Permit IN a CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
1 COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00313
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/5/2008
PARCEL: 1 S136CD -00500
SITE ADDRESS: 08050 SW PFAFFLE ST 100 ZONING: C -
SUBDIVISION: PACIFIC CROSSROADS CORP LOT: JURISDICTION: TIG
PROJECT: FBR
Project Description: Low voltage for thermostats.
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: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: .
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
FBR OREGON HEATING & AIR CONDITIONING
10300 SW GREENBURG RD PO BOX 397
SUITE 375 TIGARD, OR 97223
TIGARD, OR 97223
Phone: 503- 647 -5416 Contact #: PRI 503 -538 -2953 .
FAX 503- 691 -8556
FEES Reg #: ELE LHR40
LIC 172126
Description Date Amount
[ELPRMT] ELR Permit 11/5/2008 $75.00
[TAX] 12% State Surch 11/5/2008 $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. -
c
Issued By: ��- _ �� - . ee Signature: 5 / �;�
4 ,-,--„, �
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.
•
• E- l.ectrical Permit •A lication FOR OFFICE i 5a : ONLY
City of Ti and R ccc 1v e 4
13125 SW Hall Blvd, Tigard OR 97 A Data/By;
an
Phone: 503.639 - 4171 Fax 503.598.1
0 • 4.0, `v'- :� > :, :: �i �iDtae/B Review Other Petmit:S 0 44 ! _,L(,L�yi,
Inspection Line: 503.639.4175 _ • a ' ; J„ Date Ready/By. ® See Pagel for
Internet www.citigard.or.us r V` ` ` Notified/Method &mph:meow mrormatlou
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❑ New wrist]T 1CtiOn Addison/: •.:.t !t\' - t ..- meat Please check all that apply.
❑ Demolition ❑Other; ['Service over 225 amps, control ❑Hazardous location
❑Service over 320 amps - ruing ❑Bu04ng over 10.000 sq. tr,
-r, : f!,� a y12..r �_ ,: ,/:^.: . ' : -7,3,; _Y'' 'a ' " :r ' ' ' ta ..,.3, : << ' of 1 - and 2 dwellings 4 or more new residential
/ r• s +l :d ..,''� , : ,..:....; G `�` .Ei0 4. . .,:. ,': . . ; 0 ' Y SS
❑ 1 - and 2- family dwelling Eq 0 Accessory building ❑System Ova 600 volts nominal units in one structure
El Multi-family ❑Master builder CI QOM: ❑Building over three stories ❑Fees, 400 amps or more
r, p ersons sfiuctures of
,,; -= : : : : :_: , :..;a Y �i�f1�M{l'FI(�+ : K•FJtOs�r . : �; �;- ;; : : ` : : '
Occu load over 99 u c
;...�...;. .,.,. w... ':.... �... P :filC ' :, " :- ... - : .� : : > 0 Egress/1iBhtin8plan V park R
lob no•: lob site ad dress ; j ❑Healrh - care facility .
Submit 2 sets of any with any of the e a aboveeve.
City /Statc/ZIP:" T nc - l �Gk, 3 .. The above are not applicable to temporary consnnetion service.
P' �• :.
SniteJbldg /apt no.: ( name: lag.... - .' �'�"k '' �;. 7 ..
, Sis~ ' „ F n _.
nert>wa Qtr >:e< rue i :
Cross Street/directions to job site: New residential single- or multi - family dwelling uait.
Includes attached game.
1,000 sq. ft or less I 145.15 4
Subdivision: I Lot no.: Ea. add'1500 sq. $ or portion 33.40 _1
Limited energy, residential 75.0(! 2
Tax map/parcel no.:
Limited energy, non - residential 75.00 2
t a' iLai�c+..f, '". "y� t ;r.' ,'.-`5 .�.: • ;�.^r, 3 7 ��... i ';:. _; i t's. 'Y- y�' I t1%`
at•., .c£?rj� :" s `p 'tC :ic!1Q : v .". .- }- gs :ji�.;3i`�`a a E��'.A "y' i' ':•i' .• Each manufactured OinlOdnlar
dwelling. service and/or Seeder 90.90 , 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 8030 2
• ,.�• „ - a •,Y : „ � �/ fir :" 201 arnpsto400 amps 106.85 2
'fi��':'" n .,,�.** n ±�, "(' =w ` +1'` P l i :.'�`f!j.l'1t. . ��Qt 4;6;V4'1,•1 Y,n
