Permit �/
C IT 1 OF 1 T
I GARD ELECTRICAL RESTRICTED ENERGY PERMIT
A� ,,�11 DEVELOPMENT SERVICES PERMIT #: ELR2006 -00195
RBI I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/18/2006
PARCEL: 2S113BA -00400
SITE ADDRESS: 07632 SW DURHAM RD 300 ZONING: I -P
SUBDIVISION: SW CENTER SDR1999 -00020 LOT: JURISDICTION: TIG
Project Description: Thermostat & contol.
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:
UNITED HEALTH GROUP AMERICAN HEATING
9900 BREN ROAD EAST 1339 SW GIDEON ST
MINNETONKA, MN 55343 PORTLAND, OR 97202
Phone: Contact #: PRI 503- 239 -4600
FAX 503- 239 -7038
FEES Reg #: ELE 26- 993CRE
LIC 33135
Description Date Amount
[ELPRMT] ELR Permit 8/18/2006 $75.00
[TAX] 8% State Surcha 8/18/2006 $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 questions to OUNC at 503- 246 -6699. /
Issued By: Permittee Signature: /-�rgc/ / ( ' /J �7� q �G b C S `
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.
E GNH
Electrical Permit Application : FOROFFICE °USE,ONLY
City of Tigard AUG �_ t7 2006 Received _ / Permit No '7 1 ' , /
Date/I3 : A • ` ma.— t -
13125 SW HaII Blvd., Tigard, OR 97223 P lan Review
Phone: 503.639.4171 Fax:• 50j .!9 ! 6 /�rimn try , il D : Other Permit
Inspection Line: 503.639.41
T . ? Date Ready/By: H See Page 2 for
Internet: www.ci.tigard.orUS
1 h '' ' 't t �� Notified/Method fI Supplemental Information
fi -
d w C Y od +, 24,714:''' Utz � g , ^. ..� Vi i` 1., tI s '.r'n..a - - � r r �. ! �a�°3''r":rt:� .;€': }
❑ New construction Rr Addition/alteration/replacement Please check all that apply:
❑ Demolition El Other: Service over 225 amps, comm'l ❑ Hazard ous location
['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
,
1, x'r ,f-; -4- -''"'w r'4i V' (' ,p`" ,r"'ro 0
.,,"`,� I''; e'-' r 4 'a 4= f 1 and 2 -fail M of and ..„sr, � <.7?. >� - -_ :, r =: �, rte, s - . ..ra , Y dwellings 4 or more new residential
g
❑ 1- and 2-family dwelling 15ZCommerciaVindustrial ❑Accessory building
❑System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi - family ❑Master builder ❑ Other:
❑Occupant load over 99 persons ❑Manufactured structures or
�- - 4 t y�e ! t li ' t ' a ,. ' ` ii § 1 ® ` 2- 0 Egress/1ightin lan RV park
❑Health -care facility ❑Other:
Job no.: W( Job site address: 7 ( S‘....) N 1 (2_( y y l *300 Submit 2 sets of plans with any of the above.
City /State /ZIP: 'r Ir N Q-Q, T, z11-4 The above are not applicable to temporary construction service
Suite/bldg./apt. no.: - “; 1 0 Project name: ii ,, 'r Q ,Y 1 I f ' .c:8 . �", � ' ,' 1„" r` c {M Y -,.',,„%; ,
(A et - Ir �c Description Qty. i 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: I 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
° TI f `" i — � i ® ®; � �- , 1: Each manufactured or modular
� l �0{1C� dwelling, service and /or feeder 90 90 2
_ _ - v» 1 r i }� �_ � Services or feeders installation, alteration, and/or relocation
c�ti A- ZYi, may• Z°-k-L) , 200 amps or less 80.30 2
, �� t I .f r m zai iriw• -, . ° T 201 amps to 400 amps 106.85 2
, - 4 f =`, " _ ® E.,, s l' L,;a -q r fir,; "`h ' ' � 401 amps to 600 amps 160.60 2
Name: �J,A) 601 amps to 1,000 amps 240.60 2
Address: Li C tic? SN 5Y4.J,01A.I1 Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State/ZIP: LR (�C� i - IL . °1 '1t73.S Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( S-o3 ) 5 - (-Ls - 1) 4( I Fax: ( 503 Z q 44.0 D 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 R r ; �° ir. "'x i ' " � R� �" � ,��' r '� "" ` r "� A. Fee for branch circuits with
° ' i-- a � ` �� r �a z � � �" s - ® a „ ' 1 "' • '' service or feeder fee, each
6.65 2
Business name: Q Op branch circuit
1 �Q ( � n " ��l l B. Fee for branch circuits
Contact name: without service or feeder fee,
` ^' w � each branch circuit 46.85 2
Address: 1;33 3 E l.. \ C _IU fl1 s4, Each add'l branch circuit 6.65 2
City/State /ZIP: 1 0 Y -V l curi 6 t C) rz q- a l) )- Miscellaneous (service or feeder not included)
(�99) a3 ( 6 00 I ( )D .: 0 1 1 6 � j g Pump or irrigation circle 53.40 2
Phone: Fax: Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
,' - 47/ u r t energy panel, alteration, or
' ti t 1- i ® 4 .. '.; s ay" ,% extension. Descnbe: 1 Page 2 2
gY P
��, `"
Business name: (A--y (i ('per l4Z i n L1 c .
Address: 3� vl 5e nil b �^ ` J 1 r Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: "T (La f Q 0 q.-- -Do. Investigation per hour (1 hr min) 62.50
Industrial plant per hour 73 75
Phone: (50) a39_(-1 (p 0 U Fax: ( ) _ 123 ;- ri fir. P R,
CCB Lic.: 33 ` 3 5 Electrical Lic.: 0. 6619 ce Sup . Lic.: boy d LEE Subtotal
Suprv. Electrician signature, required: J ,t/ll Plan review (25% of permit fee)
Vrr /� `� State surcharge (8% of permit fee)
Print name: ��'t'c v y Q Date . 73 t G ' i ) /1 _ TOTAL PERMIT FEE 1 , G/J
Authorized signature: iiir / � � This permit application expires if a permit is not obtained within 180
�1 l i I / ( I //ll/" days after it has been accepted as complete
Print name: ( . M 0 'i � d n Date: • Fee methodology set by Tri- County Building Industry Service Board
`J °° Number of inspections per permit allowed.
1\ Building \Permits\ELC- Perm,tApp doc 12/03 440- 4615T(10 /02/COM/WEB
•
CITY OF TIGARD
BUILDING DIVISION A
PERMIT #: ELR2006-00195
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: ail 9/2006
Phone: (503) 639-4171 i to
Inspection Requests (24 Hrs.): (503) 639-4175 -
INSPECTION WORKSHEET FOR DATE: 13/25/2006 TIME: 7:16AM PAGE: 25
SITE ADDRESS: 07632 SW DURHAM RD 300 CLASS OF WORK:
SUBDIVISION: SW CENTER SDR1999-00020 LOT #: TYPE OF USE:
PROJECT NAME: UNITED BEHAVORIAL
DESCRIPTION: Thermostat & contol.
OWNER: UNITED HEALTH GROUP, PHONE #:
CONTRACTOR: AMERICAN HEATING PHONE #: 503-239-4600
Inspection Request Scheduled For: Date: 8/25/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Loirie.. 035567-01 503-209-0555
Corrections/Comments/Instruction .:
- v
rA PASS I I PARTIAL APPROVAL I CANCEL I I NO ACCESS
I I FAIL pi CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: . L O e L Date: # 2 0 Lct Z?)'''‘ Phone #: (503) 718- 214 '