Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2006 -00244
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/6/2006
/ S Y 7 PARCEL: 25101AA - 09700
SITE ADDRESS: W 68TH AVE ZONING: MUE
SUBDIVISION: PP1996 -024 LOT: 001 JURISDICTION: TIG
Project Description: Thermostat. 11/28/06 changed address (from 12585 68th Ave)
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: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
MARK NIELSON HVAC INC
7150 SW HAMPTON 5188 SE INTERNATIONAL WAY
STE. #228 MILWAUKIE, OR 97222
TIGARD, OR 97223
Phone: 503 -582 -5777 Contact #: PRI 503 -462 -4822
FEES Reg #: ELE 26- 571CLE
LIC 50897
Description Date Amount
[ELPRMT] ELR Permit 10/6/2006 $75.00
[TAX] 8% State Surcha 10/6/2006 $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 the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: 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.
• - Electrical Permit Applic 1 o R O 11-1(i I S i : ()N1.1
I ; -- Received City of Tigard Re Re e/B ./0 b O& Jo; Permit N. • I t? ,...or,.. — i
13125 SW Hall Blvd., Tigard, OR 97223 pl pi
Phone: 503.639.4171 Fax 503.598.1960 7 - j ■ Date/B . Other Permit:
Inspection Line: 503.639.4175 aC I 0 20 ;„l4.,1-'
, ' .i 1 Date Ready/By. iNI ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information • 'TIT' -i1 ;,•;•,-..:::_: _ • , . •PLA•`REVIEW . ;`
❑ New construction glittiailtf t &iot "tit Please check all that apply:
❑ Demolition ❑Other: ['Service over 225 amps, comm'I ['Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. R,
"V Cill? UCTION of 1- and 2-family dwellings 4 or more new residential
❑ 1 and 2 family dwelling mm�ercial/in trial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other: ['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: .�a — S( (DY ❑Healthcare facility ❑�.
_ Submit 2 sets of plans with any of the above.
City/StafeJZlP: S f �gi T The above are not applicable to temporary construction service.
1
Suite/bldg. /apt. no.: Pr t name: Lumens ���C e, s crip : �` FEE': SCHEDULE,. . r "v' . ;(:..
Description I Qtr. I Few 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
Subdivision: I Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map/parcel no.: Limited energy, residential 75.00 2
Limited energy, non -residential 75.00 2
. • ...:: DESCRIPTION OF WORK : . . • .. . Each manufactured or modular
r _ p � Ser ic es sr fe and/or feeder 90.90 2
t �j�•� Services or fe installation, alteration, and/or relocation
200 amps or less 80.30 2
r : ❑ PROPERTY.OWNER- I - .• ❑ TENANT _. _ . ; __,.. .
201 amps to 400 amps 106.85 2
: .
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/ State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) I Fax: ( ) relocation
200 amps or less 66.85 I
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
-0 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 circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address: Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) I Fax: : ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR s . energy panel, alteration, or
extension. Describe: 1 Page 2 2
Business name:
f4t)14C^,- &.4Ac_- -
Address: 511 gg s ....L cj I t Each additional inspection over allowable in any of the above
""" {1 Per inspection 62.50
City / State/ZIP: k_ - C,11 - LI, Or 9.714 Investigation per hour (1 hr min) 62.50
Phone: ( ) 4 (Pa % A .3..... I Fax: ( ' 4� — bsS Industrial plant per hour 73.75
:ELECTRICAL "PERMIT. FEES• .:.-x, -:
CCB Lic.: 50gc) 7 Electrical Lic. j -57/ �� Suprv. Lic.: ererlif79 Subtotal
Suprv. Electrician signature, required: r' 7 Of'? Plan review (25% of permit fee)
Print name: 4 E c O b Date: 10/ a State surcharge (8% of permit fee)
/ � TOTAL PERMIT FEE O 1 OO
Authorized signature: � / - � J /�� This permit application empires If a permit Is not obtained within 180
�✓V) t days after It has been accepted as complete
Print name: �A en'-rl b - p, P 0 vn5or7 I Date: 0 /5 5 1 D(p .• Fee methodology Tri- Coumty Building Industry Service Board
!!! Number o inspections per permit alloned.
is\&rildma\Permiu .C-Pnn i App.doc 12103 4 0- 46iST(1d02JCOM/W®
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR200&-00244
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1016/2006
Phone: (503) 639 -4171 � 4pi I l tiN
Inspection Requests (24 Hrs.): (503) 639 -4175 �..�.._ `__..
INSPECTION WORKSHEET FOR DATE: 11/1/2006 TIME: 7:O3AM PAGE: 17
/c)—S g7
SITE ADDRESS: -42686 SW 68TH AVE CLASS OF WORK:
SUBDIVISION: PP1996-024 LOT #: 001 TYPE OF USE:
PROJECT NAME: NEILSON
DESCRIPTION: Thermostat.
OWNER:. NIELSON, MARK PHONE #: 503 -582 -5777
CONTRACTOR: HVAC INC PHONE #: 503 - 462 -4822
Inspection Request Scheduled For: Date: 11/1/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 039158 -01 503.462 - 4822 N
Corrections /Comments/ Instructions:
/1)
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 08 Date: "1. ' 01 0 Phone #: (503) 718- V
CITY OF TIGARD -
BUILDING DIVISION :.- \ -- PERMIT #: ELR2O06 -00244
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/6/2006
Phone: (503) 639 -4171 laram
Inspection Requests (24 Hrs.): (503) 639 -4175 ' `'i I..
INSPECTION WORKSHEET FOR DATE: 10/31/2006 TIME: 7:01AM PAGE: 22
A=.517
SITE ADDRESS: 4 - 5 SW 68TH AVE CLASS OF WORK:
SUBDIVISION: PP1996 -024 LOT #: 001 TYPE OF USE:
PROJECT NAME: NEILSON
DESCRIPTION: Thermostat.
OWNER: NIELSON, MARK PHONE #: 503 - 6815777
CONTRACTOR: HVAC INC PHONE #: 503462 - 4822
Inspection Request Scheduled For: Date: 10/31/2006 Pour Time:
••e # Inspection 1 - '•tion Confirm # Contact # Message
199 Electrical final 039077 -02 503 - 462 -4822 Y
Corr- ' • - • - ctions:
\ N IC-
Nb w6Ct,� D 1
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
'NAIL XCALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: - 0 `-' (6 Date: 1 ' 31 6') Phone #: (503) 718-