Permit j` -` CITY OF T I GA R D ELECTRICAL RESTRICTED ENERGY PERMIT
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` ` COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00481
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/28/2007
PARCEL: 2S 102 BA -02000
SITE ADDRESS: 12353 SW GRANT AVE ZONING: R -4.5
SUBDIVISION: GRANT AVE ELITE CARE EXTEND RE LOT: 045 JURISDICTION: TIG
PROJECT: GRANT STREET ELITE CARE
Project Description: Low voltage for fire alarm.
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:
ELITE CARE CASCADE LIFE & SAFETY SYSTEMS INC
2300 SW 103RD 2701 22ND ST SE
PORTLAND, OR 97225 SALEM, OR 97302
Phone: 971 - 506 -0151 Contact #: PRI 503 -315 -2204
FAX 503- 315 -9928
Reg #: ELE 24- 375CLE
FEES LIC 121899
Description Date Amount
[ELPRMT] ELR Permit 12/28/2007 $75.00
[TAX] 8% State Surcha 12/28/2007 $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 R. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire , work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires yo to follow r , es -dopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -4100. You ay obtain copies of these
rules or d' - ques s • !UNC at 503.246.6699 or 1.800.332.2344.
Issued y: I � ' ' / 4k... Permittee Signature: ' v
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 . :
FOR OFFICE USE ONLY . '
^ City of Tigard Received y: / 74 Permit No.: pea-- CYO g/
Date/By:
SW Hall Blvd., Tigard, OR 97223 Plan Review
C ' Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready /By Jun ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method. � Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
�, New construction ❑ Addition /alteration /replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION - exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
vIulti- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "] -2 ", "I -3 ",
Job no.: (..31C.A..S100c, Job site address: (134 Sv.) (.�1 Ah)7" 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: —n, ► Q C1 �2- 2 ❑ Health -care facilities. ❑ Supply voltage for more than
�1 ❑Hazardous locations. 600 volts nominal.
�6
Suite /bldg. /apt. no.: Project name: PZc e ,f j N/.,Q �' e 12 Service or feeder 600 amps or more.
/� FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
• DESCRIPTION OF- WORK (with above sq. ft.)
i/ n f_ C� A 4 Limited energy, multi- family
/L residential (with above sq. ft.) 75.00 2
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
Name: E ( 17 6_ ,, Q 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: . Over 1,000 amps or volts . 454.65 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 599 amps 133.75 2
Branch circuits – new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
"APPLICANT. ❑ CONTACT PERSON . above service or feeder fee,
each branch circuit 6.65 2
Business name: C C c ) L i I ? ? T ' Y B. Fee for branch circuits
_1 tl i72— first service or feeder fee,
Contact name:
�6 jr C ci t CO Irst branch circuit 46.85 2
Address: c art 1 Z Z N() Cr t) s 5 Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: SI L F ; iv) e2 9-7-oz Each manufactured or modular
dwelling, service and /or feeder 90.90 2
• Phone: E S ) ' ' ' S 7 . - 22 J tf Fax:: (cd ) 7f S r 4 C t 2's Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: r� Z e Q L Signal panel, or limited -
�'l /� energy panel, alteration, or
Address: extension. Describe: 1 Page 2 2
cl 21 4c4-P A-I
City/State /ZIP: � `' Each additional inspection over allowable in any of the above
Phone: ( ) Fax: ( ) Per inspection 62.50
� � Investigation per hour (1 hr min) 62.50
CCB Lie.: 62 1 sq a Electrical Elea/ ) Suprv. Lie.: 1 SZS L 5A. Industrial plant per hour 73.75 ELECTRICAL.- PERMIT FEES
Suprv. Electrician signature, required: a C� t 1 Subtotal:
Print name: 1,44 Q7 ` n 6 , 1 Date: i 2 / /� Plan review (25% of permit fee).
/ l State surcharge (8% of permit fee):
Authorized signature: Ns, TOTAL PERMIT FEE: ,#¢, / •°°
Print name: ��j _ I This permit application expires if a permit is not obtained within 180
A/ V ( Date:t 2 /2 &/ 6-7 This
after it has been accepted as complete.
—
` Number of inspections allowed per pennit.
I:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(i 1 /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:
n Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
❑ Other: •
F COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
•
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
•
n Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
•
for all other installations
C\ Building \Permits\ELC- PermitApp.doc 03/23/06
` . ' ~ `
CITY �~���
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BUUKU DUNG DUVUSKON PERMIT #: ELR2007-00481
13125SVV Hall B|vd, Tigard, ORQ7228 DATE ISSUED: 12/28/2007
Phone: (503) 639-4171
Inspec equests (24 Hrs.): (503) 639'4175
i„fiiiiiilloV
.
INSPECTION WORKSHEET FOR DATE: 7/16/2008 TIME: 7:00#M PAGE: 21
SITE ADDRESS: 123G35W GRANT AVE CLASS OF WORK:
SUBDIVISION: GRANT AVE ELITE CARE EXTEND RE LOT #: 045 TYPE OF USE:
PROJECT NAME: GRANT STREET ELITE CARE
DESCRIPTION: Low volta9e for tire alarm. 5f7/00: Phase I West, Phase II East.
OWNER: ELITE CARE, PHONE #: 971-508'0151
CONTRACTOR: CASCADE LIFE & SAFETY SYSTEMS INC PHONE #: 503-315-2204
.
Inspection Request Scheduled For: Date: 7Y16Q008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
.
109 Electrical final 072721'01 503-209-8850 N
Corrections/Comments/Instructions:
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n | I FAIL I] CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
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|Inspector: ~° / --� Date: v^xV ^~ ~� � Phone#� (5O3)718- — " " w
CITY OF TIGARD _.
