Permit ' n CITY ®� T I G� R ® ELECTRICAL RESTRICTED ENERGY PERMIT
' ° COMMUNITY DEVELOPMENT PERMIT #: ELR2008 -00255
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 9/5/2008
PARCEL: 2S 101 AD -00100
SITE ADDRESS: 12725 SW 66TH AVE 207 ZONING: MUE
SUBDIVISION: WEST PORTLAND HEIGHTS LOT: 034 JURISDICTION: TIG
PROJECT: CRAWFORD CLAIMS
Project Description: Low voltage for 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:
EXECUTIVE CENTRE LLC NORTHWEST COMTECH INC
1590 NW 117TH CT 12807 NE 22ND ST
PORTLAND, OR 97229 VANCOUVER, WA 98684
Phone: 503 -526 -1331 Contact #: PRI 503- 252 -1462
FAX 503- 252 -2343
Reg #: ELE CLE9
FEES LIC 179040
Description Date Amount
[ELPRMT] ELR Permit 9/5/2008 $75.00
[TAX] 12% State Surch 9/5/2008 $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 Notifi - - - ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or rect question o OUNC at 503.246.6699 or 1.800.332.2344.
Issued = : i ` / 'I Permittee Signature: )C4 2 &�
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
Electrical Permit Application o FOR OFFICE USE ONLY
RE C E I V ED Re ceived 9 City of Tigard
Date/By: �� Permit No.: (,/�. O -7�
a 13125 SW Hall Blvd., Tigard, Plan Review
II . ' Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
T I G A l: D Inspection Line: 503.639.4175 S EP — (5 , Date Ready /By: Juris ® See page 2 for
Internet: www.tigard - or.gov Notified/Method: ( � Supplemental Information
TYPE 1ll�Lt�1/�F
0�F TII R ® PLAN REVIEW
❑ New construction pLAdditiOtllP121C2NV1R N Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling oiCommercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. A
❑ Addition of new motor load of ❑ "A ", "E ", "I - ", "I - ",
100HP or more. occupancy.
Job no.: Job site address:
Z 7 Z S- '5 Cr) 6 „,, ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Po 2_7 /� ! ok j -- 7 ❑ Health -care facilities. ❑ Supply voltage for more than
❑
�� ( !i ti Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: — 2 071 Project name: ( xxi.„„le "� s ❑ Service or feeder 600 amps or more.
Q c"�� �A.-<,.., FEE SCHEDULE
Cross street/directions to job site: �y n / ,2,i � Description 1 Qty. i Fee. 1 Total 1 •
`� ( New residential single- or multi- family dwelling unit.
ig i/e_ / )`'3 a -S ' Includes attached garage.
Subdivision: .5 Y op 0 y /../e Jq 4/ Lot no.: 1,000 sq. ft. or less 145.15 4
v Ea. add'l 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.)
t Limited energy, multi - family
/ e 1.4) 1.70 / C,9,6 /, , j � residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER 1 yl, TENANT 201 amps to 400 amps 106.85 2
Name: r 401 amps to 600 amps 160.60 2
�
�e C v f t vPi Ge"'��✓�1� l' � ( � 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: p 2 -/ '( o , 2 9'- 7 2 z 3 Temporary services or feeders installation, alteration, and/or
1 relocation
Phone: Fax: 200 amps or less 66.85 I
) `S� � ‘"'"s1 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
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) I Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Co , � Q Signal panel, or limited-
( C- I \ C. energy panel, alteration, or
1
Address: ) 7-10 7 rt / �� �� S extension Describe: ^ Page 2 757 00 2
City/State /ZIP: U�� � / �/ ve/t Gt/ Each additional inspection over allowable in any of the above
/ Per inspection i 62.50
Phone: (3(o) 7.6. 7 _ / cm Z Fax ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: t 71�"
pt Electrical Lic.: C,L Suprv. Lic.: Industrial plant per hour 73.75
r I ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: ,7' 9'
/ / /(S q /177 Plan review (25% of permit fee): ��
Print name: Date:
//,..‘_ Date: surcharge (12% of permit fee): od
Authorized signature: TOTAL PERMIT FEE: 4/.00
+ ' D
This permit application expires if a permit is not obtained within 180
Print name:
'3. ,� M, S c 7/.5 $ days after it has been accepted as complete.
