Permit ICAL CITY OF TIGARD RESTTRICT PERMIT - ENERGY
* Ail DEVELOPMENT SERVICES PERMIT #: ELR2004 -00313
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/8/2004
SITE ADDRESS: 14650 SW 97TH AVE PARCEL: 2S111AC -02700
SUBDIVISION: TIGARDVILLE HEIGHTS ZONING: R -4.5
BLOCK: LOT: 037 JURISDICTION: TIG
Project Description: Installation of (1) limited energy system for security in new addition.
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: SECURITY. X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
TIGARD TUALATIN SCHOOL DISTRICT ELECTRIX LLC
6960 SW SANDBURG ST 115 V STREET
TIGARD, OR 97223 VANCOUVER, WA 98661
Phone: 503 -431 -4000 Phone: 360 - 694 -5094
Reg #: LIC 148685
ELE 37 -930C
SUP 3161S
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 10/8/2004 $75.00 Elect'l Final
[TAX] 8% State Surchar€ 10/8/2004 $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'S' -i -0100. You may obtain copies of these rules or direct questions to OUNC aL(503) 246 -6699.
` SWAZI � •
Issu d by ' � ` Permittee Signatu , �►,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 639 -4175 by 7:00 P.M. for an inspection needed the next business day
/ .10/07/2004 04:24 3606950670 ELECTRIX PAGE 02
Electrical re1r1mit Anr*Eicatitorr, Received
lis Fork (>1 i•r(1 i ()NIA
u• a ti V L. j
City of Tigard Date/B : OA/ ,4 Permit No.: EL ' , • —efite:
■ 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
o !t <yz "', Oi:her Permit:
Phone: 503.639.4171 Pax; 503.59r1y 60 7 200 y „i ^ . Date/B
Inspection Line; 503.639.4175 v , _a , = _.. Do te ReF dyi y; Air ' 0 See Pngc 2 fur
Internet: www.ci.tigard,or.us CITY OF TIGARD Notified/lvlethod: Supplemental lnfnrmntier
u ^MIS i i'.5:, . 5'krtt�� g 1 1r� { �.�d:iptt (., •.. ;� Rt.x+ t r+ f • it i i, t l i 1 �i 'qi 14, � _ ^� { ��+�� y ��W� t+it �;t
;?,,/ . , i ; ? I ! �
, �1 ciilfi k;' , iYy+ � �t7a t ,! 1i6d fie"'ti{l It innl'.ri�t3f;' i at!,f>irhni !a gii i gii i i !„ A i f f 1 .k' 1:,� L l i ,i e 1�,IIkI. I� 6 it l JF+ w+1N i , Y i ..,, ,,, ,I, "n? ,.-(+f 4i ill Ef!1'11 §!T i t +i,�� i+fif,i�4
❑ New construction ® Addition /alteration /replacement Please check all that apply:
['Service over 225 amps, commi OHazardous location
0 Demolition ❑ Other;
m' 7� _ j]5ervice over 320 amps — rating ❑Butldrt over ].0.000 s , tt..
w d'i@° t ,; , .i , i ! 1 z i + n +g i s t ' ,h�iti� n tr i'`' 7II''E{t r @ f ' +; i(1hjk�I I +��}r t (� ! Se v and over 32 il mps — r7 s 4 ui more new residential .000 s f' i'lY + , ,.? A w ri._ uni., xila4a�hrlF ;fllt�iitnf'ifl�aiRzfn dt,i+�l�1i1$Mi"�,ll�(lii]i Y S
❑ i and 2- family dwelling ® Commercial/industrial 0 ] Accessory building ❑System over 600 volts nominal units in one structure
1:1 Multi family ❑ Master builder ❑ Othei: ['Building over three stories ['Feeders, 400 amps or more
��yy ��gg Multi-family ' ryr��} ty I r , 1 +J {t I � asterbui rn ,ern +}a,, ,c ?� � {j(t j {+{(rt}„� 11 � ❑Occupant load over 99 persons ❑Manufactured structures or
1ilIi7111 (alifl!'lelWttlt 'i ti?f,+ i{' 7r'r. ;!'a', es}i=sltrTTi i "1 { r�>6liila�s;r�h`i + � {.jilf'2P11 �1i1 bill! {�lf'1Hjit E? i °Egress/lightingplan RV park
Job no.: Job site address: � (60 QI t k, OI4ealth -care facility ❑Other.
Submit 2_ sets of plans with any of the ahttve.
