Permit CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00153
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/22/2007
PARCEL: 1 S135CD -00900
SITE ADDRESS: 11511 SW 98TH AVE ZONING: R -12
SUBDIVISION: GLACIER LILY APARTMENTS LOT: JURISDICTION: TIG
PROJECT: GLACIER LILY APARTMENTS
Project Description: Installation of CCTV low voltage system.
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: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: CCTV X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
SHARON DEVELOPMENT CO, LLC ADVANCED CASTLE TECHNOLOGIES INC
5795 SW CRANBERRY CT 220 SE 32ND AVE
BEAVERTON, OR 97007 HILLSBORO, OR 97123
Phone: 503- 627 -0153 Contact #: PR1 503- 869 -4626
Reg #: ELE 34- 579CLE
FEES LIC 149864
Description Date Amount SUP 1142LEA
[ELPRMT] ELR Permit 5/22/2007 $75.00
[TAX] 8% State Surcha 5/22/2007 $6.00 REQUIRED ITEMS AND REPORTS
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 re• ires you to follow rules adopted by the Oregon
Utility No • ' ion e =r. Those rules are set forth in OAR 952 - 001 -0010 through OA' •' 2- 001 -0100. You may obtain copies of these
rules • direct questions to •1 • C )at 503.246.6699 or 1.800.332.2344.
4
Issued = 1 Permittee Signature: % ' Ar. •' /
A i r � .
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 C FOR OFFICE USE ONLY
C ity of Tigard DateB� 7 / 07 lig Permit No.: // ,— CO/
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
i . Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
TI G A It D Inspection Line: 503.639.4175 Date Ready/By: J /�► 0 See Page 2 for
Internet: www.tigard or.gov Notified/Method: I Ls 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
❑ 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
1001-IP or more. occupancy.
Job no.: Job site address: 11 II s (I .l 9R T N f ' v ,
0 Six or more residential units. 0 Recreational vehicle parks.
City /State /ZIP: TI G A gL'b / G 1` nn 9 22.. 3 ❑ Health -care facilities.
❑Hazardous locations. ❑ 600v o nomi a more than
Suite/bldg. /apt. no.: Project namegL I L Li A-Pm' ❑ Service or feeder 600 amps more.
Cross street/directions to job site: Description I tom. I Fee. I Total
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
11 Limited energy, multi - family 75.00 2
L.,C1 W U 0. 1 C1 .E ,) ,k .∎ l T 1 Q_ l� -�+'1- 422 S residential (with above sq. ft.)
1 Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
C. PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: S h � dl _ N b w e.� /' P. 4 CO LZ.� 401 amps to 600 amps 160.60 2
It�� P h 601 amps to 1,000 amps 240.60 2
Address: S1 CIS S W e. 9.0 to t �y C7 Over 1,000 amps or volts 454.65 2
City /State /ZIP: BQ eJ �� ' 0 R IJ 9 -70 61 Temporary services or feeders installation, alteration, and /or
relocation
Phone: (63) (va l ._ 01 5 - Fax: (50 ) 52 _ c s-- 200 amps or less 66.85 l
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
Owner signature: Date: Branch circuits- new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit _
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
C T� \ 1n Signal circuit(s) or limited -
Business name:
061..��1� � (F-r._i 0(..„) C / E j. energy panel, alteration, or
Address: a� a A U c` extensi De_ scribe: Page 2 ?� 2
City/State /ZIP: IBS /�,eD p,e 9 712.3 Each additional inspection over allowable in any of the above
rr ��, I 14624, -�/ Fax: ( ) Per inspection 62.50
Phone:
Va3 8 tLC( J T6 Investigation per hour (1 hr min) 62.50
CCB Lic.: /4/9 g(, e f Electrical Lic.:�{%L57? Suprv. Lic.: /f - Industrial plant per hour 73.75
I / ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 7A/ ELECTRICAL /40V Subtotal: 75. 0c)
Print name: Date: / Plan review (25% of permit fee):
5 /Z1 / 7 St ate surcharge (8% of permit fee): Authorized signatu TOTAL PERMIT FEE: 8/ . 0O
-7 Date This permit application expires if a permit is not obtained within 180
Print name:
` 9 LL I S .1 Z ? T zl o 7 days after it has been accepted as complete.
V • Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
LlBuilding\Permits\ELC- PermitApp.doc 03/23/06
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CITY OF TIGARD .
BUILDING DIVISION PERMIT #: 1.0015
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639-4171 Af 11410 1,'
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6" 25 07 TIME: '� p rA,, PAGE:
SITE ADDRESS: 41511 S lla 98 AWE • CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: CC"1 V Ckeai
( V 1
OWNER: PHONE #:
CONTRACTOR: pa PHONE #:
Inspection Request Scheduled For: Date: S • 1'• t1 • Pour Time:
Code # Inspection Description Confirm # Contact # Message
\°lot Fit At
Corrections/Comments/Instructions:
--- -A . )
% PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL U CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �` � � Date: 51 2 01 Phone #: (503) 718- 26151) -