Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I DEVELOPMENT SERVICES PERMIT #: ELR2005 -00189
x 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/12/2005
PARCEL: 1S135BC-00200
SITE ADDRESS: -10000 SW CASCADE AVE ZONING: C -G
SUBDIVISION: r0 8S0 LOT: JURISDICTION: TIG
Project Description: Installing new HVAC controls (DDC) 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: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
VERIZON NORTHWEST BUILDING CONTROL SYSTEMS
1800 41ST STREET 21218 66TH AVE. W.
EVERETT, WA 98206 LYNNWOOD, WA 98036
Phone: 425- 261 -5408 Phone: 425- 774 -1680
Reg #: ELE 37- 879CLE
LIC 115260
FEES SUP 1191LEA
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 7/12/2005 $75.00 •
[TAX] 8% State Surcharl 7/12/2005 $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 are set forth in OAR 952 - 001 -0010
through OAR 952 -101 -0100. You may obtain copies of these rules or direct questions to OUNC at 513 '46-6699.
Issued By: Pl / �� Permittee Signature: " aii
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 of OFFICE t SL ON Y
CI of Ti and Received permit No.: J•
`� g �� �C Date/By d 9 / . „A. -00 A.
13125 SW Hall Blvd., Tigard, OR 97223 p— Plan Revie
Phone: 503.639.4171 Fax: 503.598.1960! Ii 1 �'I g, �{,; +' I + Date/By: Other Permit:
Inspection Line: 503.639.4175 '' U s � *' = '_ Date Ready/By: la s' Fa See Page 2 for
CITY nom, ' (>
Internet: www.ci.tigard.or.us �00 Notified/Method: t fc,( Supplemental Information
6 UI • YPi p **e ° PLAN REVIEW'
' ` h P lease check all that apply:
❑New construction � Addition /alteratitin/repl'acement pp y
❑ Demolition ❑Other: ❑Service over 225 amps, comm'I ❑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 fa Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
El Multi - family El Master builder ❑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 plan RV park
Job no.: Job site address: 1)T D �/ � CA d e ❑Health -care facility ❑Other:
d Submit 2 sets of plans with any of the above.
City /State /ZIP: 1 5 a r`ei l) Q (I
/ / 3 The above are not applicable to temporary construction service.
FEE* SCHEDULE •
Suite/bldg. /apt. no.: Project name: '
e - / Description I Qty. 1 Fee. I 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'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 2
DESCRIPTION OF WORK • ' � Each manufactured or modular
' j�'�' /� / / AC dwelling, service and/or feeder 90.90 2
._L, 5-4q i j r` ✓I ),-1 L° I� // !/ ITC Services or feeders installation, alteration, and /or relocation
( - n-- ph f , C VD c) StSTe M 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: Vej ill-, o )\ 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: C ij-e , p' � " f .
i (, 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, 46.85 2
Address: each branch circuit -
Each add'I branch circuit 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax:: ( )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR • energy panel, alteration, or
�II �^
Business name: B i P 1` i extension. Describe: Page 2 2
G I C-/4/4 rl7l 3 ys - renA 5 T »C
Q / k / 1 (, ) , //' / Each additional inspection over allowable in any of the above
Address:
1 a / tT !� v . (A Per inspection 62.50
• City/State/ZIP: L
Investigation per hour (1 hr min) 62.50
Phone: 7 / 1 Fax: '� J 7-7 t ( / 3 ' ((�] i �f �/ ( Industrial plant per hour 73.75
^ ! ELECTRICAL PERMIT 'FEES*
CCB Lic.: /f— h`').,(,( Electrical Lic "• 7._ y /7r J uprv. Lic.: / /G/ / LEA Subtotal lc �
Suprv. Electrician signature, required: ���/!/ - / Plan review (25% of permit fee)
(� '�1 • t )� ate: _ L � State surcharge (8% of permit fee)
Print name:
lkii,'r`1r ce 1 c l.J t?r ? -- 0 7 TOTAL PERMIT FEE q i
Authorized signature: �r� '
This permit application expires if a permit is not obtained within 180
•
days after it has been accepted as complete ni /Z
Print name: r i? C p J Date: / . )4' * Fee methodology set by Tri- County Building Industry Service Board
�1' /� ��� *" Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PernitApp.doc 12/03 4404615T(I0 /02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
( R WORK•:ONIY . _ rvN s'
Fee for all residential systems combined........ $75.00
Check Type f Work Involved:
❑ Audio a , d Stereo Systems*
❑ Burglar A rm
❑ Garage Door • pener*
❑ Heating, Ventila on and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMM ERCIAL WORK ONLY: •
Fee for each commercial system.... $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involve :
❑ Audio and Stereo Sy.tems
❑ Boiler Controls
❑ Clock Syste
❑ Data Tele •mmunication Installation
❑ Fire A . rm Installation
❑ HV C
❑ , nstrumentation
f 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 04/03
CITY,OF TIGARD
BUILDING DIVISION PERMIT # j _00(Sci
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: ( V PAGE:
SITE ADDRESS: (da - Su) CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: Ve('t I PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
i�to \( r U z .- O t
Corrections /Comments/ Instructions:
•
•
xe PAS U PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
FAIL [ I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: - Nv ve Le Date: \I' 3 . 3,5 Phone #: (503) 718- L k