Permit i~ •
C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 -00029
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/30/2008
PARCEL: 25101 AA - 08700
SITE ADDRESS: 12511 SW 68TH AVE ZONING: MUE
SUBDIVISION: WEST PORTLAND HEIGHTS LOT: 029 JURISDICTION: TIG
PROJECT: HPNORTHWEST
Project Description: 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:
THE BEVELAND BUILDING LLC A -REBS COMMUNICATIONS INC
12511 SW 68TH AVE 5855 SW TARALYNN AVE
TIGARD, OR 97223 BEAVERTON, OR 97005
Phone: 503 -597 -1600 Contact #: PRI 520 -0625
FAX 503- 641 -5216
FEES Reg #: ELE 34- 558CLE
LIC 86096
Description Date Amount
[ELPRMT] ELR Permit 1/30/2008 $75.00
[TAX] 12% State Surch 1/30/2008 $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 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 questio o OUNC at 503.246.6699 or 1.800.332.2344. gr./6 Issued By: u 42 Permittee Signature•
OWNER INSTALLATION ONLY
The installation is being made on property 1 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 Application FOR OFFICE USE ONLY
City of Tigard Received
I V E D Date/B , , Permit No.� ■ ` / • } y
q 13125 SW Hall Blvd., Tigarir l`' ' 2 Plan Re w
Phone: 503.639.4171 Fax: 51' = :. Date/By: Other Permit:
T l G `` D Inspection Line: 503.639.4175 Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard or.gov JAN 3 0 2OO8 Notified/Method: Supplemental Information
TYPE O PLAN REVIEW
TI ARD Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction EgAddi i Ngris
N ❑Demolition ❑ Q� I • ����� ❑ Service or feeder 400 amps or more ❑ Building over three stories.
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 KCommercial/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.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: `?!5 i k S w fh 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: ^ {� ,c1Q Z Z�j O Health -care facilities. ❑ Supply voltage for more than
--c—
� 7 L C J� Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Doer iption
1 Qty. 1 Fee. I Total 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 -
Ea. add'I 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.)
Limited energy, multi - family 2
vA1 A --- residential (with above sq. ft.) _ 75.00
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 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 2
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 ex tension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ 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: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: _ KE caGS CO M M . 1 K1 C.. energy panel, alteration, or
Address: S8SS w AR ALy I\) &) .AV C extension. Describe: I Page 2 2
City/State /ZIP: AV 6 [ — r 7 1I (DR, 9 7 pp 5 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (So3 ) 520 16 ZS _ Fax: (S 63) 0-e-/ 52.. / i q Investigation per hour (1 hr min) 62.50
CCB Lic.: 860% Electrical Lic.:3 - SS? Suprv. Lic.2430 Le-13 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: -, ( Subtotal: 7�
Print name: t 3cG S -T--�U Date: 1 _35)._ p g Plan review (25% of permit fee):
State surcharge (12% of permit fee): l
Authorized signature: TOTAL PERMIT FEE:
' This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
' Number of inspections allowed per permit.
I: \ Building \Permits\ELC- PermitApp.doc 05/23 /06 440- 4615T(l1/05 /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*
❑ Other:
r COMMERCIAL 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
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\ Building \Permits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD •
BUILDING DIVISION PERMIT #: ELR2008- 00029
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 113012008
Phone: (503) 639- 4171 Qd9py
Inspection Requests (24 Hrs.): (503) 639 -4175 - I �I
..
INSPECTION WORKSHEET FOR DATE: 2/112008 TIME: 7:02AM PAGE: 62
SITE ADDRESS: 12511 SW 613TH AVE CLASS OF WORK:
SUBDIVISION: WEST PORTLAND HEIGHTS LOT #: 029 TYPE OF USE:
PROJECT NAME: HPNORTI (WEST
DESCRIPTION: Data
OWNER: THIS BEVELAND BUILDING LLC, PHONE #: 603- 597 -1600
CONTRACTOR: A - REBS COMMUNICATIONS INC PHONE #: 520 -0625
Inspection Request Scheduled For: Date: 2/1/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
13:: Low voliagc 064340-01 503 - 520.0625 N
► q ct F SML
Corrections /Comments /Instructions:
N
v 1
PASS ❑ PARTIAL APPROVAL ❑ CANCEL 111 NO ACCESS
❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G' N Og t' Date: 2..-1 0 "4 Phone #: (503) 718 - L •