Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
, 1 DEVELOPMENT SERVICES PERMIT #: ELR2005 - 00069
c�lll 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/24/2005
PARCEL: 2S115AD-00600
SITE ADDRESS: 16740 SW 108TH AVE ZONING: R - 4.5
SUBDIVISION: WILLOWBROOK FARM LOT: 030 JURISDICTION: TIG
Project Description: All encompassing low voltage.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: X AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: X BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: X CLOCK: MEDICAL:
HVAC: X DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: X FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: ALL ENCOMP : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
MAY, MARTA DYNASTY SECURITY
16740 SW 108TH AVE 8301 SW 135
TIGARD, OR 97224 BEAVERTON, OR 97008
Phone: 503- 380 -1693 Phone: 503- 319 -4754
Reg #: ELE 34- 501CLE
LIC 135086
FEES SUP 2227JLE
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 3/24/2005 $75.00
[TAX] 8% State Surcharl 3/24/2005 $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 ar: set forth in OAR 952 - 001 -0010
through OAR 952 -001 -1100. You y obtain copies of these rules or direct quest'• to OUNC a 51 / 46 -6699.
Issued By: AP _ � Permittee Signature: A� /,`
OWNER INSTALLATION 0 i
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.
�►pproved plans are required on the job site at the time of each inspection.
• Electrical Permit �'b cM/ .,, 3 - ? -FOR.OFFICE,USE ONLY _ ~
IJI»
1 Received /�, J C
City of Tigard DateB : ;j/=j / tj Permit No. ` Q vU
13125 SW Hall Blvd., Tigard, OR 97D 2 4 200 Plan Revie
Phone: 503.639.4171 Fax: 503.598.1 A' � `� Date/By: Other Permit:
Inspection Line: 503.639.4175 r _ d� Date Ready/By: Juan: 0 See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGAR.JJ Notified/Method: 17 Supplemental Information
BUILDI,;(311AlakkSION PLAN REVIEW
❑ New construction r, Addition/alteration/replacement Please check all that apply:
❑ Demolition El Other: ❑Service over 225 amps, comm'l ❑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
,:( 1- 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- family El Master builder El Other:
['Occupant load over 99 persons [Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Job no.: Job site address: / � 7 vo S&) / or-'- ❑Health - care facility Ill Other:
Submit 2 sets of plans with any of the above.
City /State /ZIP: / / / /5 _ The above are not applicable to temporary construction service.
Suite /bldg. /apt. no.: Pr 3ectname: FEE* SCHEDULE *}
Description 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
DESCRIPTION OF WORK Ea ch manufactured or modular
// /sem �/ ,/� dwelling, service and /o f eeder 90.90 2
! — � � /D K £ v � s Services or feeders installati alterat and /or relocation
200 am 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: (fl/ 14 601 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:
( 57) (O - ( L.79 3 Fa x: ( ) 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
❑ APPLICANT ❑ CONTACT PERSON . A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: G/ y /7 S F c 1 g2 / �j branch circuit -
/ /C 6---z L / B. Fee for branch circuits
Contact name: ,:_3---; x without service or feeder fee,
set) each branch circuit 46.85 2
Address: `j ` 2 j S (J 3 Each add'l branch circuit 6.65 2
City /State /ZIP: E -j/ 0.7— Dy 3 ' 7 7O' Miscellaneous (service or feeder not included)
Phone: (5250)3/ 9 �/7s" > ( ) Pump or irrigation circle 53.40 2
Fax:
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name:
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: (3 D 8-6 Electrical Lic.:3 s7)/ ei f Suprv. Lic.:Z 77 G ",(- Subtotal
Suprv. Electrician signature, require• ,/ `/ � Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee)
TOTAL PERMIT FEE , ,,(
Authorized signature: This permit application expires if a permit is not obtained within 180
/ days after it has been accepted as complete
} :lam
X Print name: 4" t Date: 3 '-2 S * Fee methodology set by Tri- County Building Industry Service Board
// ** Number of inspections per permit allowed.
i:\Building\Permits\ELC- PermitApp.doc 12/03 440- 4615T(10 /02 /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*
•
I I Burglar Alarm
I I Garage Door Opener*
I Heating, Ventilation and Air Conditioning
System*
I I Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918 -260 -260)
Check Type of Work Involved:
I Audio and Stereo Systems
n Boiler Controls
Clock Systems
I I Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
•
for all other installations
i:\ Building \Pennits\ELC- PennitApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2006.00069
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/24/2005
Phone: (503) 639 -4171 . A IPulhi '�h
Inspection Requests (24 Hrs.): (503) 639 -4175 ..:.=W " -_..
INSPECTION WORKSHEET FOR DATE: 4/14/2005 TIME: 7:10AM PAGE: 74
I
I SITE ADDRESS: 16740 SW 108TH AVE CLASS OF WORK:
SUBDIVISION: WILLOWBROOK FARM LOT #: 030 TYPE OF USE:
PROJECT NAME: MAY
DESCRIPTION: All encompassing low voltage.
/
OWNER: MAY, MARTA, PHONE #: 503 -380 -1693
CONTRACTOR: DYNASTY SECURITY PHONE #: 503 - 319.4754
Inspection Request Scheduled For: Date: 4/14/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 004446-01 503.3194754 Y 7 LvL fan
Corrections /Comments /Instructions:
, cZ
,ll"1..��rl - -- 7 lorrIv . 7 (--•(' __
•
K PASS ❑ PARTIAL APPROVAL - ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
64) Inspector: Date: 1 4i Phone #: (503) 718-