Permit C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
vi I"t° DEVELOPMENT SERVICES PERMIT #: ELR2005 -00331
��I DATE ISSUED: 10/11/2005
13125 SW Ha Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 25101 AB -01606
SITE ADDRESS: 07357 SW BEVELAND RD 200 ZONING: MUE
SUBDIVISION: CLARKE BUILDING LOT: 017 JURISDICTION: TIG
Project Description: Low voltage: Audio and Data.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: X 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: 2
Owner: Contractor:
TOM CLARKE NW SOUND AND SECURITY
7357 SW BEVELAND STE. 100 10300 NE MARX ST
TIGARD, OR 97223 PORTLAND, OR 97220
Phone: 503- 793 -2621 Phone: 503- 254 -2811
Reg #: LIC 112538
ELE 34- 423CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 10/11/200E $150.00
[TAX] 8% State Surcharl 10/11/200E $12.00
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 95 -0 1- 0. You may obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699
Issued By: , Permittee Signature: 7 _ � / , 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.
r
Oct 10 05 03:58p p.1
•, Electrical ] it A rip Bcati n FOR OFFICE USE ONLY
City g of Tigard 2005 Date ei II l I LIZ.'a l9'O�i o
13125 SW Hall Blvd., Tigard, ?emlit No. 9722 Plan Review
Phone: 503.639.4171 F.• 1 �''. 1 Other Permit:
Inspection Line: 503.6 i �� p S y � A .,i• e "� DaterB
ardt' LlJlNG DIVISION .�• Date Ready/By: locus: El See age 2 for
Internet: www.ci.ti
g Notified/Method: Supplemental Information
.I. j( 2/ t(i +`�' F :' ;. i,m•�
r `I`I PE` OF >•WO. ;..
,.. ..� „ '•..i;. .... �.. ...,.,. i ' i,,_,- ,�i,�:�.':. 2/i. ,_. . ,a '. 1'LAPi ' 'REV!IEW:.' , 7.
few construction ❑ Addition /alteration/replacement Please check all that apply:
❑ Demolition ❑ Other:
['Service over 225 amps, comm Hazard us location
amps u over , sq. .,
. yil,, . 'COR' F ' { _CO R : ['Service over 320 ams - rating ❑ Bildn 10000 ft
1 '
'v
?:�,;, „ •. . r ;; ', ''t -, X:;Q I!1ST >ON�..; • .,,,, ;,:.;:;;„''',;1:„'„ o I -and 2 -famil dwelli s 4 or more new residential
:' ; '.; •, � `. , ,. - ,.,,, , . ' , . .,:, . `� .' : Y ng
❑ 1 - and 2 family dwelling rgCommercial/industrial ❑ Y Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑ Master builder ❑ Other: ['Building over three stories ❑Feeders, 400 amps or more
; it 5 ['Occupant load over 99 persons ❑Manufactured structures or
. , 'av: r, "*.i. ' §i.1* iJ -0.iiMAAIONi . ,}• ;}LOC . 'CON' i ,,„ 111,/1' 1 y :. ,_. , iE`n; ° ['Egress/lighting plan RV park
Health -care facili ❑Other
Job no.: Job.site address: ?35'7 514.) aevelar�d Si-e. 2.ek Submit 2 sets of plans with any of the above.
City /State /ZIP: 7 I6a(_ e f 0 t2.. 9 72:2. 3 The above are not applicable to temporary construction service.
u ]dg. /apt. no.: ZOO Project name: /� h ,l�p R I // }} ,n h` :.,.FED G. Av. ;.'.
