Permit . • ;
Pp a C ITY OF TI GARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00012
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/14/2008
PARCEL: 2S 101 DA -00100
SITE ADDRESS: 13010 SW 68TH PKWY 140 ZONING: C -P
SUBDIVISION: TRIANGLE CORPORATE PARK LOT: 007 JURISDICTION: TIG
PROJECT: PACIFIC SOURCE HEALTH
Project Description: Install low voltage audio /stereo system.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: X 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:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
SCHNITZER INVESTMENT CORP SPECTRUM SYSTEMS DESIGN
PO BOX 10047 MCGILL SYSTEMS INC
PORTLAND, OR 97296 937 SW 14TH AVE STE 201
PORTLAND, OR 97205
Phone: Contact #: PRI 503- 248 -0248
FAX 503- 274 -7684
FEES Reg #: ELE 26- 1232CLE
LIC 79244
Description Date Amount SUP 4276
[ELPRMT] ELR Permit 1/14/2008 $75.00
[TAX] 12% State Surch 1/14/2008 $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 B, . � / Permittee Signature:)( W
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.
El Permit Application FOR OFFICE. USE ONE
Received / �O E y� • _ 4I 12_
Re e
City of Tigard Received Permit No.: /`
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie
C . Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
1' I A R D Inspection Line: 503.639.4175 Date Ready/By: ® y: See Page 2 for
Internet: www.tigard- or.gov Notified/Method: r ! ( Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ 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.
CAT OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
I , 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 ", "1 -2 ", "l -3 ",
Job no.: Job site address: /� ' l Cos -th 100HP or more. occupancy.
30 I 0 w �J "' ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: ) ,1 I 0 r` "L9- ZZ if ❑ Health -care facilities. ❑ Supply voltage for more than
/ ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I /1 - Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 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.)
• Limited energy, multi - family
Low v0 11-� /�f . a(�(-pd i e /creo O residential (with above sq. ft.)
75.00 2
F� _ U ;} Services or feeders installation, alteration, and/or relocation
200 amps or Tess 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name:
p 5,,A. r C 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 Tess 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 ❑ 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
fast branch circuit
Address: Each add'l 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: ( ) I 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: e Ck it a. It A Ag ■ e J energy panel, alteration or
Address: C .) b3 ILI t t l 1_` 10 ( • extension. Describe: 1 P a g e 2 J 2
City/State /ZIP: P v D w � 0 S Each additional inspection over allowable in any of the above
n 4 - 0 8- Fax: (SC3) 2 f j ^ I �� Per inspection
ti i n 62.50
Phone: G �7 � n Investigation per hour (1 hr min ) 62.50
CCB Lic.: qc 2_14 I Electrical Lic.: 210 --/ 3 Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: ARA? 42 Subtotal: 3C 1')0
r Plan review (25% of permit fee): 5
Print name: 4 la 1- • (,��_ Date: _� v....0 4.04,h,.....----- State surcharge (12% of permit fe ci . 00
Authorized signature. TOTAL PERMIT F EE : 6 . � � 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(11/05/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:
it 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
I:\ Building \Permits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD
Ai,,,
BUILDING DIVISION PERMIT #: ELR200800012
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/14/2O013
Phone: (503) 639 -4171 9pi'�h�
Inspection Requests (24 Hrs.): (503) 639 -4175 F__..
INSPECTION WORKSHEET FOR DATE: 2/15/2008 TIME: 7 :00AM PAGE: 35
SITE ADDRESS: 13010 SW 68TH PKWY 140 CLASS OF WORK:
SUBDIVISION: TRIANGLE CORPORATE PARK LOT #: 007 TYPE OF USE:
PROJECT NAME: PACIFIC SOURCE HEALTH
DESCRIPTION: Install low voltage motto /stereo system.
OWNER: SCHNITZER INVESTMENT CORP, PHONE #:
CONTRACTOR: SPECTRUM SYSTEMS DESIGN PHONE #: 503 248 -0246
Inspection Request Scheduled For: Date: 7J 15/2008 Pour Time:
Code # Inspection Description 71• • Contact # Message
135 Low voltage - 065074 -01 503-248.0248 N
I°l°l F'1 0 (AL
Corrections /Comments /Instructions:
i
K PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
IL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G N d8 Date: 2- Phone #: (503) 718- Z 6