Permit n CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00043
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/26/2007
PARCEL: 1S136DD-03400
SITE ADDRESS: 11740 SW 68TH PKWY 100 ZONING: MUE
SUBDIVISION: TIGARD TRIANGE COMMONS LOT: 008 JURISDICTION: TIG
PROJECT: TIGARD TRIANGLE COMMONS
Project Description: Building 4,1 st floor, fire alarm.
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: X OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC NW PROPERTIES SALEM FIRE ALARM, INC.
ATTN: PAUL GRAM PO BOX 12789
P.O. BOX 2206 SALEM, OR 97309
BEAVERTON, OR 97075
Phone: 503- 626 -3500 Contact #: PRI 503- 364 -4566
FAX 503- 3640617
FEES Reg #: ELE 24- 133CLE
LIC 76884
Description Date Amount
[ELPRMT] ELR Permit 2/15/2007 $75.00
[TAX] 8% State Surchart 2/15/2007 $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 - - - set forth in OAR 952 - 001 - 0010 through OAR 952 - 001 - 0100. You may obtain c ies of these rules or dired questions to OUNC at
503. • 6.6699 or 1.::! 33 • .
Iss d By: / Permittee Sig • •ture: � 144 ! /
OWNER INSTALLATION 0
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.
c' r, . ' rival Permit Application - � FOR OFFICE USE ONLY
;If Rec
City of Tigard — Dateived dli ��0 7 &
Permit No. ' � �-" 6c,3
13125 SW Hall Blvd., Tigard, '17 Plan Review
o C Phone: 503.639.4171 Fax: 5 .598.1960 Other Permit:
DateB
Inspection Line: 503.639.4175 �S � 1 b Date Ready/By: tom: ® See Page 2 for
Internet: www.tigard-or.gov T I G A R D 4 , 2 1
otified'Method: Supplemental Information
,� ttPP
TYPE OF WO S. I ` 1 (41 0 , ' PLAN REVIEW 443
❑ New construction Addition/alte 'd( 13010 t� `� Please check all that apply (submit l sets of plans w /items checked below):
x(11 rr��``aa ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ther ® • 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 ❑ 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 ", "I -2 "• "1 -3 ",
Job no.: 240023 I Job site address: II -710 5 (o'W'" Als 100HP or more. occupancy.
❑
❑ Six or more residential units. Recreational vehicle parks.
City / State/ZIP: `r `-� 3 -� ❑ Health -care facilities. ❑ Supply voltage for more than
� (�i./yu / (�� q ( -/ ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: —r-; Thrif �' . ❑ Service or feeder 600 amps or more.
J J" FEE SCHEDULE
Cross street/directions to job site: Deurtpt1on 1 Qty. 1 Fee. 1 Total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I 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
DESCRIPTION OF WORK (with above sq. R) 75.00 2
Limited energy, multi - family w 75.00 2
�` ` f ( 'T O/ � y
( ' p Ai -I- C9r✓ residential (with above sq. ft.)
'`� 144 r at` n r Services or feeders installation, alteration, and/or relocation
•K�J� r 200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ 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: ( ) I 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 100.30 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 ( ONTACT PERSON above service or feeder fee, 6.65 2
\ each branch circuit
Business name: t2M"._ L ,4 i - of,vt. B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
"/ i � . '- f.c5L first branch circuit
Address: lb goy- 12-' el Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder_ not included)
City/ State/ZIP: C 1.P.r., D a- G 7 Each manufactured or modular 90.90 2
✓'� dwelling, service and/or feeder
Phone: ( 9)) 3 f ,1 ._ (,...t_5 I Fax: : ( 9.1,) 34,41_ 06, 17 Reconnect only 66.85 2
E -mail: K r/ 5.t!¢,wl. {; r e NC/1" ,. . Cd 6 t Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Signal circuit(s) or limited -
�t.) av� �L"c '�Q'^^ ex tensfo panel, alteration, or
Describe: Page 2 75 2
Address: PO • > L /fib!
City/State/ZIP: 9 73a. Each additional inspection over allowable in an of the above
/ Per inspection 62.50
Phone: (5,)) bt ^ S 6,4, I Fax: ( 5D3 3'eq — 060 Investigation per hour (1 hr min) 62.50
CCB Lic.: 76, 1(64 Electrical Lic.: .-1.-iy.Jc Suprv. Lic.: 4 .1,94 _ a::::/41 Industrial plant per hour 73.75
- ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 75
Print name: r /„ An//; ' I Date: j-- 23 , 0 7
Plan review (25% of permit fee):
/`�t -v • State surcharge (8% of pennit fee): (o
Authorized signature: ! TOTAL PERMIT FEE:
Ads q IOW If I .00
i - 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:\ Build ing\Pamits\ELC- PamitApp.doc 05/23/06 440.4615T(1I /05 /COM/WEB
CITY OF TIGARD z._-= ��
BUILDING DIVISION PERMIT #:2 7 4000' " 3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 , � , ' 1
Inspection Requests (24 Hrs.): (503) 639 - 4175 ,_._11,
p'I �
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: (/1 U W q t -1 At 4l0 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: /^ /�
DESCRIPTION: g y j✓j; , ' ,q' 4 �e 41,04 7/4
OWNER: PHONE #:
CONTRACTOR: 5414 ��R a / ( 01.4.4,1 PHONE #5j3 _34 i i._ -
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection D scription Confirm # Contact # Message
6/4 a-' kba
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C.7 ' vii5 t�� Date: 2' Phone #: (503) 718- 2LA