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Permit - ELECTRICAL PERMIT - C I TY OF TIGARD RESTRICTED ENERGY , R :_�II DEVELOPMENT H BMENT Tigard, � 639 -4171 DATE PERMIT E%9/2 0400309 SITE ADDRESS: 11560 SW 67TH AVE PARCEL: 1 S136DD -00200 SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE BLOCK: LOT: 004 JURISDICTION: TIG Proiect Description: Installation of data telecommunication, fire alarm & HVAC. 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: X OUTDOOR LANDSC LITE: OTHER: : HVAC: X PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: . TOTAL # OF SYSTEMS: 3 Owner: Contractor: GREEN, JOSEPH W SUPERIOR LOW VOLTAGE LLC PO BOX 759 10027 SE RAMONA ST PORTLAND, OR 97207 PORTLAND, OR 97266 Phone: Phone: 877 - 336 - 6213 Reg #: LIC 150766 ELE 26- 1126CLE SUP 3422LEA FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 10/5/2004 $225.00 Elect'I Final [TAX] 8% State Surcharl 10/5/2004 $18.00 Total $243.00 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 SAAR 952 - 001 -0010 through R 952- 1- 0100. You may obtain copies of these rules or direct que .• n to 0 NC :t (503) 246 -6699. Issued ■ ( �CXX Permittee Signature ,/i / \'il'i 1 OWNER INSTALLATION ONLY 4 The installation is being made on property I own which is not intended for sale, lea - , or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N DATE: LICENSE NO: Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day [A-- Electrical : F - USE O , City O 'fiigard Received WT. permitNo.: DateB :ID $ D -�, rl�Z 3 D 13125 S W Hall Blvd., Tigard, OR 97�, i 7 2004 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Uaaa4 l ' ,ti '\ Date/B : Other Permit Gorey Q /0 (p Inspection Line: 503.639.4175 CITY OF TIIGARD r ]' Ii = . Date Ready/By: Juris: El See Page 2 for Internet: www.ci.tigard.or.us BUILDING DIVISION Notified/Method: Supplemental Information .ay ca - 3 'Fa, . ea ,a+•x ,. ,r, 'a tit e ¢ w'' L 5P, t ' k -. ,fi , ' � Y PE O r 'C?WU� I t 5, x n ' r , z"r fi 3 ,, , ? =P.: � , P ARE W will f: � �: � r�s ,. .tin,.:_ k�.. r�_,�:e.,�i, 4,.a�,� .. re�� w��. . - �s �. y , . _ -„.„ . .... ew construction ❑ Addition/alteration/replacement Please check all that apply: El Demolition ❑Other: ['Service over 225 amps, com'l Hazardous location g e�[ j ¢� r 4� � ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., ; x,� �9 � �ji)4 A+..�f'eiic " _ �';" h +EGU .'c. u'..Ai. ti effo ` 'r"" u P; P " ' of 1- and 2- family dwellings 4 or more new residential r.«„ ;:mq +�WiN ii s + w.e.,+a ...,t r,,F.l s ... 'te ii: i:k ❑ 1 and 2 family dwelling 10 ❑ Accessory building ['System over 600 volts nominal units in one structure ❑ Multi ❑ Master builder ❑ Other: ['Building over three stories ['Feeders, 400 amps or more ['Occupant load over 99 persons ['Manufactured structures or c �* _ K. f'dOB 07 T((01l ' OCATTOI1I �, ❑ P RV. park ai"�' .�.,. �� .�..- �:x...y..,s%� a, �; Egress/lighting Ian P Job no.: Job site address: 5( - (.•.0 --/ ❑Health care facility ['Other: Submit 2 sets of plans with any of the above. City/State /ZIP: 'fl b1/lyl_ t, 0 2— The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: (rS/Fg Project name: 6 ( ��`' 1 5 0 ` `P ��'FFE' S D Fee. Total .. Cross street/directions to job site: 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 Limi esidential 75.00 2 Tax trap /parcel no tmited energy nergy, non - resider 3 75.00 a,'{S 2 , i A s . lEt4- $ 0 P ' ..) 