Permit 11 1-.,CITY OF TI GARD ELECTRICAL RESTRICTED ENERGY PERMIT
r l` DEVELOPMENT SERVICES PERMIT #: ELR2005 -00247
n - 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/2/2005
PARCEL: 2S 101 DA -00102
SITE ADDRESS: 13221 SW 68TH PKWY 100 ZONING: MUE
SUBDIVISION: TRIANGLE CORPORATE PARK LOT: 002 JURISDICTION: TIG
Project Description: Thermostat.
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: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1 -
Owner: Contractor:
TIGARD TRIANGLE I LLC AMERICAN HEATING
4650 SW MACADAM AVE STE 220 1339 SW GIDEON ST
PORTLAND, OR 97201 PORTLAND, OR 97202
Phone: Phone: 239 - 4600
Reg #: LIC 33135
ELE 26- 993CRE
FEES SUP 2640LEP
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 9/2/2005 $75.00
[TAX] 8% State Surchart 9/2/2005 $6.00
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 t 503 - 246 -6699.
Issued By: / , ,/ -,C Permittee Signature: Q ^
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.
Elect/ Permit Application FOR OFFICE USE ONLY
' .■ 1
City at t igard '; u'./.; Receive ..."
' Date/By - ,2' . 5 "- O ' c - - VC e l .
....._ Permit No.:c--;CX 5 cia 9'
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 C Y 0 ,-- TiLig Date/B Y'
Other Permit:
ili : .9 1 ,1 / ;,I li •
Inspection Line: 503.639.4175 fmr....ny, ,..5,1.11..-- -..... Date Ready/By: kris: Ei See Page 2 for
Internet: www.ci.tigard.or.us BLS Notified/Method: I(1 Supplemental Information
,' ',. ' . '-'''. 7,- -^ -, ' ,1, 44.:A:iiiViEW . '"'''''''' 1 " .1 ;'" 1: ' " • - ' .-
-- -,--, --;'''fl.'::".. ) . ... ." — ---,-----.:, :"":•::::-.:""'' --'''' ! :"•::4.f ''.■:'"11.- '''.:.%, ' :.•.■ .,.... ,-;.- ; - r.i ''';.,, ,--., : ‘; •; • -
0 New construction 15-‘Addition/alteration/replacement Please check all that apply:
0
['Service over 225 amps, comm'I ['Hazardous location
Demolition 0 Other:
ier`or
['Service over 320 amps - rating 0Buildng over 10,000 sq. ft.,
k .
.V ..e,;A.-gi o*i..T.1 , ..c.'eTrUPW71;.'6.-7::: 1` .‘: i :".F1.;t
'A.;.• ,t-:?-1/zi-i'l.:-4,.e.ra - 1.--:::.A: - -...-_ , V ,::, - ..,,,,,...,;,,c... ,,,,r.,::,,t-",.4-, .. :.:::,.. of 1- and 2-family dwellings 4 or more new residential
ID 1- and 2-family dwelling Vornmercial/industrial 0 Accessory building OSystem over 600 volts nominal units in one structure
['Building over three stories ['Feeders, 400 amps or more
0 Multi D Master builder 0 Other:
DOccupant load over 99 persons ['Manufactured structures or
i VfteilCilifitiVidtof kl*to D RV park
-,:-.• .....::: :4: 4 4, : r.441:4 4 ...;,...4 1 1f.i. , •,.k... , , 4 .. -4,....„2-.., . t -',. ,. -,„-„,... : • Egress/lighting plan
0Health-care facility ['Other:
Job no.: Job site address: /3 ) 6 p
Submit 2 sets of plans with any of the above.
City/State/ZIP: 77 arr ,/ e:, 9,2,x3
,/ J The above are not applicable to temporary construction service.
.f4: .a;.:.t.:COW.( --.::'.;-:.'...
k 8C9dg./apt. no.: /ov Project name: ,'.:!.
e
_ Destiiption I Qty. I Fee. I Total I "
Cross street/directions to job site: New residential single- or multi-family dwelling unit.
Includes attached garage.
