Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
i k, DEVELOPMENT SERVICES PERMIT #: ELR2006 - 00158
��i,,., DATE ISSUED: 6/21/2006
-- , 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S136DD -00200
SITE ADDRESS: 11560 SW 67TH AVE ZONING: MUE
SUBDIVISION: WEST PORTLAND HEIGHTS LOT: 004 JURISDICTION: TIG
Project Description: Low vg for building vac.
l C oda_ W ca:= AA11R t.,..__ 000 3
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: VACUUM X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
LEISER, ANNE TRUSTEE HANSEN TECHNOLOGY GROUP
6009 SW PENDLETON CT PO BOX 83783
PORTLAND, OR 97221 PORTLAND, OR 97283
Phone: Contact #: PRI 503- 351 -1290
FEES Reg #: ELE 3090LEA
LIC 154012
Description Date Amount
[ELPRMT] ELR Permit 6/21/2006 $75.00
[TAX] 8% State Surcha 6/21/2006 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by th Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obt ' ies of these
rules or direct quest ns to OUNC at 503 - 246 -6699.
Issued By: - .4 L ' Permittee Signature: /r
° OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
i rte . '
;trical Permit Apalic rt>IZ OFFICE U.SE OIN1.1
City of Tigard �D�� Received . /6 **--- / , '. / ' �i � Z ,
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revte . / ' / _ " � '
II
Phone: 503.639.4171 Fax: 503,5..9$ Date/By. Other Permit:
R()
( ) Inspection Line: 503.639.417¢,,11 i u.,.' ., J. vI t_i Date Ready/By: yv : - ® See Page 2 for
Internet: www.tigard- or.goN �q�,, • Notified/Method: �.erl Supplemental Information
TYPE OF WORK PLAN REVIEW
, J New construction NI Addition/alteration /replacement Please check all that apply:
12 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 Dlt Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
El Multi - family ❑ Master builder ❑ Other: El Building over three stories ['Feeders, 400 amps or more
['Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: Job site address: / / 54,0 ( A ` t ❑Health - care facility ❑der:
Submit 2 sets of plans with any of the above.
City / State/ZIP: Q� b bit 1 22 3 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: J Project name: FEE* SCHEDULE
Description 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 less 145.15 4
i!
Subdivision: C r', 1i_ Lot no.: Ea. add'I 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
dwelling, service and/or feeder 90.90 2
O W Ve t E •. C.0 rYN t Y►.vfk.. 0 t t G r c e+ }x •.v r> k'1 -0-.. Services or feeders installation, alteration, and/or relocation
�
�e.� % re qun a v c�,trc t ns�! l,
200 amps or less 80.30 2
IX PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: doe, ( 'B U t l a i n Q 601 amps to 1,000 amps 240.60 2
Address: 1 l S b (01 '44) Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State/ZIP: -r 1 ag.e b CI 7 2 2..-3 Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 2000 0 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 ❑ CONTACT PERSON A. 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,
first branch circuit 46.85 2
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 lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: 4.fr(11\5.e.o I e ,ck n x. to. 1 , r
!� �y Each additional inspection over allowable in any of the above
Address:
rn iS 3 312 3 Per inspection 62.50
City / State/ZlP: tA t be, -) 2g 3 Investigation per hour (1 hr min) 62.50
Industrial plant per hour 73.75
Phone: (3) 3S(_ �O Fax: ( ) ELECTRICAL PERMIT FEES*
CCB Lic.: / y ®l, I Electrical Lic.: 3070 G . Suprv. Lic.: Subtotal: `7 6
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print namei 'J� t /I / Date: 1 I 0 4 State surcharge (8% of permit fee):
/ TOTAL PERMIT FEE I
Authorized signature: 0 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: , 1r, a' / / ,-�fSeJ Date: t I ( 5 ( o (, • Fee methodology set by TO- County Building Industry Service Board
V •• Number of inspections per permit allowed.
L\ Building \Permits\ELC- PermitApp.doc 03/23/06 440- 4615T(11/05 /COM/WEB
Electrical Permit Application - City of Tigard
Pagel - 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*
❑ Other:
. COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(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
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
•
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
F .. Other i vC 4 vQ-{ ( U e t Fi s tal I k v j/CA- C 5 i
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
BUILDING DIVISION ' ' PERMIT #: ELR2()06.001 fie
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/21020(0G
Phone: (503) 639 - 4171 1111 �I
• Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6 /2612006 TIME: 7 :05AM PAGE: 52
SITE ADDRESS: 11560 SW 67TH AVE CLASS OF WORK:
SUBDIVISION: \MST PORTLAND HEIGHTS LOT #: 004 TYPE OF USE:
PROJECT NAME: GREEN BUILDING
DESCRIPTION: LOIN voltage for building vac. Work was done in 2003 and not finaled.
OWNER: LEISER, ANNE TRUSTEE, PHONE #:
CONTRACTOR: HANSEN TECHNOLOGY GROUP PHONE #: 503-351-1290 •
Inspection Request Scheduled For: Date: 6/2612006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
;,t; L. , ase 032328.01 503 - 3132010 I N
Correc ions /Co - ts/lnstr ' tions:
•
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: -A NQ W Date: 0 Of Phone #: (503) 718- 11194