CI Installation of 75 KVA or
larger separately dent-A system.
' j":',`:l"„- AND LOCATION '.., .. :::: :.--- ■ - ,
,.., Addition of new motor load of 0 "A", ''E'',"1-2", ''l - 3",
10011P or more. occupancy.
Job no.: 870 Job site address: 8050 SW Pfaffle
0 Six or incoe residential units. 0 Recreational vehicle paths.
City/State/ZIP: Tigard, OR 97223 0 Health facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg/apt, no.: 1 i 0 Project name: Account Tale 0 SCINICe or feeder 600 stops or mom.
- - FEE SCHEDULE
Cross street/directions to job site: Hall Blvd and Pacific Hwy Description -- r Qty. I Fee. I Total I •
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. ft. or less 145.15 4
Ea. addi 500 sq. 11. or portion 33.40 , I
Tax mapiparcel no.: Limited energy, residential
75.00 2
‘,:',.....:'' tiCwottic.::,::,:;:::-...-:1,:'::-17:':::.=;';: (With above sq. 0) --
Limited energy, multi-family
Datacom work only residential (with above sq. 0.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
Ef:;1'12;0160741'.0"002 ':' ::- a Tir -S-,:.--:-- zo I amps to 400 amps ___ 106.85 ..
Name: Account Tax _401 amps to 600 amps 160.60 2
601 amps 10 1.000 amps 240.60 2
Address: 8050 SW Pfaffle Over 1.000 amps or volts 454.65 2
City/State/Z1P: Tigard, OR. 97223 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (NA) Fax: ( ) 200 amps or less 66 85 I
Owner installation: This installation is being made on property that I own which iS not 201 snips In 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 - :',. :,,,..1.: :-. 0 . :CONTACT i■ER,§iiN above service or feeder fee,
6.65 2
' _ each branch circuit
Business name: Some B. Fee for branch circuits
without service or feeder fee.
Contact name; Tom Jensen 46.85 2
first branch circuit
Address: 2501 NE 170 Court Each add'I bnmeh circuit I I 6.65 Ti
Miscellaneous (service or feeder not included)
City/State/ZIP: Vancouver, WA. 98684 Each manufactured or 'nodular
90.90T 2
dwelling, service and/or feeder
Phone: (360) 7720494 Fax: : (360) 3261586 Reconnect only 66.85 2
E-mail: tjensen®connectionsnw.com Pump or irrigation circle 53.40 2
.....'
CONTRACTOR :-.;--..-. J. Sign or outline lighting 53.40 2
Signal circuit(s) or limited-
Business name: Connections NW Inc, a Washington Corporation energy panel, alteration, or I 75.00
Address: 2501 NE 170 Ct extension Describe: Page 2 2 i
City/State/ZIP: Vancouver, WA. 98684 Each additional Inspection over allowable in any of the above '
l'cr inspection 62.50
Phone: (360) 7720494 Fax: (360) 3261586 Investigation per hour (I hr min) 62.50
1 2 .3 1 .09 CCB Lie.: 179928 Electrical Lie.: CLEI 43 Suprv. Lie.: 8591J Industrial plant per hour 73.75 _
- 7 • 11-1 -- : - ..;;,: : :E:::: ;-'-.;-:::,... ILECTIOCAVpgRMIT:.FEFs..f"::' . , • ' - .'
Suprv. Electrician signature, I Subtotal:
Print name: Tom Jensen f Date: 12/5/08 Plan leview (25% of permit fcc)'
Stale surcharge (12% of permit fee): 9.00
Authorized signature: TOTAL PERMIT PEE: 84.00
i This permit application expires if a permit is not obtained within 180
Print name: Thin Jensen Date: 12/5108 days after it has been accepted as complete.
• Number of inspections allowed per permit
I 'ND/lading \ Permits \ ELI: -Permit App doc C15/ 3.13t, 440.4515T( I tiosicommtza
To: Electrical Permits Page 6 of 6 2008 -12 -05 22:50:53 (GMT) 13603261586 From: Tom Jensen
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
•
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garagc Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other.
Fee for each commercial $75.00
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
❑ 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
P\ O�ildirg \penniti.ELC•permitApp.doc O3RI /06
CITY OF TIGARD
BULL4DING DIVISION
PERMIT #: ELR2008-00327
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/6000t1
Phone: (503) 639-4171 1, t
Inspection Requests (24 Hrs.): (503) 639-4175 .„_.,.. ,..--.
INSPECTION WORKSHEET FOR DATE: 1/912009 TIME: 7:01AM PAGE: 9
SITE ADDRESS: 08050 SW PFAFFLE ST - 110 CLASS OF WORK:
SUBDIVISION: PACIFIC CROSSROADS CORP LOT #: TYPE OF USE:
PROJECT NAME: ACCOUNTAX
DESCRIPTION: Installing data telecommunication system.
OWNER: PFAFFLE OFFICE LLC, PHONE #: 503619104g
CONTRACTOR: C-ONNECTIONS NW INC A WASHINGTON CO PHONE #: 360-772-0494
Inspection Request Scheduled For: Date: 1/912009 Pour Time:
Code # Inspection Description Confir : Contact # Message
199 Electrical final 079552-07 503-201-5718 N
) .
Corrections/Comments/Instructions:
i -
V
Ell PASS 0 PARTIAL APPROVAL Ei CANCEL 0 NO ACCESS
0 FAIL fl CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: 5 ---- (0 oe (....6 Date: L '9 , 19 Phone #: (503) 718- 14410
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CITY OF TIGARD
BUX-DING DIVISION PERMIT it; FLR2008-00327
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: .12/512008
Phone: (503) 639-4171
Inspection Requests (24 Hrs (503) 639-4175 LL
INSPECTION WORKSHEET FOR DATE: 12/22/2008 TIME: 7 PAGE: 4
SITE ADDRESS: 08050 'SW PFAFFLE ST 110 CLASS OF WORK:
'SUBDIVISION: PACIFIC CROSSROADS CORP LOT #: • TYPE OF USE:
PROJECT NAME: ACCOUNTAX
DESCRIPTION: Installing data telecommunication system.
OWNER: PFAFFLF OFFICE LLC, PHONE #: 503.619.104
• CONTRACTOR:- CONNECTIONS NW INC A WASHINGTON CO PHONE #: 360.7710494
Inspection Request Scheduled For: Date: 12/22/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
1 3 5 Low voltage 079185- 02 503-201-5718 N
Corrections/Comments/Instructions:
•
•
PARTIAL APPROVAL El CANCEL 0 NO ACCESS
0 FAIL CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
nspector: dg54744/S-. • - Date: 2 - - 2 7 - Phone #: (503) 718- • •• . • •
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