Permit CITY T I GA R D ELECTRICAL RESTRICTED ENERGY PERMIT
, ; DEVELOPMENT SERVICES PERMIT #: ELR2006 - 00089
.� �1 DATE ISSUED: 4/21/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S102DB - 00100
SITE ADDRESS: 08840 SW BURNHAM ST ZONING: CBD
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: HVAC AND DDC CONTROLS,
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: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
GTE NORTHWEST INC BUILDING CONTROL SYSTEMS
GARY N WILLIAMS 21218 66TH AVE. W.
GTE TELEPHONE OPERATIONS LYNNWOOD, WA 98036
IRVING, TX 75015
Phone: Contact #: PRI 425- 774 -1680
Reg #: ELE 37- 879CLE
FEES LIC 115260
Description Date Amount
[ELPRMT] ELR Permit 4/21/2006 $75.00
[TAX] 8% State Surcha 4/21/2006 $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 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 quest to OUNC at 503 - 246 -6699.
i
Issued By: AI 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.
.te y
Electrical Permit A o p tca - o FOR OFFICE E -USl ONLY Recei
City of Tigard pp i Date/B d I Permit No../ _ r0 '?VO6
a 13125 SW Hall Blvd., TigarAuto 97223 200" Plan Review
: C ' . Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
T I C A R D Inspection Line: 503.R 4 OF Y ll7 f g Date Ready/By: 111652 ® See Page 2 for
Internet: www.tigard- B ov Notified/Method: Supplemental Information
TYPE OF WORK 'PLAN REVIEW
El New construction jl' Addition/alteration/replacement Please check all that apply:
ID Demolition ❑ Other: ❑Service over 225 amps, comm'I ❑Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. fl.,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
❑ 1 - and 2 family dwelling JJ Commercial /industrial ❑ Accessory building OSystem over 600 volts nominal units in one structure
❑ Multi - family ❑ Master builder El Other: ['Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting RV park
❑Health -care facility ❑Other:
Job no.: i._ 61 Job site address: ) 61,0 f. 11 r n hctp.I,l Submit 2 sets of plans with any of the above.
City /State/ZIP: / 1 a G bR The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE
Description I Qty. I Fee. I Total I **
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'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 ��� _ 2
Tax map /parcel no.: Limited energy, non - residential / 75.00 /0 2
DESCRIPTION OF WORK ' Each manufactured or modular •
J . 1l f � / dwelling, service and/or feeder 90.90 2
—+[ , ` i✓1Q J NV /t; C- i DP Cy � Services or feeders installation, alteration, and /or relocation
200 amps 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: l / v / p fl 601 amps to 1,000 amps 240.60 2
Address: if 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
' ' ❑ . APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
first branch circuit 46.85 2
Address:
Each add'l branch circuit 6.65 2
City /State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax: : ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited-
. - CONTRACTOR energy panel, alteration, or
B extension. Describe: Page 2 2
Business name: 13 u ;1 J 1 n e Co o .!. rp / Sync S
c i
Address: of i IR i�f Avt w'€ t Each additional inspection over allowable in any of the above
I Per inspection 62.50
City /State /ZIP: % � i ( -I 0 Investigation per hour (1 hr min) 62.50
`., I wDD el
�
Phone: 40,---) i / 7 .-1��d Fax: (L), 1/14 - II i/ Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: !' C U Electrical Lic.:37_ vi l Suprv. Lic.: 1/91 Leff Subtotal:
v/
Suprv. Electrician signature, required: f - / Plan review (25% of permit fee): ? i_.,"
Date:
Print name: Date: � I J State surcharge (8% of permit fee):
�� j r n I ! � ` — "' — TOTAL PERIT FEE ( / Authorized signature:,'1-!,A 1 gavA, This permit application expires if a permit is not obtained within 180
Print name: 'e days after it has been accepted as complete
/ * Fee methodology set by Tri- County Building Industry Service Board
M61 up up N t c v �� rrj - -t r ** Number of inspections per permit allowed.
I:\ Building \Permits\ELC- PennitApp.doc 03/23/06 440- 4615T(I I /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*
❑ Other:
COMMERCIAL WORK' ONLY: I
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \Building\Permits\ELC- PermitApp doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: El_It200 00089
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/21/2006
Phone: (503) 639 -4171 NI
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/412006 TIME: 7 :00AM PAGE: 66
SITE ADDRESS: Otii340 SW I3URNFiAl i ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: VERIZON
DESCRIPTION: FIVAC AND DOC CONTROLS,
OWNER: GTE NORTHWEST INC, PHONE #:
CONTRACTOR: BUILDING CONTROL SYSTEMS PHONE #: 42&774 -1600
Inspection Request Scheduled For: Date: 51412005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
ICON u�, u lIta a 029244 -01 ? 11 -981 -0 501 N
Co _ - s /Comments /Instruc , •ns:
•
PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: &4 `lam N Date: 3/ y 3 6 Phone #: (503) 718- tiq'16
•