Permit RESTRICTED E
CITY O F TIGARD
ERG
ENERGY
•h DEVELOPMENT SERVICES PERMIT #: ELR2004 -00007
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/21/04
SITE ADDRESS: 12665 SW 69TH AVE PARCEL: 2S101AD -02800
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 031 JURISDICTION: TIG
Proiect Description: Low voltage for Voice and Data Cabling.
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:
CEDAR ENTERPRISES BROADWAY ELECTRIC - COCHRAN INC
MARTY GOLDSMITH & RON ENYEART 626 SE MAIN
4004 KRUSE PLACE PORTLAND, OR 97214
LAKE OSWEGO, OR 97035
Phone: Phone: 503 234 - 6564
Reg #: LIC 72942
SUP 3447S
ELE 37 -546C
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 1/21/04 $75.00 Elect! Final
[TAX] 8% State Surchart 1/21/04 $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 throuc
9
Issued by / w Permittee Signature owo p
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 639 -4175 by 7:00 P.M. for an inspection needed the next business day
A Electrical Permit Applicatio
rillIMET1111111117_.
tereceived: / -34.O4 rmit no. j( - ,, �;" . i J City o f Tigard ject/appl. no.: ' pire date: .
•
CityofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 te issued: yJ I Receipt no.: -
Phone: (503) 639 -4171
Fax: (503) 598 -1960 - se file no.: yment type: . . .
Land use approval: = ..... _ -77 , -' -
TYPE OF PERi\IIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family ❑ Tenant improvement
New construction 0 Addition/alteration /replacement . . - . 0 Other. .. 0 Partial
JOB SITE INFOli19ATION
Job address: ig 6 55 SW 69-- Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: (Subdivision:
Project name: EA ye wet Tr =ti 41:..7 I Description and location of work on premises: io t ' .., it j) k? ik. Cat, 41, .z 7
Estimated date of completion/inspection:
_ , . _ .._ (QNRACCOR APPL1( *v., ._ ... FEE SCIIEDIA.E
Jobno: 606 0 ? S T - ?Co 7Y3 Fee Max
Business name: 13 r 69.41 . at ec7 ri c Description . Qty. (ea) Total no. insp
New resideatial- single ormufti-family per
Address: 6 2.6 SE rK ^ . dweWng unit. Includes attached garage.
City: Po r7 N. I State: II I ZIP: ? 7 xi Y Servieetncludech
Phone: yo 3 -'a3' -6 ay' Fax: 23J -2ofi' I E -mail: 1000 sq. ft. or less 4
I 3 7 S - Y i, Each additional 500 sq. ft or portion thereof
CCB no.: 7,? 74(2,
Elec. bus. IiC no: Limited energy, residential - 2
City /me C. O:: -
V.. Limited energy, non-residential 2
.) Each manufactured home or modular dwelling
Signature of supervisi g electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): .e.v.e.. u _ ■ License no: 3 -1.5 5 Services or feeders - installatioth,
,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Ova 1000 amps or volts 2
Phone: I Fax: 1E-mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders - .
which is not intended for sale, lease, rent, or exchange according to hhstrdladon ,altehation,orrelocation:
201 amps or less 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am s 2
Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: - I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E -mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apple) Misc. (Service or feeder not included):
O Service over 225 amps - commercial 0 Health -care facility Each pump or irrigation circle 2
O Service over 320 amps- rating of 18a ❑ Hazardous location Each sign or outline lighting isN - 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, ' °o
O System over 600 volts nominal more residential units in one structure alteration, or extension* 8 - 2
❑ Building over three stories 0 Feeders, 400 amps or more • *Description:
❑ Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable In any of the above:
O Egress/lightingplan ❑ Other Per inspection 1 1 . 1
Submit — sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other - ,
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee $ 7s. 0 0
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
• Credit card number: 1 / within 180 days after it has been State surcharge (8%) .... $ 6.0 0
Expires TOTAL as comp TOTAL $ 81.
Name of cardholder as shown on credit card
$
Cardholder signature Amomt 440-4615 (6AO/COM)
Electrical Permit Fees: Limited Energy Fees: ,
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY •
Complete Fee Schedule Below: Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 1, Check Type of Work Involved: •
R%sidential - per unit • -- .. •
1000 sq. ft or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof , $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular ❑ Garage Door Opener'
Dwelling Service or Feeder $90.90 2
Services or Feeders . ❑ Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation
200 amps or less $80.30 2 ❑ Vacuum Systems`
201 amps to 400 amps $106.85 2
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 ❑ Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918-260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts, ❑
see "b" above. Audio and Stereo Systems
•
•
Branch Circuits ❑ Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 - ❑ Intercom and Pam Systems Each sign or outline lighting $53.40 Paging y
Signal circuit(s) or a limited energy
panel, alteration or extension 1 $75.00 7 S .00 ❑ Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over ❑ Medical
the allowable in any of the above
Per inspection $62.50 ❑ Nurse Calls
Per hour $62.
In Plant $73.75 ❑ Outdoor Landscape Lighting'
Fees: ❑ Protective Signaling
Enter total of above fees $ 7 S..00 l l Other
8% State Surcharge $ 6 . G 0 Number of Systems
25% Plan Review Fee
See "Plan Review' section on $ * No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $ '(.OD
Enter total of above fees $
•
❑ Trust Account # 8% State Surcharge $
Total Balance Due • $
i:\dsts\forn s\elc- Cees.doc 10/09/00