T. 3;.vti� :;t ' ,lw ,n,'-0!. rr!R ;'• :�F.i .err' :'.. , :! :..;xiFSnd : . ?r' :.'t';�= 9r�: l�r%�. ,.. .^.:, :.,.
x 401 arcs to 600 amps 160.60 2
Name: e? n nn 601 amps to 1,000 amps 240.60 2
Address: �� �,I. ,C (-- • Over 1,000 amps or volts 454.65 2
Ti Reconnect only 66.85 2
City/State/ZIP: - u�� j . Oa. k
e;3 Temporary or feeders installation, alteration, and/or
`
Phone: ( ) flax: ( ) relocation '- 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 arripS to 600 amps 1 33.75 2
Owner signature: • Date :, Branch circuits - new, alteration, or extension, per panel ,
a 4 ,I'� < :..,.: 044 , t4 F � :�4.;�a;;..r,rr
a..ir_ :.�f•'" Tt?�. , , w� r �. r ".,;� :2's A Pee for branth eircaits with
Y?iTi;�4T •4.P :.M.�. 't'M: ^. :n"l r±d ?'r :�l'C' }, ^: hi'a: ,; <.. •: , ?.'a ?)k1s :.5� €t�' q; ' :'. Q ,c_�1.. :,.;;';=m. "i'. es&
Service or feeder fee, 6.65 2
branch circuit
Business name: , i - .
0, Fee for branch circuits
Contact rrame: :± without service Of feeder fee,
each branch circuit 46.85 2
Address: Nr.. Each add'1 branch circuit 6.65 2
C i t y / S t a t e / T . . T P : - r - - - - . , y „Q iiid., ____` i ts _ Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2 _
Phone: () Fax: : (�j ‘. _ Sin or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
"° .s`'^ t'`r- ?: ,;p., ^i�'t ' :'CO 'cioa "` u ;`.Z :r. . . magi panel, alteration, or _
.� r
e �•
�. -�. :. ... _ t. 1�TIRA .. .. � :. extension Describe: erg 2
Business name: - t ✓,
Address: Each additional inspection over allowabk io any of the above
Per inspection - 62.50
City /State/ZIP: Investigation per hour (1 hr rein) 62.50
( ) : ( ) Industrial plant per hour 73.75
Phone r
� . . ., ... -_.- '��� .. . , �. �_ ��l] H. r�l�i .p�ria ■'I�]Fw�'. :`, ,. i•�.� ij
CCB Lie.: 1, Electrical Lic.: 1.) S uprv. Lie.: Subtotal -
Suprv. Electrician signature, required: Plan review (25% of permit fee) •
.
(keg � _ State surcharge AN, ofpermit fee) �, ,c1
'^'
Print name: C, , !r Dat e: I t •
TOTA P1ER PE E qs
Authorized signature: 4 , This permit applicattoo e p res if a permit is not obtained within 180
r� ! i% �. /t- days after it has been accepted as complete
Print name: ti Y _ Dare: I ( 4.- • Fee methodology set by T -Cownty Balding industry Service Board
.. Number of inspections per permit ailowed.
i:VautidieaTermirslELGPerm• • .3 44o-4ei trio ret/tOM/ama
•
E0 /TO 39Gd 9NI1C3H N09a10 9SS8 T59 - £05 0b:9t 8002 /b0 /TT
--
CITY OF TIGAR® -- _, ,_
6
BUILDING DIVISION PERMIT #: ELR2008-003 ►3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/5/20013
Phone: (503) 639 -4171 ICI A A ,
Inspection Requests (24 Hrs.): (503) 639 -4175 . '_ "_ _..
INSPECTION WORKSHEET FOR DATE: 11/19/2008 TIME: 7 :02AM PAGE: 22
SITE ADDRESS: 081)50 SW PFAFFLE ST 100 CLASS OF WORK:
SUBDIVISION: PACIFIC CROSSROADS CORP LOT #: TYPE OF USE:
PROJECT NAME: FBR
DESCRIPTION: Low voltage for thermostats.
OWNER: FBR, PHONE #: 603- 647 -5416
CONTRACTOR: OREGON HEATING & AIR CONDITIONING PHONE #: J03- 538 -2953
Inspection Request Scheduled For: Date: 11/19/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage C 4 % 0702 , 11 -01 503 - 538.2953 N
Corrections /Comments /Instructions: ( 11
SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: flilltg Date: /SL- iC9 R Phone #: (503) 718-
INSPECTOR'S SIGNATURES ARE NOT
Inspections Required for: Ze Fr - oc S Z REQUIRED ON GREEN INSPECTION CARD.
