Permit III q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/8/2008
PARCEL: 2S 101 AD -03200
SITE ADDRESS: 12909 SW 68TH PKWY 100 ZONING: MUE
SUBDIVISION: TIGARD TRIANGLE CENTER LOT: JURISDICTION: TIG
PROJECT: TIGARD TRIANGLE 082
Project Description: Voice and 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:
PACIFIC REALTY ASSOCIATES BRITTINGHAM ENTERPRISES INC
15350 SW SEQUOIA PKWY #300 -WMI PO BOX 1978
PORTLAND, OR 97224 SISTER, OR 97759
Phone: Contact #: PRI 541 -549 -1977
Reg #: ELE CLE48
FEES LIC 144883
Description Date Amount
[ELPRMT] ELR Permit 1/8/2008 $75.00
[TAX] 8% State Surcha 1/8/2008 $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 questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: _ .c Perrnittee 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:
Cali 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.
E lectrical Permit A t • l < t ,1 , —. 4 - 1../.•R oFIICE usl, ()NIA
eceived D `,�/ ��0 ev�
City of Tigard Date/By:
1 `d Permit No. /�.
a 13125 SW Hall Blvd., Tigard,OR 97223'. 9 :, ; 0 log do ' q
C a , logo Plan Revie t: �ry q 1
Phone: 503.639.4 F ax: 503.598. F966 Date/By: ether Permi - �/ l J
1 I G n R D Inspection Line: 503.639.41018 y rl . . �
D . , Date Ready/By: ® y: Jur See Page 2 for
Internet: www.tigard -or k t % � �`; Notified/Method: Supplemental Information
LI ''4'8.1 c 0 D IO PLAN REVIEW
❑ New construction a 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 I 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 ",
Job no.: I Job site address: 1 2 Ci c S4) GS 7°' P,w 100HP or more. occupancy.
❑
y 0 Six or more residential units. Recreational vehicle parks.
City/State /ZIP: Vh(Z F L,A.,,) I i - 7 223 / ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. net. , name: • _ � 9 _ ❑ Service or feeder 600 amps or more.
��i9 `�` -,• FEE SCHEDULE
Cross street/directions to job site: Description 1 tom. ] Pee 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'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family
L,CXCC__, -0/E -, 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
401 amps to 600 amps 160.60 2
Name: J/}n
�e » J P e tc t A L �-Ce__. 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 100.30 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 I ECONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B R.1 -t- I06 H 4 ,tre,, P /?r seS B. Fee for branch circuits
without service or feeder fee,
Contact name:
Vc-,.,./ i 2 I}n1 eA_ first branch circuit 46.85 2
Address: 20 t E : C7 Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: C A.„ , 9 7 0 ( 3 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (91 1 ) SOC. - A DO Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: L� Signal circuit(s) or limited -
2 l �'�/iJ� H Ain S energy panel, alteration or
Address: PO (So , 9 - 7 t3 extension. Describe: I Page 2 2
City/State /ZIP: S ts7iets 0/1 9 5c/ Each additional inspection over allowable in any of the above
a DI' Per inspection 62.50
Phone: (S`{ /) 5 `{`T - it 7 - Fax: ( ) 1 .1 ' Investigation per hour (1 hr min) 62.50
CCB Lic.: / L} 1./ S93 Electrical Lic.: E `i Suprv. Lic.:.fi4WA Industrial plant per hour _ 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician gnature, required: / Subtotal: iiS mt7
Print name: ,Z.,.....„ t c En Date: 1 /� /et:), Plan review (25% permit fee):
State surcharge (12% of permit fee): 0 1 • OD
Authorized signature: TOTAL PERMIT FEE: e Ob
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 4615TO1/05 /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:
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
El 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: 1
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permiu\ELC- PermitApp.doc 03/23/06
IMF 11.IIIIIIIIIIIIIIIIIIIIIMI
CITY OF TIGARD 0 _ •
BUILDING DIVISION PERMIT #: ELR2008.00007
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/8/2008
Phone: (503) 639 -4171 A �i
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 1/18/200 TIME: 7 :02AM PAGE: 2
SITE ADDRESS: 12909 SW 68TH PKWY 100 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE CENTER LOT #: TYPE OF USE:
PROJECT NAME: TIGARD TRIANGLE 082
DESCRIPTION: Voice and data
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: BRITTINGHAM ENTERPRISES INC PHONE #: 641 -549 -1977
Inspection Request Scheduled For: Date: 1/18/2008 Pour Time:
Code # Inspection Description 9311film Contact # Message
199 Electrical final 063542 -01 503-956.6290 \ Y
Corrections /Comments /Instructions: {11I Ikk
CALi A Am
N
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
AIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
vv
Inspector: ' oe L. Date: 1 - 1 1 Y% Phone #: (503) 718- 1J1111)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: EL
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/81008
Phone: (503) 639 -4171 4d10pai
Inspection Requests (24 Hrs.): (503) 639 -4175 `__..
INSPECTION WORKSHEET FOR DATE: 1/9/2009 TIME: 7 :01AM PAGE: 36
SITE ADDRESS: 12909 SW 681 H PKWY 100 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE CENTER LOT #: TYPE OF USE:
PROJECT NAME: TIGARD TRIANGLE 082
DESCRIPTION: Voice and data
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: E3RITTINGHAM ENTERPRISES INC PHONE #: 541 -M9 -1977
Inspection Request Scheduled For: Date: 1/9/2008 Pour Time:
Code # Inspection Description Confir - Contact # Message
13( Low vo age 062828 -01 971- 506 -1300 N
Corrections /Comments/ Instructions:
i 1rc a 3Ttit\
c c - k Gm,f
t
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: GM N 0 e Date: It C I • 01 Phone #: (503) 718- Z4417