Permit 1 L CITY OF T I G® D ELECTRICAL RESTRICTED ENERGY PERMIT
e ® PERMIT #: ELR2008 00309
I' COMMUNITY DEVELOPMENT DATE ISSUED: 11/4/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25101 DD - 00300
SITE ADDRESS: 07100 SW SANDBURG ST ZONING: I -P
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: AMERICAN LASER
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: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: :
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
HAYTER FAMILY LIMITED PARTNERSHI VAN AIR & CONTROLS LLC
23643 SW STAFFORD HILLS DR 13327 S GLENN DR
WEST LINN, OR 97068 MULINO, OR 97042
Phone: Contact #: PRI 503- 632 -5991
FAX 503- 632 -8672
FEES Reg #:
Description Date Amount
[ELPRMT] ELR Permit 11/4/2008 $75.00
[TAX] 12% State Surch 11/4/2008 $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: ermittee Signature: � i� ; Ap ,
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.
Nov 04 08 10:22a Greg Van Damme 503 - 632 -8672 p.3
i
El:tctrical Permit Application `! ' � ;r - � �c ,�:.-� . . oR . 9 1 1 'Flo a
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sft Received /
City of Tigard , QO i emit No.: --C/6i:
i 0.1V
Date:'Bv': t 13125 SW Hal! Blvd., Tigard, OR ` ® � (� Pl an Rcv icvv ' .
4 ' = Ph one: 503.639 4171 Fax: 503.598.1960 V �lv Other Permit: ^
}I .>< Inspection Line: 503.639.4175 \*`'' �� ���� � ate Ready/By Other
j QJ a Page 2 far
N ee Internet: www.tigard- or.gov , O + f N� Notified44elhod: �CD f Supplemental Information
TYPE OF WORD 9�� PLAN REVIEW
❑ New construction ,Addition /altemtiorticement Please check all that apply (submit2 sets of plans w4lents checked below):
❑ Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 snips at 150 volts or ❑ Floating buildings.
Icss to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling JX1 Commercial/industrial ❑ Accessory building amps for all other installations buildings.
❑ Multi- famil ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Aon system. larger separately domedsystem.
❑ Addition of of new rnetor load of ❑ "A" °F" "I 2" "I
Job no.: Job site address: 7100 Jr ' IOO r' cc e r occupancy.
r Ds ix er more residential units. ❑ Recreational vehicle parks
City'Siate. /ZIP: ❑ Health -care facilities. ❑ Supply voltage far more than
�i D� 72 2 3 ❑ Ha2rirdou, locations. 600 volts nominal.
Suite!bldeiapt. no.: / Project name: AmU p ���� � el... ❑ Service or feeder 600 amps or more.
job `r J` FEE SCHEDULE Cross street/directions to ob site: D F •
DemitNion QtY. l rn Total
- b , , 7 �j New residential single- or multi - family dwelling unit.
'�J ({,c �� I do �W 1 72 J� Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK {with above sq. ft.l
Limited energy. multi - family 75.00 2
.4.3- • if . . ' • 1.: a • /L 11 S /Ital ..s. r residential (with above sq. R )
4-es Services or feeders installation. alteration, and /or relocation
�� (144/ 200 amps or less 80.3D 2
PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name:�� /1 /� L �,,, / 401 amps to 600 amps 140.60 2
, �`y .7 V'l/ 601 amps to I,ODO amps 240.60 2
7 /a S ki( Address: Ski( , / 4 : ' y I Over 1,000 amps or volts I 454.65 2
City/State/ZIP: • Temporary services or feeders installation, alteration. sad /or
(� relocation
Phone: (50i) 6 ,2 3 _ as? Pax: i,5p3) 38 y 4 200 amps or less 66.85 - 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 loupe 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, er panel
Owner signature: Date: A. Fee for branch circuits with
A APPLICANT [CONTACT PERSON above service or feeder fee, 6.65 2
r � ) Alt n � ��� each branch circuit
Business name: l �f 3. Fee for branch circuits
Contact name:6 tr. d
/ f .�1 without service or feeder fee, 46.85 2
first branch circuit
Address: 1 5, 6/ervA add') branch circuit 6.65 2
JJKJ l D1iscellaneous (service or feeder not included)
City,'State /ZIP: 14 J � O O��0� � U Each manufactured or modular 90.90 2
- VtW `� dwelling, service andior feeder
Phone: ( • ) • Fax: : ( • ) , - � - _ � Reconnect only 66.85 I 2
-
E -mail: Pump or irrigation circle 53.40 2
CONTRALTO' Sign or outline lighting 53.40 2
Business name: , Signal circuitts) or limited-
! ; Jim / / .1 Jiff ' _ .,,.1 energy panet, alteration, or 1 ^S ,�
Address: 1 , extension. Describe: 1 Page 2 / 2
014111321 ■
1 a 1 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ' 1 ) ` _ Fax: ( • I to - -� Investigation per hour (1 hr min) 62.50
CCB Lic.: 57 ! 4 f • b � . 2 Supry . Lie.: r w Industrial plant per hour 73.75
0r - = ELECTRICAL PERMIT FEES
Suprv. Electri re required - Subtotal: 13 75 0)
MI J_ l�• Plan review (25 %ofpemtit fee):
l�7.vR � .La..� • Date: �_ 7 �• State surcharge (12% of permit fee): _ r 00
Authorized signature: I 'SAM TOTAL PERMIT FEE: A gut co
� � �
• This permit application expires if a permit is nut u pturned within 180
Print Harr:: y Emit r 1 r IA ' Date: dnys after r if has been accepted as complete.
^� ' Number of inspections allowed per permit.
1 BuildingWcrmitrELC- PemitAap.doc 05/21/06 340 -461 ST(l I /0'- /COM/WEB
Nov 04 08 10:23a Greg Van Demme 503 - 632 -8672 p.4
' Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information ' -e631 C ' ) 7
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for a residential systems combined ... $75.00
Check Type of Work Involved:
0 Audio and Stereo Systems*
O Burglar Alarm
n Garage Door Opener*
• Heating, Ventilation and Air Conditioning System*
• Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercia3 $75.00
syste in
(SEE OAR 918- 309 -0000;
Check Type of Work Involved:
O Audio and Stereo Systems
O Boiler Controls
Clock Systems
• Data Telecommunication Installation
El Fire Alarm Installation
HVAC
Fl Instrumentation
E Intercom and Paging Systems
O Landscape Irrigation Control*
• Medical
Nurse Calls
El Outdoor Landscape Lighting*
O Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
n NAuildutgTmnitc.ELC.PennitAPP doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2000-00309
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1114/2U06 I
Phone: (503) 639 -4171 ." ,, " p � i & t i L
Inspection Requests (24 Hrs.): (503) 639-4175 =.
INSPECTION WORKSHEET FOR DATE: 2/3/2009 TIME: 7:00AM PAGE: 25
SITE ADDRESS: 071011 SW SANDBURG ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: AMERICAN LASER
DESCRIPTION: Lo vv voltage for thermostats.
OWNER: HAYTER FAMILY LIMITED PARTNERSHI, PHONE #:
CONTRACTOR: VAN AIR ti, CONTROLS LLC PHONE #: 503- 632 -6991
Inspection Request Scheduled For: Date: ?1312009 Pour Time:
C de # Inspection Description. Confirm # Contact # Message
13`j Low voltage 000200-01 603.670 1267 N
Corrections /Comments /Instructions:
1
le
I
(PASS ❑ P ARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
_ FAIL El CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
G"Th 1,� q _I
Inspector: 06G L Date: 1`3' 1 Phone #: (503) 718- 1