City /State/ZIP; b 4 4- of 1 The above are not applicable to temporary construction service,
,� I AA 4, + MI � " ;''"E""ai �"it�lj"i� 1, ' "� 1� rJ+ � I
Suite/bldg. /apt. no.; Project namc;'�wa.j A, �� '►lrp I '� �� .. , ,? t 1 i" ;') ��7� "i i 3 WU DM6ripl,on Qty- ice. Taft' I "-
Cross street /directions to job site: iJEtU I4'U4 ye* New residential single- or multi - family dwelling unit.
Jnchides attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: l Lot no.: Ea, add'I 500 sq. ft. or portion 33.40
Limited energy, residential 75.00 2
Tax
fymap�lparcc�lt no.; 1 y,r� 1a$g ti11f }it 6 ��ti ��{ Limitedenc non - residential 75.00 2
iiak,Ilati1 E:tltIESS 1,i1 �i +, rr< ° "nk+,4 rILA � fM �1lltT iSia, f ; t1;r,33�dIIStil lltj�li G14i ?�l `i � Each manufactured or modular
dwelling, service and /or feeder 90.90 2
. 64.4/11, 4 _ Services or feeders Installation, alteration, and /or relocation
200 amps or less 80.30 2
M i ir1r1P71.1M. y ' + .) 9 , u t , ^ a , 1 201 amps to 400 amps 106.85 2
t F ti . 4 1li� ,'cn, lg.f!; `h �i ls+rt• l (} } �� £`l �s��S{i �� R O l Ali i
•---
,, � lA1 4'Y ^ /,t+ ? " h'�,i� n ^�' �� ����f�� , �i � V,x,��.i` ir.r+? I v , +
i lii �� 4 " 4 ' 401 amps to 600 amps 1.60.60 2
Name: 7 7 . b 601 amps to 1,000 amps 240.60 2
Address: / (iQ ` — A.64, %! ` Over 1,000 amps or volts 454.65 2
_ Reconnect only 66.85 2
City /State/ZIP: 1 9 Temporary services or feeders installation, alteration, and /or
c^
Phone: ( ) Lf '"LUf b I Fax: ( ) relocation
200 amps or less 66.85 I
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— ncw, alteration, or extension, per panel
t 4 r : I •, 3 k�y { r,{t -t rmsar.rt.� rc ^r+ 7"Ai It !rt, C "s k 1 r r rt anq� gr,nr+ lr grtnuyr } ^rm � m t7 ri `cJ {p W s with
h 1l, : n2 Mal Z�C f i i "t i�fili,1 1�� ll iii t ' i 1 i i , � t i' 1 �lm(+;At II i ` " jn�9 " ,4 4 m 1 ar !INiiilli ,. 3 C A Fcc for branch circuh t
service or feeder fee, each
6.65 2
Business name: branch. circuit
Contact name: B. Fee for branch circuits
without service or feeder fee, 46.85 2
each branch circuit
Address!
Each add'I branch circuit 6.65 2
-
City /State /ZIP: Miscellaneous (service or feeder not Included)
Pump or irrigation circle _ 53.40 J 2
Phone; ( ) I Fax: ( ) Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
Mg .' :,. at, ' .f I ��` t;ti 's`�R ln�IE I�� Iflf?1f X 1 11 1€ it �l �' i', +. " f kNl[E�flilil energy panel, elter�an, or
n, extension. Describe: I Page 2 2
Business name: el 1�7r r)C �(- /� .M
Each cction over allowable in any s V - Eh dditi l i
p Y of the above
Per inspection 62.50
City /State/ZIP: V y 014 G ry" Investigation per hour (1 hr min) 62.50
Phone: (?)/ ) 6q(e� &( Fax' (rt0) log5-47-6 Industrial plant per hour _ _ 73 75
testa! i' it ill, , I I. 011; ;�,ih� ,l 41 .163,;'14,10',Z2 w `�lEii iiPa4, i+:4i!ii'l 4
CC13 Lie.: 414,K ' Electrical Lic.:,3 7 WC, Suprv. Lie.; . E (@ 15 Subtotal 15
Suprv, Electrician signature, required: 0, '"` ' M/07 Plan review (25% of permit fee)
„L aii State surcharge (8% of permit fee) �'
Print name: t! _ k K r/ w S Date: 16 ?/� r � l
TOTAL PERMIT FEE `tb 1
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,
ia13uilding1Termite \ELC- P°rtnitApp.doe 12/03 4411.4515T00//m,/cOM/WEn