Permit C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2009 -00037
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/16/2009
PARCEL: 1 S135BD -00300
SITE ADDRESS: 09735 SW SHADY LN 101 ZONING: C -G
SUBDIVISION: DRS FAMILY CLINIC LOT: JURISDICTION: TIG
PROJECT: DR SCHWARTZ
Project Description: Installation of voice & data.
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:
ARTHUR MCFADDEN BY ERIC SKLARZ TECHNOCOM INC.
621 SW MORRISON ST STE #800 7929 SW BURNS WAY # F
PORTLAND, OR 97205 WILSONVILLE, OR 97070
Phone: Contact #: PRI 503- 682 -4195
FAX 503- 682 -2781
Reg #: ELE 34- 269CLE
FEES LIC 73872
Description Date Amount SUP 2281 LEA
[ELPRMT] ELR Permit 1/16/2009 $75.00
[TAX] 12% State Surch 1/16/2009 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344. I�
Issued By: 4 fl c Q Permittee Signature: A O CikkVI
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
01/15/2009 5036822781
• TECHNOCOM
g . •„, PAGE 01
EIVEt •
Electrical Permit Applicatio Fol; on..1(y usi... oNi.,
City of Tigard ,I 6 N 1 1?. .., ?l!: i Received
Drae/Bv: (' ( IV CA U.6. P _CO i • O. ,
14 q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
1 Phone: 503,639.4171 Fax: 503.59 OF TIGARD - Daterly: ___ Other Permit:
T 1 ( , A ,, 0 3uunING owls* Inspection Linc: 503.639.4175
Date RCOcIviBy: i 63 See Page 2 for .
Internet: www.tigard-or.gov IS bL - la_tifictUtvicthod: Tiri Supplemental information
..i./ 0 1 1 : : ' , 1 1 . ' .. -.--iit, -i'd'N•li ::,:iP;;;:li!ii.:::.'4'llnili.:).•i011iri;!•:!....,,;-,,,,-"-im„,,,,....,,,7 „ .• . :‘V.;,..2.•,,pc,,,,,,..,,....t''''';''''*01""IT":''''''''..tr-P.-: ::.:!. ''"" • . . • ' • 77777-7•7777•7.01,itt4).'ratiffe;Ws,;:;"Tii:liiiii.:,?:,.$!::Ni.:iii;.V....,1/4:1,1
' 1.1 ....:,, t - . • . - -:•• - •••• -'• • , - •,• • .."•:•;••• Please check all that apply (sulnnit Z sets of plots w/iterns checked below):
0 New construction -jg Addition/alteration/replacement 0 Sorvire crr feodcr 400 amps or more D Building over three stories.
0 Demolition ---"-- 0 Other: where Ate available fault current 0 Marinas and boatyards.
1.
__-
-WitOt6 EtVoViittitilltittet liiii (li,' ''-:' :. ,, . , exceeds 10,000 amps at 150 volts or El Floating buildings,
i - ..L,.... ,- `...: ,-.4: ,..:-...........p., ,... I "'''.;:'1' ;-• .. . ' • • .- less to ground, or exceeds 14,000 0 COMOICTCial-tOlt agrioultural
0 1 - and 2-fa.mily dwelling Sli , Commercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: El Fire pump. CI Installation of 75 VA or
0 Etnergency system. target separately derived system.
ff; 1101I ::: :. : #ThibleiiiiintlittOiltit ` ., ••• . f "P r • . :-" " " ['Addition of new moor load of
i (PM!' or more. occupany.
Job no.: _ Mil Job site address: mr 5 : . I ../ _.., 0 Six pr more re.sidentiai o aits. 1:I Recreational vehicle parks.
City/State/Z1P: .A../ i ' 61122,a 0Hc ,, b .cnre facilitieR.
0 Hazardous locations. 121Sertoly voltage for more than
GOO volts nominal.
il M. • • CI SontiCO OT feeder GOO nmps OT Mora.
Suite/bldg./apt. no.: rwri ) Project name: 111. . nail ( a l , ,.. , i .
..... . --. - -:4M2Seittnitlit:iir
_ .
Cross street/directions to job site: 0 A NI,/ De!tcriptInn__.• I Qtr. 1 I'm 1 TOIIII I •
-- New residential single- or multi-family dwelling unit.
includes attached garage.
Subdivision,: Lot no.: -. _1.000 sq. ft. or legs 145.15 4
----------------------- En. add'l 500 sq, ft, or portion 33.40 1
Tax map/parcel no.: Limited energy, residential
75.00 2
Pr71:•:!iiZQI.d.':tsii'.15••'-::l'i:,1•••;':!:i:rili!i;(1016001tIPTIN.I.:0.,Prit4Oiq'il...:::.%iii::'''''::'.:.1... •.:'' .. with above 5 , A.
' Limited energy. multi-family .
75.00 2
A r A , ,eg0. residential (With fltrov0 ft.) I • _
Strike or feeders Installation. alteration, and/or relocation
. 200 amps or less 80.30 2
'....:;•:W::iilli,11:;jiCtilitilkottlitt.),trOldit.',i,•:';.oll■;.,-V.V1,!,titi;.4111Meitt';• ..• . • • :': 201 amps to 400 imps 106.85 2
..--
.60 2
Name: 401 amps to 600 amps 160
.