•tee Fe-r +L 4 3 /UDC 'Vs cettie1 y Description I Qty. I Fee. I Tend I .•
Cross street/directions to job site: J 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 i 1
Tax map/parcel no.: Limited energy, residential 75.00 2
. ......, : ;l' , ;D S. rONr'O 'W_ '. , , ;
�, ,, Limited energy, non - residential 75.00 2
,_., •, , ,. �,�'y �.� �i�i .. , ::.::...:. ....r::.'.. Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Services or feeders Installation, alteration, and/or relocation
200 amps or less 80.30 2
.. „? ;: ;• •r : -,; : ❑,:iEg. *,,ii it '.• Qvvi R1ti•li?ii :r;i;• , ji, :i1;: : • a.. _ , 201 amps to 400 amps 106.85 2
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, anti/or
Phone: ( ) Fax: ( ) relocation
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
"s,i;i t;; : ; ,i, t .v. :; I" t ??t,';: i' .. A. r branch ' ,.; .. fi .�, ��` -� ` � G0 „�Ti,` � ' - o b nch circuits with .
nr,r i A Fee for
or feeder fee, each
6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.35 2
Address:
each branch circuit
Each add'l branch circuit 6.65 I 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax: : ( ) Pump or irrigation circle 53.40 I 2
Sign or outline lighting 53.40 2
E -mail:
• ...7:-
wt, }, qi s ,.1 � hn, t Signal circuit(s) or limited- ,
'.:ii 1,;, C.( j`{' ,A;C`I'Olt;, ; a•%a'1,'rt = • ; i ; ,,. ... - ,"'!:::'1:'q:;-
: . energy panel, alteration, or extension. Describe: Paget /50 2
•
Business name: N IN jou li{'U �e
4. 5ecGch } l oves
Address: 16 300 A// /1/1�., , s.f- J Each additional inspection over allowable in any of the above
Yrvr Per inspection 62.10
J
City /State /ZIP: (. j a - n d C � 9 7Z 2i Investigation per hour (t hr nun) 62.50
q �� J Industr plant er hour 73.75
Phone: (5b3) s�- �`l�z�� Fax: ( 2�` T7 - Z8! 8 p P
ET;Y+<..0' TCATJ;'PEI MIT "kits*
CCB Lic.: /Z3aaE Electrical Lic. : 7/2538 I Suprv. Lic.: 3(y�'►7 Subtotal / 573
Suprv. Electrician signature, required: • Plan review (25% of permit fee)
State surcharge (8% of permit f
Print name: D� 5 W y 4, Q Date: /ON 0S / a`
TOTAL ERMIT FEE i I . 07
Authorized signature: This permit application expires s if a permit is not obtained within 180
1 days after it has been accepted as complete
Print name: J e ' et bYS e. 1 Date: 1 611 o /as • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
iABuilding \Pennits\ELC- PernutApp.doc 12/03 440.461 ST(lo /02 /COtf/WEB
•
Oct 10 05 03:59p p.3
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
TI Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other: _
.�✓ ", -,',� ,'•' [� 11�;Lll!.��Y � �,''ii„� ?:9i!l;; :y ..I: itri:::. �f �I' S�
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
g Audio and Stereo Systems
❑
•
Boiler Controls
❑ Clock Systems
N i Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
El Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n 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
0 Building \Permits1ELC•PemitApp.dx 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005-00331
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/11/2006
Phone: (503) 639-4171 ./4/00 lit
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: itie/2006 TIME: 7:01/%1 PAGE: 86
SITE ADDRESS: 07357 SW BEVELAND RD 200 CLASS OF WORK:
SUBDIVISION: CLARKE BUILDING . LOT #: 017 TYPE OF USE:
PROJECT NAME: BFVELAND WELLNESS CENTER
DESCRIPTION: Low voltage: A dio and Data.
OWNER: CLARKE, TOM PHONE #: 503-793-2621
CONTRACTOR: NW SOUND AND S CURITi` PHONE #: 503-264-281 I
Inspection Request Scheduled For: Date: 1/18/2006 Pour Time:
Code # Inspection Description e . .... Contact # Message
199 Electrical final 025151-01 503-793-2621
Corrections /Comments/ Instructions:
i K PASS PARTIAL APPROVAL n CANCEL _._.— NO ACCESS
I I FAIL H. CALL FOR INSPECTION Li ADDITIONAL FEES ASSESSED
Inspector: q) Date: I 12) 64 Z) Phone #: (503) 718- .1-4t6