Permit III u CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00323
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/27/2007
PARCEL: 1 S 136DA -00101
SITE ADDRESS: 11410 SW 68TH PKWY ZONING: MUE
SUBDIVISION: PERS SITE LOT: JURISDICTION: TIG
PROJECT: PERS
Project Description: Access control (5) doors
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: ACCESS CON X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
OREGON, STATE OF PUBLIC SELECTRON INC
EMPLOYEES' RETIREMENT FUND 7225 SW BONITA RD
11410 SW 68TH PKWY TIGARD, OR 97224
TIGARD, OR 97223
Phone: Contact #: PRI 503- 639 -9988
FAX 503- 684 -4357
FEES Reg #: ELE 26- 497CLE
LIC 64341
Description Date Amount SUP 3645LEA
[ELPRMT] ELR Permit 8/27/2007 $75.00
[TAX] 8% State Surcha 8/27/2007 $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 dire : • - 'ons to OUNC at 50 . •.6699 0 1.800.332.2344.
/� Permittee Signature ) ( 4�` - �' d7 7
Issued = � � ���� / /� f 1f
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.
�.'- w
y P Electrical Permit Applicatio d `, FOR OFFICE USE ONLY
Ci Of Ti and R e c eive d - G .7 e 6 � : apD --O(�
�' g AUG 00 Date/B : w
III
0 131 SW Hall Blvd., Tigard, OR 97223 hi 2 Plan Rev w
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Phone: 503.639.4171 Fax: 503.598 1 Date/B : Other Permit:
T I G A R D Inspection Line: 503.639.4175 C, I J 1 Ur' , :. • eady/By: ®See Page 2 for
Internet: www.tigard- or.gov x � y•� S[ { eth o d :
Supplemental Information
TYPE OF WO I Di V ISIS + PLAN REVIEW
❑ New construction tgl Addition /alteration/replacement
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: 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 J Commercial /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 ",
1. ,}.�,� IOOHP or more. occupancy.
Job no.: , Job site address: 1�) O SW
y
0 Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: TT d q ❑ Health -care facilities. ❑ Supply voltage for more than
r ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: P � roject name: St OT OR :per J C ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description [ Qty. 1 Fee. 1 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
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
- fI- Limited energy, multi - family "
add 5 dooi s access Oo $m %l h'1 residential (with above sq. ft.) 75.00 2
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 1 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 599 amps _ 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee,
' each branch circuit 6.65 2
Business name: B. Fee for branch circuits
without service or feeder fee,
Contact name: first branch circuit 46.85 2
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: SELECTRON, INC energy panel, alteration, or
Address: 7225 SW BONITA RD extension. Describe: 1 Page 2 75.00 .2
City /State /ZIP: PORTLAND, OR 97224 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 639 -9988 Fax: (503) 684 -4357
investigation per hour (i hr min) 62.50
CCB Lic.: 64341 Electrical Lic.: 26497CLE Suprv. Lic.: Industrial plant per hour _ 73.75 _
i ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 75.00 . 7 7
Print name: JIM LEPPER Date:
81221 7 Plan review (25% of permit fee):
State surcharge (8% of permit fee): 6.00
Authorized signature: TOTAL PERMIT FEE: 81.00
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.
(:\Building \ Permits \ELC- PermitApp.doc 05/23/06 440- 4615T(II /05 /C0M/WEB
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELtt Z001.0a 323
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 47uagp y j 1hl
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: I - TIME: PAGE:
SITE ADDRESS: I I t 0 6 ki.) `1 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: t f VI 01$ Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments /Instructions:
' PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Nc.8
Inspector: �/ Date: 1 2 4 - /1 Phone #: (503) 718- 1 D