Permit ei
CITY F TGARD ELECTRICAL RESTRICTED ENERGY PERMIT
i; DEVELOPMENT SERVICES PERMIT #: ELR2006 -00031
1,1 �� ;:. 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 1/19/2006
PARCEL: 25101 AA -06400
SITE ADDRESS: 12323 SW 66TH AVE ZONING: C -G
SUBDIVISION: WEST PORTLAND HEIGHTS LOT: 024 JURISDICTION: TIG
Project Description: Limited energy for 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:
TING, ELON + SYLVIA PTSC
BY WILLIAM R SOUTHARD 710 NE CLEVELAND
603 SE VICTORY AVE STE 100 GRESHAM, OR 97030
VANCOUVER, WA 98661
Phone: Contact #: PRI 503 665 - 4900
FAX 503- 665 -4830
FEES Reg #: LIC 150175
ELE 26- 1117CLE
Description Date Amount
[ELPRMT] ELR Permit 1/19/2006 $75.00
[TAX] 8% State.Surchar€ 1/19/2006 $6.00 REQUIRED ITEMS AND REPORTS
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
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to fo = ' • = adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
throu. OAR 952 -06 0 ou may obtain copies of these rules or direct questi ns to OUNC at 503 - 246 -6699.
Issue • By: i ,. I — .i Permittee Signature: _
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.
1
1 • E al Perniet A licatio® , ,. �(. 01.1 �(_1. -1,!. O -N I
• City of Tigard R Dat Date/By: ( I4 G , I Permit No.: E 6 .610 3/
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 ��"'*" ti s ltl f I l i ' , Date/By: Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: 1 SI See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: ( -7 tee Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑Demolition ❑Other:
['Service ['Hazardous over 225 amps, com'I Hazardous location
['Service over 3 0 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- fanny dwellings 4 or more new residential
❑ 1- and 2- family dwelling Commercial/industrial ❑ Accessory building ❑System over 6 volts nominal units in one structure
❑ Multi- family El Master builder ❑Other: ❑Building over duce stories ❑Feeders, 400 amps or more
['Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lightin plan RV park
1•ti A
01-care facility ❑mar:
Job no.: Job site address:
/p9.3 r� 6lA) ( �t)e. Submit 2 sets of plans with any of the above.
CitylState/ZIP: q vR 9 7� / The above are not! t applicable to temporary construction service.
Suite/bldg. /apt. no.: U / Project name: i FEE* SCHEDULE ,
. .
Description I I Qty. I Fee. I Total I ••
Cross street/directions to job site: New residential Single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or les¢ 145.15 4
Subdivision: Lot no.: Ea add'I 500 sq. R or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90.90 2
0 01 e.J2. — bp, k4 + I = 6 Services or feedelrs installation, alteration, and/or relocation
200 amps or less I 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 arrtps 106.85 2
401 amps to 600 aI nps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps ¢r volts 454.65 2
Reconnect only I 66.85 2
City/State/ZIP: Temporary servi es or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less I 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 I ❑ CONTACT PERSON. :.,; A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch lircuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline ligiting 53.40 2
E -mail: Signal circuit(s) or limited-
CONTRACTOR energy panel, alteration, or
extension. cribe ( Page 2 75 CO 2
Business name: R.-1-1 S . C
Address: ` Each additional inspection over allowable in any of the above
Q �� prof_ TT Ste' r Per inspection I 62.50
City/State /ZIP: Ca redbkka.sm ` OR. 9 70 30 Investigation per hour (1 hr min) 62.50
Phone: ( 5o3 ) C4.5_ Too Fax: (5 a ci Y830 Industrial p lant pea hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: /go / ?.S Electrical Lic. v.N7CLC Suprv. Lic.: l &39 aiti Subtotal 3'/C'e
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee) 6•°°
TOTAL PERMIT FEE 3 f . eV
Authorized signature: i This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: ,:d , Date: /it�o 6 * Fee methodology s et by Tri-County Building Industry Service Board
CITY OF TIGARD
BUILDING DIVISION PERMIT #: l I_I Z2(')(lt1000 >"i
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: - i /19 / :30Qr •
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 1/20/2006 TIME: 7:00AM PAGE: 26
SITE ADDRESS: 12323 SW 66TH AVE CLASS OF WORK:
SUBDIVISION: WIEST PORTLAND HEIGHTS LOT #: 024 TYPE OF USE:
PROJECT NAME: FARMER'S INSURANCE
DESCRIPTION: Limited energy for voice /data.
OWNER: TING, ELON SYI_VIA PHONE it:
CONTRACTOR: PTSC PHONE #: . 66
Inspection Request Scheduled For: Date: 1/20/2008 Pour Time:
Code #. Inspection Description Confirm # Contact # Message
Low voltage 025300 -01 503- 969.4091 Y
g
Co : .• • : /Comments /Instructions:
CaVV Ch ,
IKPASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: , Date: `io Phone #: (503) 718 � - G9