Permit to.
CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2006 - 00285
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/27/2006
PARCEL: 2S 101 AA - 09800
SITE ADDRESS: 12570 SW 69TH AVE ZONING: MUE
SUBDIVISION: PP1996 - 024 LOT: 002 JURISDICTION: TIG
Project Description: (3) low voltage. Audio, Data & CCTV.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: X 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: CCTV X
TOTAL # OF SYSTEMS: 3
Owner: Contractor:
JT ROTH DEVELOPMENT GEORGE FOX UNIVERSITY
12600 SW 72ND AVE, STE 200 1101 VILLA ROAD
TIGARD, OR 97223 NEWBERG, OR 97132 -1218
Phone: 503- 639 -2639 Contact #: PRI 503 -554 -2014
FEES Reg #: ELE 36 -75C
SUP 3973S
Description Date Amount
[ELPRMT] ELR Permit 11/27/200E $225.00
[TAX] 8% State Surcha 11/27/200E $18.00 REQUIRED ITEMS AND REPORTS
Total $243.00
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 pr 1.800.332.2344. �p
Issued By: '�; j, Permittee 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:
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.
•
- Electrical Permit Applicati rpriC i;T:1 FOR OFFICE USE ONLY
Received ;
City of Tigard 7 Permit No.:
U PI
a "ii q 13125 SW Hall Blvd., Tigard,OR 9723, i� ?_006 Plan Review
' 2 Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit.
T I G A R D Inspection Line: 503.639.4175 C. Y U i=' _,e i / 1kdd Date Ready/By: Juris: ,/ ® See Page 2 for
Internet: www.tigard - or.gov ∎;6;'r!Ne. DIVISION Notified/Method: // 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.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
12 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
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A", "E", "1 -2 ", "1 -3 ",
Job no.: Job site address: 12570 SW 69 St 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Su p p ly l voltage for more than
❑ Hazardous locations.
Suite /bldg. /apt. no.: I Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Corner of 69 and SW Beveland. Description I Qty. I Fee. I Total 1 •
' New residential single- or multi- family dwelling unit.
Come south on 68 and turn right on Beveland Includes attached garage.
Subdivision: 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. ft.) 75.00 2
Limited energy, multi - family 75.00 2
Voice, Data, Video, and Audio wiring residential (with above sq. ft.)
Services or feeders installation, alterati on, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ® TENANT 201 amps to 400 amps 106.85 2
Name: George Fox University 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 414 N. Meridian Over 1,000 amps or volts 454.65 2
City/State /ZIP: Newberg, OR 97132 Temporary services or feeders installation, alteration, and /or
relocation
Phone: (503)538 -8383 I Fax: (503)554 -2009 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 ® CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: George Fox University B. Fee for branch circuits
Contact name: Andrew Baker without service or feeder fee, 46.85 2
first branch circuit
Address: 414 N. Meridian Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Newberg, OR 97132 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (503) 523 -7655 cel I Fax: : (503) 554 -2009 Reconnect only 66.85 2
E -mail: abaker @georgefox.edu Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
a Fox University Signal panel, a ) or alteration, Business name: George or
g ty energy panel, alteratioq or
Address: 414 N. Meridian St extension. Describe: Page Page 2 225 2
"L City/State /ZIP: Newberg, OR 97132 Each additional inspection over allowable in any of the above
) Per inspection 62.50
cr Phone: (503) 538 -8383 Fax: (503) 554 -2009 Investigation per hour (1 hr min) 62.50
CCB Lic.: I Electrical Lic.: 36- C Suprv. Lic.: 3973S Industrial plant per hour 73.75
���" ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 1�i�Gf.� (% Subtotal: 225 ad ,
Print name: Paul Corbett- Furgal Date: // _ �7 _ 0 Plan review (25% of permit fee):
_ State surcharge (8% of permit fee): 18
Authorized signature: Irr (4 TOTAL PERMIT FEE: 299 5--
This permit application expires if a permit is not obtained within 180
Print name: Andrew Baker 0 SA (E Date: - ? —O 6 days after it has been accepted as complete. d J
• Number of inspections allowed per permit. ei.y3
I:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(I I /05 /COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2006 -00285
13125 SW Hall Blvd., Tigard, OR 97223 - DATE ISSUED: 11/27/2006
Phone: (503) 639 -4171 Ahr�
Inspection Requests (24 Hrs.): (503) 639 -4175 "LL
INSPECTION WORKSHEET FOR DATE: 12/22/2O06 TIME: 7:OOAM PAGE: 6
SITE ADDRESS: 12570 SW 69TH AVE CLASS OF WORK:
SUBDIVISION: PP1996 -A24 LOT #: 002 TYPE OF USE:
PROJECT NAME: GEORGE FOX UNIVERSITY
DESCRIPTION: (3) low voltage. Audio, Data & CCTV.