00:*k 1?VC►i ~ W gi ` r". x „, ` s eRa€actus e dwelling, service and/or feeder 90.90 2 Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 r. l RQP1 &T W}YTs 1 E,zg RZi 14 (4k l ' , 201 amps to 400 amps 106.85 2 1 401 a mps to 600 amps 160.60 2 Name: J nsc_lott (.3. 12.4..1 J 601 amps to 1,000 amps 240.60 2 Address: . i lciQ >‹ I ,b o t\f g-( .6 / o—k Over 1,000 amps or volts 454.65 2 / Reconnect only 66.85 2 City/State /ZIP: 7 -.-.m. � ein a 0 Temporary services or feeders installation, alteration, and/or Phone: (561) PO 6 - Soo I 2000 0 amps I Fax: ( ) 2 am 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 xrx °r�. �.i' ° F�""'a 2 u. t i3rti.,.. y3,i.�: -,s. , �-,? ;r V: �t e , �"QR LICAiY r,' n n � f N ACT f A. Fee for branch circuits with �, . ,,._ . t� a , , �,a.,.. . -:.:.. k service or feeder fee, each Business name: y 6.65 2 branch circuit B. Fee for branch circuits Contact name: without service or feeder fee, 46.85 2 each branch circuit Address: Each add'I branch circuit 6.65 2 City/State /ZIP: Miscellaneous (service or feeder not included) Phone: ( ) I F es:: ( ) Pump or irrigation circle 53.40 2 Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited - 1 '+ -a*, - E°S "2 q ” z s^ ' i" `" ., �e.-, : y .., "a+a, ^1'.a 5 ,. energy �_- '�_�a:�`�'�,�. ��i . i.�c��:��'�2h.�:�itACR ��w�, ;:� �? �� 't��:� ��s�- s #'it�'bi: P anel, alteration, or F �� extension. Describe: Page 2 2 Business name: 5 wpm ro r v � b G e L L� f Address: O(� a S 6 ✓yv, h S Each additional inspection over allowable in any of the above Per inspection 62.50 City /State /ZIP: Pot. , TG d ` ©, Gj '7 �4C Investigation per hour (1 hr min) 62.50 Phone: (677 ) 3 6- G / Fax.;_(__ Industrial plant per hour 73.75 , � ' �,..ea'�A'7A.'A.,'*s...r'r:Aa}R °'_...e.. ffil"^ in..s .w�-,�YktN CCB Lic.: / 'O 76 6, Electrica ic.: ,,l , _ / /dd , S prv. Lic.: All, L � Subtotal a a s, 0 0 Suprv. Electrician signature, required: -' _ Plan review (25% of permit fee) Print name: //160/6.03 bG(Gt c m Date: /. / `h State surcharge (8% of permit fee) �� 'ad / TOTAL PERMIT FEE a y3, Q Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board , '• Number of inspections per permit allowed i:\ Bui lding\Pennits\ELC- PermitApp.doc 12/03 440-4615T(10/02/COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: naaa -;u� x axxPn^�i nmez�m",r ,: �s nog a ITE;;: '24.1-5414 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: Fee for each commercial system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ lock Systems Data Telecommunication Installation Fire Alarm Installation /IVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* • ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: 3 *No licenses are required. Licenses are required for all other installations i:\Building\Pe mits\ELC•PemutApp.doc 04/03 CITY OF TICAR® ^�- fi BUILDING DIVISION PERMIT #: Qv [f -DO D? 13125 SW Hall Blvd., Tigard, OR 97223 Z DATE ISSUED: Phone: (503) 639 -4171 47i� r Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: / f 5 0 6 7 CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: Li _ fr$ \ s ' • OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: 3 — 7 O Pour Time: Code # Inspection Description Confirm # Contact # Message ?,06, -3p0 `f Corrections /Comments / Instructions: Mi t WEL w Coo )"8 c`'',}�SQ_ 1" k ®5V C6spG'tsl... `Sk05 r t . -W P ii ft? r, 1 fl PASS ❑ PARTIAL APPROVAL $CANCEL ❑ NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: v Kc� N"v Date: 3 7 0 'O Phone #: (503) 718-1-4*.