Permit 4 4-7 do-viz—ti 2 r //t$ l 7 GZece
! a CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00003
T I G A R D DATE ISSUED: 1 /4/2007
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1 S136DD -03400
SITE ADDRESS: 11740 SW 68TH PKWY 100 ZONING: MUE
SUBDIVISION: TIGARD TRIANGE COMMONS LOT: 008 JURISDICTION: TIG
PROJECT: OREGON MEDICAL ASSOC
Project Description: Low voltage for voice /data. Job No. 64258
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:
PACIFIC NW PROPERTIES TECHNOCOM INC.
PO BOX 2206 7929 SW BURNS WAY# F
BEAVERTON, OR 97075 WILSONVILLE, OR 97070
Phone: Contact #: PRI 503- 682 -4195
FAX 503- 682 -2781
FEES Reg #: ELE 34- 269CLE
LIC 73872
Description Date Amount
[ELPRMT] ELR Permit 1/4/2007 $75.00
[TAX] 8% State Surchar€ 1/4/2007 $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 direct questions to OUNC at
503.246.6.: ' or .: i :. 32.2344.
— 7
Issued By: it ; / / Permittee Signatu ,T ,„ /
____,
OWNER INSTALLATION ONLY U
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.
Il k
Elf: al Permit Application FOR OFFICE USE ONLY
Received ,�' /� A_
City of igard p ELV ED Dateiv : e � Permit No.: f-�" a'- Ore'b
13125 SW Hall Blvd., Tigard, EEP Plan Review
. Phone: 503.639.4171 Fax: 503.598.1960 // "'" I sq I DateB : Other Permit:
�a :
Inspection Line: 503.639.4175 JAN o 2001, 4l Date Ready/By: �� ®See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
CIT o .
t ! N PLAN REVIEW
12 New construction ® 1 • t to alteration /replacement Please check all that apply:
❑Service over 225 amps, comm'I ['Hazardous location
❑ Demolition ❑ Other:
❑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 ommercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family Master builder ['Building over three stories ❑Feeders, 400 amps or more
❑ Other: ❑Occupant Toad over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Job no (,(125 I Job site address: / ❑Health -care facility ❑Other:
l Submit 2 sets of plans with any of the above.
City /State /ZIP: The above are not applicable to temporary construction service.
/ ' 0 y �� A � p FEE* SCHEDULE
Suite/bldg. /apt. noirO Project name: °r�on A jr
Description I Qty. I Fee. I Total I
Cross street/directions to job site: or. . 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
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
V O/6& / d /il , /� dwelling, service and/or feeder 90.90 2
v 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
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
relocation
Phone: ( ) Fax: ( ) 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
❑ 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'l branch circuit 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
tension. De rib : Page 2 2
"T
Business name: c h r?GCory) l r7 C i / - / /i/ . r li 00
a Z 5 (,ti f30 rnu W a� .�iL o �— Each additional inspection over a owable in any of the above
Address: G" G 1
Per inspection 62.50
City /State /ZIP: NI 150 n v I 1 oe, U g (/7C) 7 &i Investigation per hour (1 hr min) 62.50
Phone: (56;1 + 8,9 , y(C(s Fax: ('j3) (2'& a 9 78 1 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 7 '3s 7 Electrical Lic.:' i:teCth Lic.: Subtotal -
/ �
Suprv. Electrician signature, required: j / Plan review (25% of permit fee) .
State surcharge (8% of permit fee) 6', 0 0
Print name: .....)kf G Dater 2 / D
/ TOTAL PERMIT FEE j l t D Q
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
\\ �z C ' 5 L. Print name: D 2 ? /00 • Fee methodology set by Tri- County Building Industry Service Board
J • • Number of inspections per permit allowed.
i\BuildingTermits\ELC- PermitApp.doc 12/03 440- 4615T(10 /O2/COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR JOfi7 00003
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/4/2007
Phone: (503) 639- 4171 °' ii � l��
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 2i2112007 TIME: 7 :00AM PAGE: 39
SITE ADDRESS: 11740 SW 68TH PKWY 100 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGE COMMONS LOT #: 008 TYPE OF USE:
PROJECT NAME: OREGON MEDICAL ASSOC
DESCRIPTION: Low voltage for voice/data. Job No. 64258
OWNER: PACIFIC NW PROPERTIES, PHONE #:
CONTRACTOR: TECHNOCOM INC. 9 ( s PHONE #: 503- 682 -4195
Inspection Request Scheduled For: Date: 2/21/2007 Pour Time:
Code # Inspection Description nr,tir # Contact # Message
135 Low voltage 043643-01 503-209-9278
Corrections /Comments/ Instructions:
135- ) . . . o 4 Vot'At ko.)ct I -►N ett\ 5620 24 b(01 (&)
Wpb
G-RDvAZ (3 X 53 n Nip i
T .
PASS IAL L ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: " Vv) t Date: 21 1 0 Phone #: (503) 718- 210 •