Permit CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 -00229
�� �.��I DATE ISSUED: 8/11/2005
`"'� -- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 25101 BD - 00105
SITE ADDRESS: 12805 SW 77TH PL ZONING: I -L
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Low voltage, voice /data.
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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:
B R + G CO LLC RICHARDSON COMMUNICATIONS
PO BOX 23009 10200 SW ALLEN BLVD # B
TIGARD, OR 97223 BEAVERTON, OR 97005
Phone: Phone: 503 -617 -9800
Reg #: LIC 137396
ELE 3- 390CLE
FEES SUP 2956LEA '
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 8/11/2005 $75.00
[TAX] 8% State Surcha 8/11/2005 $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 at 503 - 246 -6699.
Issued By: - 77,7_,et . rz . z 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 Application t FOR OFFICE. USE ONLY - ,
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' City Tigard Date/By: ,) 0 �� PemiitNo.: p03-- 04,26Z9
r3i25 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 I?tt Date /By: Other Pemitt:
Inspection Line: 503.639.4175 s � fi Date Ready /By: luris: El See Page 2 for
Internet: www.ci.tigard.or.us Notifed/Method: 1 Cr Supplemental Information
❑ New construction Addition/alt Pleases heck all that apply: omm l ['Hazardous '
E�'IEW
111 Demolition ❑Other ❑Ser ice over 225 amps, ' location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
" CATEGO OF ON
CS1 RUC fidi � ' of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2 family dwelling Commercial /industrial ['Accessory building ESystem over 600 volts nominal units in one structure
['Building over three stories ❑Feeders, 400 amps or more
❑ Multi - family El Master builder ❑Other:
P r B SITE= INFORM ATION AND LOCAT1®N "` ` " ❑Egress/lighting E plan99 persons rsons RV park
structures or
e ❑
".: ID? i 2 ) c t .3 7 ��
Job no.: G' J o b s a ❑Health -care facility ❑Other:
e U r/4 Submit 2 sets of plans with any of the above.
City /State /ZIP: - ; 744 f1/ `/ '7 1<k / The above are not applicable to temporary construction service.
/ .;. ` rI E SCHEDULE,
Suite /bldg. /apt. no.: Pro name:
Description I Qty. Fee. 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 map /parcel no
Limited energy, non - residential 75.00 2
; k ::'< s ESCR1Pi4O OH ` W ORK � `
a l N �_ o � �D ,�, ,.. _,. ,.�,,.,,,��, �,�. "b_ t Each manufactured or modular
/' 6. 1 dwelling, service and /or feeder 90.90 2
I/ 6 1C. C / ..PG- I�� Can // Services or feeders installation, alteration, and /or relocation 0.
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
PROPERTY OWi i 1 TENA NT : �_
�.,,�_�.H.,.. ,- _... ... .�" �..a 401 amps to 600 amps 160.60 2
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: ( ) 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
W A. Fee for branch circuits with
, T I] APPLICANT COlc'TACT PERSON service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
each branch circuit
Address: Each add'l branch circuit 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2 •
Phone: ( ) Fax: : ( )
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited-
?,: E i..
CON LR �1 �, m � ", .... - . ".
Nk 'i energy panel alteration, or
�,.. -
" """ / � _/ extension. Describe: i Page 2 �1 � , 0 J 2
Business name: i� , 6 -.--- S6 t-, co, %YIpG-s• • e_ Ac.,,.. l
Each additional inspection over allowable in any of the above
C` Address: / / 6 z co J 9 4/1- eit f 7 tj f Per inspection 62.50
i City /State /ZI P: L's if . y , ' X q 7°0 5 Investigation per hour (1 hr nun) 62.50
r / �y Industrial plant per hour 73.75
C Phone: ( _cc�) ,b / 7 7 ?o U Fax: (y4�3) T 'c� 9 f 0 p p
/ „,: . E LECTRICAattO IT,,F'EES* " . , NV
CCB Lic.: /3-73, �' Electrical Lic.: 3 ' °706L‘ Suprv. Lic.: 2 e 4 Subtotal '4 e Q
C- Sup Electrician signature, required: -`� y1� Plan review (25% of permit fee)
Print name: t L Date: j / /
I State surcharge (8% of permit fee) _ 0 D
I /7" ill i TOTAL PERMIT FEE v i . 0
Authorized signature: / This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: . Date: * Fee methodology set by Tri- County Building Industry Service Board
** Number of inspections per permit allowed.
i:\ Building \Permits \ELC- PennitApp.doc 12/03 440 4615T(10 /02 /COM/WEB
•
OF TIGARD
D ING DIVISION PERMIT #: ELR2005 -00229
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/11/2005
Phone: (503) 639 -4171 / pinpi4cdl��pAI i til\
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/12/2005 TIME: 7 :O$AM PAGE: 61
SITE ADDRESS: 12805 SW 77TH PL CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TEREX UTILITIES WEST
DESCRIPTION: Low voltage, voice/data.
OWNER: B R + G CO LLC, PHONE #:
CONTRACTOR: RICHARDSON COMVMMUNICATIONS PHONE #: 503 -617 -9800
Inspection Request Scheduled For: Date: 8/12/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 013428 -01 . 503.619 -2578 N
Corrections /Comments /Instructions:
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 1 O Phone #: (503) 718- 21\6