_ .. 601 a mps I° 1,1)00 amp 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/Stale/ZIP: - Temporary services or7ceders installation, alteration, and/or
- • • relocation
Phone:( ) TFax: ( ) 200 amps or less
- • 66.85 I
201 amps to 400 amps 100.30 2
Owner installation: This installation is being made on property that 1 own which is not '
intended for sale, lease, rent, or exchange, according to ORS 447. 449. 670, and 701. 401 amps to 599 amps 133.75 2
Bra ncli circuits - new, alteration, or extension, . er panel
Owner signature: _ . Date: - A. Fcc for branch circuits with
, ,r1',t..,T ig=EZABEgger4 .i , :lit ;A;p00 :.....1.. .... above service or feeder fec, 6.65 2
each branch circuit
Business name: 7;•_ , r ,LO _h ' C.," B. Fee for brunch circuits
.
Contact name: t.. IIM Li . . ..,....: _ , 46.85 2
- ...,....... .... __ ...... ._. • ".. ..
-
.. - . /A . . .
.
Address. -ig zci i vErammut vie. P
,._ 4._... I . - • It och1 trraneh-eiccuil- • III 6.65 2
-- Miscellaneous (service or feeder not included
City/State/ZIP. ,.. V f 1 1 , # 0 • Each manufactured or modular 111 90.90 2
dwcllin service and/or feeder
Phone: (6 t if ff "2_ 4 Fax: : ip 0 00 2- 2:1 a Reconnect only 1111 66.85 2
E-mail: . - ' .1 algieraOrrd'OiCaPOI 66 6 JA ,CC/1A POTTlp OT irrigation circle II 53.40 2
t:•00„■••„ •F';' g :i? . '7771 L , El ' i:..V1;:::•:::::":.'(:..:'!1'..:!!!';;;.:•i3'.1.:.' '..• fii m or Outline lighting 53,40 2
Business name: . •
en Address: (2) gy panel, slteratiOn Or
.
• . • .
extension. Describe: Page 2 -15 2
A : ' . A 0 ---.
City/State/ZIP: . F V ,M2 .■• . - , ' r allowa hle in ROY of the nhnvc
Per inspection II 62.50
Phone: ( ) Fax: ( ) investigation per hour fi hr min) 62,50
. -
CCB Lie.. ,. , • e ,. 4, Electrical Lie.: • Suprv. Lie.: z.. LA Industrial plant per hour 73.75 _
e. ELECTRTGW031011114Etgii'!•!'-1.0.!;11 ,'..'.•!,:•
Suprv. Electrician signature, required: , 44 - ,I, LA All.,2. Subtotal: 1 C .0 0
Mr_ M/ ISM
Print name: sie. Pian review (25% of permit fee):
: i ..miti.lorki,,,„ Date: C) k. 16 , 0 9
Slate surcharge (12% of penrnit fee):47
Authorized si 1111M O.L, i 4/12.1 TOTAL PERMIT FEE: S Li.
.--- -
"-- --• if n permit 11 nut obtained within 1110
, _
Print name: 12. WA° Date: k i::::„..._.... - --- ---
.". b een Aroopted 55 comptrtr.
, _. _ ---- awed Elor PrTinit.
1: TtIMITEOPennitaLC • - • .• c TIS/13,06 atn
•
CITY OF TIGARD 9
BUILDING DIVISION � . PERMIT #: s
Et_f 2009 -00037
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/1EI2009
Phone: (503) 639-4171 i A,
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 1/26/2009 TIME 7:00AM PAGE: 26
SITE ADDRESS: 09735 SW SHADY LN 101 CLASS OF WORK:
SUBDIVISION: DRS FAMILY CLINIC LOT #: TYPE OF USE:
PROJECT NAME: DR SCI
DESCRIPTION: Installation of voice & data.
OWNER: ARTHUR MCFADDEN BY ERIC SKLARZ, PHONE #:
CONTRACTOR: `I'ECHNOCOM INC. PHONE #: 503-6814196
Inspection Request Scheduled For: Date: 1/26/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 I. voltage 07998 01 503760.151 8 Y
Corrections /Comments/ Instructions:
1 0 in S 1` l #0-al (!)-,--c C O O- e!e -d— P-r)1 0'
.Q_ i ✓x ,V Q lQtii
!e/vt.t,0 7/4 /e.s V'2- c.e, 6 (e
Sueeic_a 1\,i kfre-ie- e_.e.' h i/c
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL e lc7CEL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: //WO Date: 1-26 6 - 0 ' Phone #: (503) 718-
01/15/2009 13:16 5036822781 TECHN000M PAGE 02
Electrical Permit Application - City of Tigard
P 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for a 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:
l ''I0 1r t .• 't . v � , r7 7..11' .. �'t
Fee
)Fee for eac commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
1 Data Telecommunication Installation
❑ Fire Alarm Installation
[� HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls
❑ Outdoor. Landscape Lighting'
❑ Protective Signaling
❑ Other
Total number of commercial systems: `
*No licenses are required. Licenses arc required
for all other installations
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