Permit f \ ' •
CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: E -00351
E ' 1 1 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/28/20/28/20 05
PARCEL: 25101 BB -01300
SITE ADDRESS: 11950 SW GARDEN PL BLD.7 ZONING: C -G
SUBDIVISION: CROW PARK 217 LOT: 001 JURISDICTION: TIG
Project Description: Fire alarm low voltage (adding to existing panel)
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: X OUTDOOR LANDSC LITE:
OTHER: : - -- HVAC:- - PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
SPIEKER PROPERTIES LP FIRE PROTECTION SERVICES
4380 SW MACADAM AVE STE 100 5573 SW ARTIC DR
PORTLAND, OR 97201 BEAVERTON, OR 97005
Phone: 503- 675 -8700 Phone: 503 -590 -3732
Reg #: ELE 34- 488CLE
LIC 154333
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 10/17/200E $75.00
[TAX] 8% State Surchart " 10/17/200E $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to f w ru e adopted by the Oregon Utility Notification Center. Those rules set forth in OA 952 - 001 -0010
throug OAR 952- 1 -0 : i You may obtain copies of these rules or direct que i s to OUNC a 3- 246 -6699.
Issued /'I/, 1 Permittee Signature: ?.
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
y Ef ftrical Permit Application FOR OFFICE USE ONLY
G
City of T1 i1PCl am . G Received
1312 Hall Blvd., Tigard, OR 97223 C I� (' Date/By. 10//7/0°5- fs, Permit No a� �d3*
Plan Review 7
Phone: 503.639 4171 Fax 503.598 1960 44p'I Date/By Other Permit.
Inspection Line: 503 639.4175 I OCT 17 ' erl I Date Ready/By. I r ® See Page 2 for
Internet: www.ci.tigard.or.us _ Notified/Method Supplemental Information
r : -4' TXPE _ � t ;
,� 1 .;; ;;; �.�<;. .,,ESA.; :; ,;P ..�,.:. . ,»•...��.: �� ::>''= -j
❑ New construction El Addition}1 a4LMo /r' Flat iS$I"t Please check all that apply:
❑ Demolition ❑Other: ['Service over 225 amps, comm'l ['Hazardous location
VL _ Demolition
',,,,L.„ ATEGO :, ` " -'' ' , . 4%"707"0
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
y; RY' OF: _ o f 1- and 2-family r..
,..,, dwellings 4 or more new residential
w., rte '.
`:., y ., i ,` , . ;'` . >...; ;;' � ,,,., a Y g
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
1:j Multi- family ❑ Master builder ❑ Other: ' ' r r
:' -'- ,: �':- r;.i': ..,. ,rte.: ,,. c persons red structures or
.:, /JOB.mSITE INFORMATIONr,%ANI)� °LOCATi3ONr - "� " `' ` park
u n g overt ee stories ee ers, 400 amps or more
h � ; ['Occupant ant load over Manuf
p 99 e actu
;,' ,,, .. ,,, .- r <; • . .:.'? ~..: ' ❑E li plan RV pa
Job no.: Job site address: 11950 SW Garden PI blvd ❑Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City /State /ZIP: Tigard, Or The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: Vesta '!.. :., 1;. FEE* „SCHEDULE,, `'`•t,
Description Qty. 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'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: -
' "W' £N : t ': °� -:; DESGRIPTI N= EOF ;ARIAr',=,::° ,° rp
Limited energy, non - residential 75.00 2
:'s;. ;;: ter, .y.. ,. •,... O ORKy ' x,. .,,� ..< Each manufactured ' ��E �' -� � i- `r � actured or modular
Add to existing Fire Alarm k.V dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
,
3 4 ®. P RO ' . WNER ' a „ ' �''' 201 amps to 400 amp 106.85 2
s
, .ik,,,. , ... % O .,..N2 ,.. \'' : „ ® TENANT; . -
v'�
401 amps to 600 amps 160.60 2
Name: Speiker Properties LP 601 amps to 1,000 amps 240.60 2
Address: 4380 SW Macadam Ave Over 1,000 amps or volts 454.65 2
Reconnect only 66 85 2
City /State /ZIP: Port Or 97201 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (503675 -8700) 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
,PL IC `4" '' 7 % ' ''❑ „
� -r � ® A P
... -..... .. �> CONTACT 'PERSON A. Fee for branch circuits with
service or feeder fee, each
Business name:
branch circuit 6 65 2
Contact name B. Fee for branch circuits
without service or feeder fee, 46 85 2
Address: each branch circuit
Each add'l branch circuit 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Phone: Pump or irrigation circle 53.40 2
( ) Fax: ( )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
i;'!:4""1.4.:ii.eoliqt 4 „5 .'„ . fib„
CONTRACTOR -r ” 14 -� ', ; "10 energy panel, alteration, or
extension. Describe: Page 2 2
Business name: Fire Protection Services Inc
Address: 18270 SW Mountain Home Rd Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: Sherwood Or,97140 Investigation per hour (1 hr min) 62.50
Phone: (503) 590 -3732 Fax: (503) 628 -6214 industrial plant per hour 73.75
ELECTRICCAli.PERMITFEES ,,
CCB Lic.: 154333 Electrical Lic.: 34- 488CEP / uprv. Lic.: 4120LEA Subtotal 1 S
Suprv. Electrician signature, required: /i Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Print name: Date:
TOTAL PERMIT FEE
_ 'i. iii' �► — —' g mU
Authorized signature: This ermit application expires if a permit is not obtained within 180
P PP P
days after it has been accepted as complete
I
Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board
— ** Number of inspections per permit allowed.
i \Buddmg \Permits \ELC- PermtApp doc 12/03 440- 4615T(10 /02 /COM/WEB
CITY OF TIGARD
BUILDING DIVISION ' " ' PERMIT #: �?O 2w5- (7035 1
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171
Inspection Requests (24' (503) 639 -4175
INSPECTION WORKSHEET FOQ DATE: I0IA / 5 TIME: PAGE:
SITE ADDRESS: i t g &a I CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: � / \\
DESCRIPTION: VV/471—<--
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: \Date: Pour Time:
Code # Inspection Description Co ifirm # Contact # Message
(C-A1/4 01_9-7
Corrections /Comments /Instructions:
t408 S 1
iii PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
` '
Inspector: — ' `� O� �'"� Date: � Z� (�� Phone #: (503) 718- 2 C