11 * Number of inspections allowed per permit.
I:\Building\Permits\ELC- PermitApp.doc 05 /23/06 440- 4615T(1I /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL: WORK ONLY:
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*
n Other:
C OMMERCIA L: WORK ,ONLY! „
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
g _ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I.\ Building \Permits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD , 'I,- 4,,,,
BUILDING DIVISION PERMIT #: ELR2008- 00255
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/51200B
Phone: (503) 639 -4171 aia�y f�
Inspection Requests (24 Hrs.): (503) 639 -4175 ;1 i
INSPECTION WORKSHEET FOR DATE: 10/7!2000 TIME 7 :00AM PAGE 37
SITE ADDRESS: 1 2725 4 66TH AVE 207 CLASS OF WORK:
SUBDIVISION:
WEST PORTLAND HEIGHTS LOT # : 034 TYPE OF USE:
PROJECT NAME: CRAWFORD CLAIMS •
DESCRIPTION: tow voltage for data.
OWNER: EXECUTIVE CENTRE LLC. PHONE # 503 -5: 6- 1331
CONTRACTOR: NORTHWEST COKIITECH INC PHONE #: 503252 -1462
Inspection Request Scheduled For: Date: 10/ J2000 Pour Time:
Code # Inspection Description Confir # Contact # Message
199 Electrical final 076184 -0 3G0•931 -4943 N
Corrections /Comments/ Instructions:
\ ( N
\f \
\�\
) A , \
a\ \.
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G---- N C)Q L Date: _ ® Phone #: (503) 718- /J'i I k
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2008 -002 a5
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: r1'50008
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 VV.' .
INSPECTION WORKSHEET FOR DATE: 9/29/200B TIME: 7:tf2AM PAGE: 42
SITE ADDRESS: - OF WORK:
12725 SW 66TH AVE. 2U7
SUBDIVISION: WEST LOT #
ST PORTLAND HEIGHTS 034 TYPE OF USE:
PROJECT NAME: CRAWFORD CLAIMS
DESCRIPTION: Low voltage for data.
OWNER: EXECUTIVE CENTRE LI-C, PHONE #: 503 -526 -1331
CONTRACTOR: NORTHWEST COMTECH INC PHONE #: 503-252-.1462
Inspection Request Scheduled For: Date: 9/29/2008 Pour Time:
Code # Inspection Description Corfir-m__ # Contact # Message
135 Low voltage 076007 -01 603252 -1462 N
Corrections /Comments /Instructions:
Criten 0 N C D L 40 b1 e c a ` V . , gag 100 .
&L ., t om& loAvo e Cret okit M
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
`! FAIL A CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ---'• Nt6 Date: C f12 Phone #: (503) 718 -11ft
.
CITY OF TIGARD - - A BUILDING DIVISION MIT #: t =t_L� tf1013 002 5
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/5/2000
Phone: (503) 639 -4171 l ���
Inspection Requests (24 Hrs.): (503) 639 -4175 °_
INSPECTION WORKSHEET FOR DATE: 9/012000 TIME: 7:00AM PAGE: 24
SITE ADDRESS: 12725 SW 66TH AVE 207 CLASS OF WORK:
SUBDIVISION: WEST PORTLAND HEIGHTS LOT #: 034 TYPE OF USE:
PROJECT NAME: CRAWFO12D CLAIMS
DESCRIPTION: Low voltage for data
OWNER: EXECUTIVE CENTRE LLC, PHONE #: 503- 526.1331
CONTRACTOR: NORTHWEST COMTECH INC PHONE #: 503- 257-1462
Inspection Request Scheduled For: Date: 9/0 /2008 Pour Time:
Code # Inspection Description 4 # Contact # Message
135 L..ow voltage 075199 O1 360.931 -4943 N
Corrections /Comments /Instructions:
;;\ PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 6-Th N be LE
Date: € 10' 1 • 1 Phone #: (503) 718- 1,1%