Permit 1'1 .,
TY TI D ELECTRICAL RESTRICTED ENERGY PERMIT
PERMIT #: ELR2005 -00412
I' D EVELOPMENT SERVICES
i� , DATE ISSUED: 11/15/2005
`- - 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S136DD-03800
SITE ADDRESS: 11675 SW 66TH AVE ZONING: MUE
SUBDIVISION: WEST PORTLAND HEIGHTS LOT: 007 JURISDICTION: TIG
Project Description: TI, low voltage.
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:
Owner: Contractor:
CASEY, EDWARD L JR + PTSC
CASEY, PATRICK D 710 NE CLEVELAND
BY COMMERCIAL REALTY MGMT GRP GRESHAM, OR 97030
CLACKAMAS, OR 97015
Phone: Phone: 503 665 - 4900
Reg #: LIC 150175
ELE 26- 1117CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 11/15/200E $75.00
[TAX] 8% State Surchart 11/15/200E $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
star = : : • days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
y. to follow rules a. . pted • the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
rough OAR 952 -001 -0 .0. •u may obtain copies of these rules or direct qu- - 'ons to OUNC at 503-24; 6699.
.sued By: „ // 1 / . !-j J Permittee Signature: _ -he' '
v _
OWNER INSTALLATION ONLY
The installation is being made on property 1 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.
Elec rical Permit Application . z- $ { ice= 1 ')'4 ' — '\ .4. " ' i c .(I I I c i i ( i i r R `'' ''
City of Tigard Received /� / 5 6 LA I Permit No.: e(e ;D ap cik
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 r''.a ; �i a ; 1 , Date/BY. Other Permit:
Inspection Line: 503.639.4175 _ - - i m Date Ready/By: to ' n ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method l CO Supplemental Information
TYPE OF WORK _ - - " PLAN REVIEW ' '
❑ New construction IA Addition/alteration /replacement Please check all that apply:
❑ Demolition ❑Other: ❑ m
Service over 225 amps, com'l ['Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
' CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling [ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ['Building over three stories ❑Feeders, 400 amps or more
❑ Other: ['Occupant load over 99 persons ❑Manufactured structures or
• JOB SITE INFORMATION AND LOCATION DEgress/lighting plan RV park
/` 7 / $ � 4 � A Ll 6 /3 ❑Health -care facility ❑Other:
/
Job no.: Job site address: (C � S
Submit 2 sets of plans with any of the above.
City/State/ZIP: 9A/Ed 0/ L 9 7 2.1- The above are not applicable to temporary construction service.
• Suite/bldg. /apt. no.: / Project name: -FEE* SCHEDULE . - .
S� TC JlJ T 1 c 7 ✓JAL Description I Qty. I Fee. I Total I **
Cross street/directions to job site: 6 13 I e ,, 2 , u , ,_„_) New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 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
0 P,Mz / � dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
. ❑ 'PROPERTY OWNER ` . ' I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 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
Phone: ( ) / Fax: ( ) 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 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT 1 0 CONTACT PERSON Fee for branch circuits with '
service or feeder fee, each 6.65 2
Business name: / � branch circuit
B. Fee for branch circuits
Contact name: !/ without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'I branch circuit 6.65 2
City/ State/ZIP: / - . - Miscellaneous (service or feeder not included)
Phone: ( ) F es: ; ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited-
.
--• . ' - CONTRACTOR energy panel, alteration, or p✓
Business name: extension. Describe: 1 Page 2 . 7., 2
Tl S C.,
Address: Each additional inspection over allowable in any of the above
7 / . ' e_ LE -t-)0 Per inspection 62.50
City/State/ZIP: g /2 ____. 5 ) vo D /L 97030 Investigation per hour (1 hr min) 62.50
)
Phone: 0 ypov Fax: (. 3) 6:4,5 c /Ss 3 o Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES* ' - -
CCB Lic.: 1,--,0 1 Electrical Lic.: 2 ) 7 ,4 Suprv. Lic.: Subtotal '75 °`'
Suprv. Electrician signature, required: �� Plan review (25% of permit fee)
o
. State surcharge (8% of permit fee) / ^o
Print name: Date: Date: �j
T LI Ai _,& _,&---../e--/ ` «/' / fir TOTAL PERMIT FEE
s y J o0
Authorized signature ^ J /
gn This p application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name. ' S7 Ue_ / di-5' Date: / / /.5/ • Fee methodology set by Tri -County Building Industry Service Board
•• Number of inspections per permit allowed.
iABuilding \ ?omits \ELC- PennitApp.doc 11/03 440 - 4615T(1 0/02/COM/WEB -
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
(;:RESIDENTIAL. WORK ONLY: '
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*
❑ Other:
:`,COMMERCIAL WORK ONLY 71 ' 7 1
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
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
El Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
is
•
\ Building \Prnnits\ELC- PermitApp.doc 04/03
CITY OF TIGARD Z�Z
BUILDING DIVISION
PERMIT QJS D l
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 ihat'4p' l
Inspection Requests (24 Hrs.): (503) 639 -4175 "'I ..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: f / c 7 S (e Lay 1-)-42-- CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: // 17 — 65- Pour Time:
Code # Inspection Description Confirm # Contact # Message
l
9qNi o $0 01,.
Corrections /Comments /Instructions: 470 _ a 7 O 7
enLi.P
\(21
'12 PASS n PARTIAL APPROVAL ❑ CANCEL , ❑ NO ACCESS
n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: dG' Date: / 7 " Phone #: (503) 718 -
p )