1,000 sq. ft. or le§s 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map/parcel no.:
Limited energy, non-residential 75.00 2
;‘ - ; -: .:Pli:i4•!'"p'... P' 1 I
' 4 0 trraWl - ta: . k.1 , 8t!■i■-■Ple . ^^ . :41 , . - .."' '" , ' : . .. 1 ' ^. ., 4 ■• , •,.•;./.4;.:MZ;:.;1-2:i1 , ..,.:-, .,...:' ; .'...i - ` , IvkiT Each manufachtred or modular
dwelling, service and/or feeder 90.90 2
,J6/09C-- ..-- 7;4 e e-er,c,47407 Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
it:ty .:fit.5? i4.24,4 201 amps to 400 amps 106.85 2
lo..4. , :.7.:!:,-..7.: )14)::Tirtir:.r!:::,;_tuitaTi..,yi,
401 amps to 600 amps 160.60 ?
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: ( ) 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 600 amps 133.75 2
Owner signature: • Date: Branch circuits - new, alteration, or extension, per panel
itgrAW:WO.:BNI:Oilt:4):74,,,,,,111;:fi,t1n:-,:ittlgeflMag.4,40;6$Tardr:;1.:5:; A. Fee for branch circuits with
Business name: A A J4.4 ...dT)Co'
igat service or feeder fee, each
branch circuit 6.65 2
B. Fee for branch circuits
Contact name:
e., 4-›..ore
7 47.--
without service or feeder fee,
46.85 2
each branch circuit
Address: /33 9 ,..fe Oiiiet74 S Each add'I branch circuit 6.65 2
City/State/ZIP: ,.... 6w 97ia2- Miscellaneous (service or feeder not included)
. ,
Phone: (OR)02111.,..9, I Fax: : (4‘43 23Y--2039 Pump or irrigation circle
Sign or outline lighting 53.40
5340 2
2
E-mail: Signal circuit(s) or limited-
'': !, i'; ',..:." r/ ' .:::1 ' : '' ;-, -.. ''''';'-:Y' ' '''''' tOgfitA, . -'.. - . ',:ic• tc:! ',... s . ". ..4`* . t , j1 energy panel , alteration, or
Business /9", , c , am
#7 ..,
extension. Describe: . Page 2 2
usiness name:
_ .
Each additional inspection over allowable in any of the above
Address: i 33, je- . 4 -/
Per inspection 62.50
City/State/ZIP: •-, i of 5P22."8.- Investigation per hour (1 hr rain) 62.50
•
Phone: Sria ) 2 4440,01 j Fax ,239_7,228 Industrial plant per hour 73.75
. ':" .r ;.I' -, ''''," :'
.
CCB Lic.:2343S Electrical 4 -,...,...,. suprv.Lic.... Subtotal
6 /'3
Suprv. Electrician signature, requirecCi Plan review (25% of permit fee)
(8% o p MIT ermit FEE
fee)
Print name: L f ) 4,,
l I Date:dir State surcharge
TOTAL PR
A
Authorized signature: (d j , , , /', This permit application expires if 2 permit is not obtained within 180
days after It has been accepted as complete
Print name: )21 e i 7 4-- Date: ffilA2. • Fee methodology set by Tri Building Industry Service Board
i:\Building\Pcsmits\ELC 12/03
440 s* Number of inspections per pemnt allowed.
git TIGARD
. _
BUILDING DIVISION PERMIT #: ELR2005 -00247
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/2/2005
Phone: (503) 639 -4171 °7 " ,,"49 '1iI 1 `
Inspection Requests (24 Hrs.): (503) 639 -4175 : 44 - - ":_
INSPECTION WORKSHEET FOR DATE: 9/8/2005 TIME: 7 :09AM PAGE: 24
SITE ADDRESS: 13221 SW 68TH PKWY 100 CLASS OF WORK:
SUBDIVISION: TRIANGLE CORPORATE PARK LOT #: 002 TYPE OF USE:
PROJECT NAME: CAI NCE
DESCRIPTION: Therm -+ at.
OWNER: TIGARD TRI GLE I LLC, PHONE #:
CONTRACTOR: AMERICAN HE: ING PHONE #: 239 -4600
Inspection Request Scheduled For: Date: 9/8/2005 Pour Time:
Code # •ec • ! - scription Confirm # Contact # Message
199 Electrical final V • • 3- 01 503-209-66' : N
Corrections /Comments /Instructions:
--"T V AN\
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: v • v B L� Date: Phone #: (503) 718 - 0 •GO