Permit CITY T I GA R D ELECTRICAL RESTRICTED ENERGY PERMIT
do, , ,,IA, DEVELOPMENT SERVICES PERMIT #: ELR2006 -00168
11
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/11/2006
PARCEL: 2S113AD -01700
SITE ADDRESS: 16940 SW 72ND AVE ZONING: C -G
SUBDIVISION: ROSEWOOD ACRE TRACTS LOT: 030 JURISDICTION: TIG
Project Description: (2) HVAC.
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: 2
Owner: Contractor:
BRIDGEPORT LAND LLC LORENZ ELECTRICAL CONSTRUCTION INC
3939 NW ST HELENS RD PO BOX 3580
PORTLAND, OR 97210 HILLSBORO, OR 97123
Phone: 503- 241 -2875 Contact #: PRI 503- 614 -0400
FAX 503- 614 -0401
Reg #: ELE 34 -516C
FEES L1C 138608
Description Date Amount SUP 4673S
[ELPRMT] ELR Permit 7/11/2006 $150.00
[TAX] 8% State Surcha 7/11/2006 $12.00 REQUIRED ITEMS AND REPORTS
Total $162.00
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.
Issued By: ( � Permittee Signature: ( z> i\
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.
Ju.1 11 06 10:31a P. 1
Electrical Permit Applicat' : ¢ FOR OFFICE USE ONLY ,
Rec eived . r
City of Tigard — �' Permit No.:6&
Date Received 4
13125 SW Hall Blvd., Tigard, OR 97223 `� ' rI
� t l ,, P lan R ev i ew•
Phone: 503.639.4171 Fax: 503.598.1960 hrt t Other Permit:
1 ( Dat /B v:
Inspection Line: 503.639.4175 A31- � �. c`L,� Date Ready /By: KIM El See Page 2 for
Internet: www.ci.tigard.or.us b� � q "`�•,.` Notified:Method: Supplemental Information
TYPE _ sR ��,,jj t ��I , . PLAN REVIEW
❑ New construction ® Additi , t dr ItPt� acem'ent Please check all that apply:
❑ Demolition ❑ Other:
❑Service over 225 amps, comm'I ❑ Hazardous location
- ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ I - and 2- family dwelling ® Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Multi D Master builder ❑Other:
❑Occupant load over 99 persons Cl Manufactured structures or
JOB SITE INFORMATION AND LOCATION . ❑Egress/lighting plan RV park
Job no.: Job site address: MAO 1{1 ❑ Health -care facility ❑Other:
ski � O� Submit 2 sets of plans with any of the above.
City/State/ZIP: 7:G�R , 0 , t / ' i (/ O The above are not applicable to temporary construction service. •
Suite /bldg. /apt. no.: !° Project name: /�oti �1et4 e�►(�t�y ib FEE* SCHEDULE +.
F 1 j i {- Description I Qty. 1 F. I Total
Cross street/directions to job site: New residential single -or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax maplpaTCel no.: Limited energy, non-residential 75.00 2
DESCRIPTION OF WORK • Each manufactured or modular
(21.1vA r dwelling, service ad /or feeder 90.90 2
L Ys1 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: Mgu< ld yllousE 601 amps to 1,000 amps 240.60 2
Address: J C �•11 p� Over 1,000 amps or volts 454.65 2
�o L / . AVE 1 Reconnect only 66.85 . 2
_
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( )
-. _ 200 amps or less 66.85 I
Owner installation: This installation is being made on property that 1 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
❑ APPLICANT I ® CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each
6.65
Business name: branch circuit
Contact name: /� 5 f E B. Fee ou service circuits
""/` without service or feeder fee,
46.85 Q 2
, y first branch circuit
Address: �7t 22 Each add'l branch circuit 6.65 r
City/State/ZIP: C�C
Cit r' / ,� �p p Miscellaneous (service or feeder not included)
, � Pump or irrigation circle 53.40 2
Phone: ( S03) 650 -124 Fax: : (SO) ¢ Sign or outline lighting 53.40 2
E -mail: Signal eircuit(s) or limited-
CONTRACTOR energy panel, alteration, or
extension. Describe: • 1 Page 2 2
Business name: LI1.Ei etiraRYAL C p t,o ij AZ,- Low-VoLTIT- STjhTS .
j� !�� Each additio al inspection over allowable in any of the above
N- Address:
PO -RDX 3s "r) 7 Per inspection 62.50
City /State /ZIP: Il iu� /� OR q 123
� Investigation per hour t hr min) 62.50
^ j t V Industrial plant per hour 73.75
Phone: ( ) 6[4 . F ax: (03) 14- (� 1 ELECTRICAL PERMIT FEES*
I CCB Lic.: J - oz, I ` r J" I� Electrical Lic.:34 Suprv. Li C� Subtotal
Suprv. Electrician signature, required: / _ Plan review (25 % of permit fee)
■
Print name: /( �� Date• 11-
� State surcharge (8% of permit fcc)
/ TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained s.ithin 1811
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Di - County Building industry Service Board
** Number of inspections per permit allowed.
islnuildine Parmil PttnritApp.doc 12/05 44O-4615T(10,'021COM,'WEB
CITY OF TIGARD
- BUILDING DIVISION PERMIT #:t,1.C24A6.440k 6'4
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: %..1.66 TIME: PAGE:
SITE ADDRESSW) l S W • 12 'AV - CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: s 3 Z I LS a , PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments/ Instructions:
•
21. PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: ` W v `� Date: %'—/ 'v Phone #: (503) 718-