Permit C ITY OF "TICARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 -00177
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/5/2005
PARCEL: 1 S 133 D B -06500
SITE ADDRESS: 11103 SW ESCHMAN WAY ZONING: R -12
SUBDIVISION: CASTLES AT BRITTANY LOT: 011 JURISDICTION: TIG
Project Description: All compassing low voltage
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: ALL EMCOMP X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
ZIENHNERT, MICHAEL & BROOKE TELEPHONE CONNECTION SERVICE
11103 SW ESCHMAN WAY PO BOX 2075
TIGARD, OR 97223 BEAVERTON, OR 97075
Phone: 503 -519 -9235 Phone: 642 -7374
Reg #: LIC 50013
ELE 34- 142CLE
FEES SUP 458LEA
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 7/5/2005 $75 00
[TAX] 8% State Surchart 7/5/2005 $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 95211101-0100 You may obtain copies of these rules or direct qup t s t U t 503- 246 -6699
Issued By: cw -G��_� �(�u Permittee Signature 1 iv \ .12L
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- A'nnlication - .' .FO OI F ICL USF ONLY •
I L-• v t—I V LA./ Re Received
City of Tigard Date/13 S i n Permit No +z5 QO r2
13125 SW Hall Blvd, Tigard, OR 97223 Plan Rewe
Phone 503 6394171 Fax 503 598 + 2005 ta4l\ t Date/13 Other Permit Inspection Line 503 639 4175 1 ' _ I ., Date Ready/By ' m m El See Page 2 for
Internet www ci tigard or CITY OF TIGARD Notified/Method 7 / Supplemental Information
bU1LUf IVt.% f ypEl ?otA*bRK PLAN REVIEW
❑ New construction D-i( iition /alteration /replacement Please check all that apply
❑ Demolition ❑ Other: ❑Service over 225 amps, comm'l ❑Hazardous location
❑Service over 320 amps - rating ❑Buildng over 10.000 sq ft ,
�
� CATEGORY OF CONSTRUCTION of I and 2 family dwellings 4 or more new residential
I I and 2 lamily dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
0 Building over three stories OFeeders, 400 amps or more
El Multi ❑Master builder 0 Other:
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no. Job site address. / / /t . k 5C - n ❑Health - care facility Dottier
(� / � M Submit 2 sets of plans with any of the above
City /State /ZIP T / l0>T 6 O� The above are not applicable to temporary construction service
Suite/bldg /apt no Project name
FEE* SCHEDULE
Description I Q7 Fee I Tot, 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 2
DESCRIPTION OF WORK Each manufactured or modular
T61C-P / � / CA I _ (J , T/ `f�/-+ ^ COI dwelling, service and/or feeder 9090 2
� J Services or feeders installation, alteration, and /or relocation
200 amps or less 80 30 2
7 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 10685 2
� � j 401 amps to 600 amps 16060 2
Alike- +l ke- - E einat / 601 amps to 1,000 amps 240 60 2
Address 1l (U3 G &} £.s ( ' 4 *' Over 1,000 amps or volts 454 65 2
6 Reconnect only 66 85 2
City /State/ZIP' 1 046.40& Temporary services or feeders installation, alteration, and /or
(503) 7S n ' 1 2mp
\ Phone 9 7�� Fax: ( ) 2000 0 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 wrlh
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
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
extension Describe Page 2 2
Business name: 'rE_4h f ce,ve-3,Fct r7 OA) SE"--!'71r..P
Address J) a 8ex 0- 075 Each additional inspection over allowable in any of the above
�p O r-' Per inspection 62 50
City/State/ZIP' oBAVFelt]•J i / 7 7J Investigation per hour (I hr mm) 62 50
Phone ( 3 ) & y .)' 737y- Fax. (503 ) esp. - Y SCZS Industrial plant per hour 73 75
ELECTRICAL PERMIT FEES*
CD Lic. Soot 3 Electncal Ltc.:3y4 tfaC E Supry Lic' Subtotal '7 S 0
Suprv. Electrician 1 l/ � � n signature, required' ( , ((( Plan review (25% of permit fee) —
Print name' {..1- � 4 ' n t . Date: O'7 /�( Slate surcharge (8% of permit fee) 4 ccD
i `�— / TOTAL PERMIT FEE g/, 00
Authorized signature This permit application expires if a permit is not obtained within I80
days after it has been accepted as complete
Print name Date • Fee methodology set by 'I n- County Bu ilding Industry Service Board
• • Number of inspections per permit allowed
I \ Bin ddiag\Pemws\ELC- PiontApp doe 12/03 44e461ST11 n /02/COM/WFB
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
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
n Intercom and Paging Systems
n 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
\awldintl\Pemrts\ iLC.Pamiwpo doc 04/03
-
CITY OF TIGARD
BUILDING DIVISION PERMIT # ELR2005A0177
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED 7/5/2005
Phone (503) 639 -4171 m1t�i
Inspection Requests (24 Hrs ). (503) 639 -4175 al-
INSPECTION WORKSHEET FOR DATE. 7/6/2005 TIME 7:12AM PAGE 18
SITE ADDRESS 11103 SW ESCHMAN WAY CLASS OF WORK:
SUBDIVISION CASTLES AT BRITTANY LOT #: 011 TYPE OF USE: � r �' r
PROJECT OE AlE A A Sc\k ® ® � �..
DESCRIPTION All compassing 9 1 ( sing low voltage. �1 'b : 1 C
OWNER ZIENHNERT, MICHAEL & BROOKE, PHONE #: 503. 519.9235
CONTRACTOR TELEPHONE CONNECTION SERVICE PHONE #: 642 -7374
Inspection Request Scheduled For: Date: 7/6/2005 Pour Time:
Code # - in Description ?op onfirm # Contact # Message
135 Low voltage 010828-01 503-642-7374 Y
/I
Corrections /Comments nstructions:
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6F-F6� Lt 6 z WAIL IAci L�'I
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c- A BZ .
rkPASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL f] CALL FOR
` R INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: GA 2 ' N V O8 Date: 'I 6 Phone #: (503) 718-