✓; Code I Inspection Description I PASS Date I By I ✓ Code I Inspection Description I PASS Date - I By
BUP - Building Permit ELC - Electrical Permit
405 Excavation 105 Underground /slab cover
410 Fill 110 Temporary electrical service
415 Grading 115 Electrical service
205 Footing >C 120 Electrical rough -in •
805 MFG - Structure grading /footing 125 Wall cover
210 Foundation walls 130 Ceiling cover
215 Footing drain 135 Low voltage
220 Slab 140 Sign installation
310 Crawl drain 145 A /C.or heating unit circuit
225 Post /beam structural 150 Hot tub /spa /pool
. 230 Underfloor insulation 195 Misc. inspection:
235 Shear walls /anchors X 199 Electrical final
240 Exterior sheathing
245 Firewall
250 Roof nailing ELR - Restricted Energy Permit
255 Wtr proofing basement walls 135 Low voltage
260 Tilt -up panel 195 Misc. inspection:
265 Masonry 199 Electrical final
270 Reinforcing steel (rebar)
275 Framing
810 MFG- Structure set -up MEC - Mechanical Permit
280 • Insulation 605 Post /beam mechanical .
285 Drywall nailing 610 Gas line
287 Suspended ceiling 615 Mechanical rough -in
295 Misc. inspection: 620 Hydronic piping
899 MFG - Structure final 625 Duct work
498 Grading final 630 Fire damper
299 Final inspection 635 Smoke detector shutdown
640 Exhaust hood
695 Misc. inspection:
699 Mechanical final
BUP - Fire Protection System Permit
905 Sprinkler underfloor /slab PLM - Plumbing Permit
910 Sprinkler rough -in
915 Fire alarm rough -in 305 Plumbing underslab
310 Crawl drain
• 920. Suppression trip test 315 Post /beam plumbing
995 Misc. inspection:
998 final Plumbing rough -in
999 Sprinkler final 322 Shower pan
330 Water service
335 Rain drain
340 Storm drain
SIT - Site Work Permit 505 Sanitary sewer
405 Excavation 345 Culvert/catch basin
410 Fill 350 Septic tank
415 Grading 395 Misc. inspection:
205 Footing , 399 Plumbing final •
•
210 Foundation walls
215 Footing drain
420. Sprinkler supply lines SWR - Sewer Permit
495 Misc. inspection: 505 Sanitary sewer
498 Grading final 595 ' Misc. inspection:
499 Final inspection 599 Final inspection
I:\ Building \Forms \InspCard- AOP- Blank.doc 02/02/07
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
�rrni ? r� nt ..tt7 "•� Y. �� it CF ��,`r�` { {li I .r { Fp _ .[ � �I
:, -t� a� `her.. ", , k, `r -,,,.. $ h.;, .�1; .r�-Z 9 Jll _.':_ 6 ifs ;li i;,,
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*
❑ O ther.
ig tit y' Et � {u '�g M t ;; t L 2 ts t �1 p; jr �
�l�.:u.,.4:_. J, u � „n:,t K 3 ,1,.,� ti :.C.. Z .. r ......4T � I{ � 1, �i at!L.0 �: ? � . �.�!^�dlr F'teJ'il'i
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
I- VAC
❑ 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
aluilO.ng\ PnmirAELC- PermiUpp.da 03/23/06
E0 /Z0 39Vd ONI1V3H N093ZIO 9558 - 169 -E0S 00 :91 800Z/00/II
CITY OF TIGARD
BUILDING DIVISION PERMIT #: U ZO . 003J3
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED:
Phone: (503) 639 -4171 I�L
Inspection Requests (24 Hrs.): (503) 639 -4175 �!.__..
INSPECTION WORKSHEET FOR DATE: ` ., 2 1 TIME: PAGE:
SITE ADDRESS: ' t 0 p U AF �m `i' I V 0 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 1- 2' Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments/ Instructions:
\\ \ 1
A /
/ \\/
I
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ____ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED I
I I
Inspector: G' . 06Q) 1....e Date: 1 • 2' 9 Phone #: (503) 718- .2-
1