OWNER: ,IT ROTH DEVELOPMENT, PHONE #: 503 -639 -2639
CONTRACTOR: GEORGE FOX UNIVERSITY N DA 64\1L L. PHONE #: 503 -2014
Inspection Request Scheduled For: Date: 12/22/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 041486-01 503. 523-7655 Y
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: t" 6 6 (--+ `' Date: 1 a Phone #: (503) 718 - 14
CITY OF TIGARD
BUILDING DIVISION N PERMIT #: ELFt2006-00 ?_r35
13125 SW Hall Blvd., Tigard, OR 97223 - DATE ISSUED: 11127/2006
Phone: (503) 639 -4171 1 1� l
Inspection Requests (24 Hrs.): (503) 639 -4175 ' :..
INSPECTION WORKSHEET FOR DATE: /215/2006 TIME: 7:0OAM PAGE: 7
SITE ADDRESS: 12570 SW 69TH AVE CLASS OF WORK:
SUBDIVISION: PP1996 - 024 LOT #: 002 TYPE OF USE:
PROJECT NAME: GEORGE FOX UNIVERSITY
DESCRIPTION: (3) low voltage. Audio, Data & CCTV.
OWNER: JT RO TH DEVELOPMENT, PHONE #: 503- 639 -2639
CONTRACTOR: GEORGE FOX UNIVERSITY afyi 6 0..G- PHONE #: 503 -554 -2014
Inspection Request Scheduled For: Date: 12/6/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 04067401 503- 523-7655 Y
414 Ga tLItq Cod
Corrections /Comments / Instructions:
e y\
J1 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: • ( 68 Date: 1 0 6 Phone #: (503) 718- Zyq'D
CITY OF TIGARD
BUILDING DIVISION - PERMIT #: ELR200S -00286
13125 SW Hall Blvd., Tigard, OR 97223 - DATE ISSUED: 11/27/2006
Phone: (503) 639 -4171 fa
Inspection Requests (24 Hrs.): (503) 639- 4175'I�
INSPECTION WORKSHEET FOR DATE: 11/78/2006 TIME: 7:03AM PAGE: 13
SITE ADDRESS: 12570 SW 69TH AVE CLASS OF WORK:
SUBDIVISION: PP1996 - 024 LOT #: 002 TYPE OF USE:
PROJECT NAME: GEORGE FOX UNIVERSITY
DESCRIPTION: (3) low voltage. Audio, Data & CCTV.
OWNER: ,X( ROTH DEVELOPMENT, PHONE #: 503-639-2639
CONTRACTOR: GEORGE FOX UNIVERSITY A 01 BAU 0%.,I / Nt,0,6E 9 PHONE #: 503 -5&i -2014
Inspection Request Scheduled For: Date: 11/28/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 040329-01 503- 523 -7655 Y
Corrections /Comments/ Instructions:
0 ti( 1 0 PIS tag L' i N$i0 e
E i N► 6.k v AL-LS / A 6 i R 1 w ALL. .
. • ,
0 •:l-
- IA ;A 1 Yst\C
❑ PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: v oV 1`.., Date: I I 2� PO Phone #: (503) 718- 2-11I1