Permit •
;+ CITY OF T I G A R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
* DEVELOPMENT SERVICES PERMIT #: ELR2003 -00142
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/23/03
SITE ADDRESS: 12725 SW 66TH AVE 107 PARCEL: 2S101AD -00100
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 034 JURISDICTION: TIG
Project Description: Installation of data telecommunications system.
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:
PARROTT, VIAL LLC CABLE RUNNERS
12725 SW 66TH AVE #202 10500 SW BOONES FERRY RD
PORTLAND, OR 97223 PORTLAND, OR 97219
Phone: Phone: 503 245 - 3669
Reg #: LIC 122854
ELE 26 -951 CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 5/23/03 $75.00 Elea! Final
[TAX] 8% State Tax 5/23/03 $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
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to f rules adepted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 throuc
I sued by A : !,_ _ _ ��/ 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 )�I / DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Permit Application FOR OFFICE USE ONLY
Received / Electrical rL Foa00.3 --(501 '/
` g
Date/By: ✓� :tJ � Permit No.:
Cit of Tiaand Planning Approval Sign
y b Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
t„ Date/By: Case No.:
Internet: www.ci.tigard.or.us ■ mil �' l Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 _" Name/Method: Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
❑ New construction El Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
2 Addition/alteration /replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling 0 Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
El Accessory Building ❑ Multi - Family ❑ Occupant Toad over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: 127 25 SL-t) (p 6 A Vc, FEE* SCHEDULE
Suite #: (0 7 Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: e4- c-s Po • C-.4— Description Qty Fee (ea.) Total - 1
New residential - single or multi - family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Lot # Limited energy, residential 75.00 2
:
Subdivision: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
Pl�tON� G Services or feeders - installation,
-re- /- 147$ alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY OWNER j ❑ TENANT 601 amps to 1000 amps 240.60 , 2
Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
401 to APPLICANT ❑ CONTACT PERSON Branch h amps 133.75 2
circuits circuits -new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
L l��� alteration, or extension Page 2 2
Business Name: (2 Description:
Address: /ooc s� ='c/ �n _!S ce rm. {Cc/
_/ Each additional inspection over the allowable in any of the above:
�o
City /State /Zip: r' 4 / 04, of 2 r� 2 f 0 / Per inspection per hour (min. 1 hour) 62.50
Phone: )D 7- Z'S -- Fax: 503 Zy,) -s 76.j Investigation fee:
CCB Lic. #: ) ZZ6S9' Lic. #: 2 �t s
- / etE Ot her: Electrical Permit Fees*
Supervising electrician ..,,,,. $ 7�•�a
signature required: Plan Review (25% of Permit Fee) $
Print Name: ',lie- GJfi177- Lic. #: Z g 2-7 L.-1:A. State Surcharge (8% of Permit Fee) $ 6 oU
TOTAL PERMIT FEE $ d eeZ
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: � . Date: 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
i:\Dsts\Petmit Fotms\ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page . 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
n Audio and Stereo Systems
n Burglar Alarm
Garage Door Opener
Heating, Ventilation and Air Conditioning System
El Vacuum Systems
0 Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
El Audio and Stereo Systems
n Boiler Controls
0 Clock Systems
0 Data Telecommunication Installation
Fire Alarm Installation
HVAC
n Instrumentation
n Intercom and Paging Systems
El Landscape Irrigation Control* •
❑ Medical
0 Nurse Calls
Outdoor Landscape Lighting
n Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations •
i:\Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03