BUILDING DIVISION PERMIT #: ELR2007 -00481
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 12/28/2007
Phone: (503) 639 -4171 . ry���i l li'
Inspection Requests (24 Hrs.): (503) 639 -4175 :
INSPECTION WORKSHEET FOR DATE: 7/15/2008 TIME: 7 :00AM PAGE: 35
SITE ADDRESS: 12353 SW GRANT AVE CLASS OF WORK:
SUBDIVISION: GRANT AVE ELITE CARE EXTEND RE LOT #: 045 TYPE OF USE:
PROJECT NAME: GRANT STREET ELITE CARE
DESCRIPTION: Low voltage for fire alarm. 5/7/08: Phase I West, Phase II East
OWNER: ELITE CARE, PHONE #: 971 -506 -0151
CONTRACTOR: CASCADE: LIFE & SAFETY SYSTEMS INC. PHONE #: 503 - 315 -2204
Inspection Request Scheduled For: Date:, 7/15/2008 Pour Time:
Code # Inspection Description /c onfirm-# Contact # Message
199 Electrical final 072638 -01 503-209-8850 \ Y
Corrections /Comments /Instructions: • CALL I, S}'
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RI,I --1t Pa, PAP .
NH* - 77 0.16,yoz A L 2 c t 6d A(441
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❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
Z FAIL ACALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: N ()Q) Date:1 jr 0 Phone #: (503) 718- In Li‘k
CITY OF TIGARD
BUILDING. DI PERMIT #: ELR2007-00481
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/28/2007
Phone: (503) 639-4171
Pill l'\
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 5/0/2008 TIME: 7:01AM PAGE: 22
SITE ADDRESS: 12353 SW GRANT AVE CLASS OF WORK:
SUBDIVISION: GRANT AVE ELITE CARE EXTEND RE LOT #: 045 TYPE OF USE:
PROJECT NAME: GRANT STREET ELITE CARE
DESCRIPTION: Low voltage for fire alarm. 5/7/08: Phase I West, Phase H East
OWNER: ELITE CARE, PHONE #: 971-506-0151
CONTRACTOR: CASCADE LIFE & SAFETY SYSTEMS INC PHONE #: 503-315-2204
Inspection Request Scheduled For: Date: 5/8/2000 Pour Time:
Code # Inspection Description en I - • Contact # Message
V
199 Electrical final 069595.01 971-506-1973 N
Corrections/Comments/Instructions:
bcErisa, FINAL, v■rits. 1 al 1.14A NOUN'
l'eel s if 4 i\e-eNIV.L., e fav - Nit g it leciL
"theitik. EM— ' vraT will 014. FietoR3.
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I I PASS PARTIAL APPROVAL n CANCEL n NO ACCESS
n FAIL CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: C., , 0 (Se 1 .- --- Date: ik CA Phone #: (503) 718- VII__
•
CITY OF TIGARD
BUILDINGS DIVISION PERMIT #: ELR2007 -1
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12128/2007
Phone: (503) 639 -4171 IM67�d'�I�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/3 /2008 TIME: 7:00AM PAGE:
SITE ADDRESS: 12353 SW GRANT AVE CLASS OF WORK:
SUBDIVISION: GRANT AVE ELITE CARE EXTEND RE LOT #: 045 TYPE OF USE:
PROJECT NAME: GRANT STREET ELITE CARE •
DESCRIPTION: Low voltage for fire alarm.
OWNER: ELITE CARE, PHONE #: 971-506-0151
CONTRACTOR: CASCADE LIFE & SAFETY SYSTEMS INC c PHONE #: 503- 315 -2201
ti <.
Inspection Request Scheduled ,For: Date: 3/3/2008 Pour Time:
• Code # Inspection Description Confirm # Contact # Message
135 Low voltage 066015 -01 971 - 506 -1973 Y
Corrections /Comments /Instructions:
►r1s c.i'i411JS koi c., 5 11 -I 2 1I0 %,
oNi +S6f1' IA Ili 03 . o kZ.me.`iNt •
c Afl 1JS iSN ,AtJD t�5'( 51 o 3.3 •
O Cits\jeiL fl A s sr 1 1 ' W . ti 4
11 PASS I I PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Iv ®� Date: 3.S. 01) Phone #: (503) 718- 7.4
f "
CITY OF TIGARD
BUILDINGDIVISION PERMIT #: ELR2007-00481
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/260007
Phone: (503) 639-4171 (
Inspection Requests (24 Hrs.): (503) 639-4175 ...4,411 •
INSPECTION WORKSHEET FOR DATE: 2/2712008 TIME: 7:00A1v1 PAGE: 45
SITE ADDRESS: 12353 SW GRANT AVE CLASS OF WORK:
SUBDIVISION: GRANT AVE ELITE CARE EXTEND RE LOT #: 046 TYPE OF USE:
PROJECT NAME: GRANT STREET ELITE CARE
DESCRIPTION: Low voltage for firo alarm.
OWNER: ELITE CARE, PHONE #: 971-506-0161
CONTRACTOR: CASCADE LIFE & SAFETY SYSTEMS INC ^
PHONE #: 603-315-2204
Inspection Request Scheduled For: Date: 7121/2008 Pour Time:
Code # Inspection Description ( Conf . m # Contact # Message
135 Low voltage 065700-01 503-209-8850
Corrections/Comments/Instructions:
s(i) ?RAIN ics. V VIA. - IN 6 FEET CO 1.1
ItbkA vim\
ta 3S16 PASS PARTIAL PARTIAL APPROVAL ri CANCEL n NO ACCESS
FAIL 14 CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: .,~ . 46 1 Date: 140 6 %41 Phone #: (503) 718- 1-00
CITY OF TIGARD
BUILDING. DIVISION PERMIT #: [ I_i 2007 00481
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/20/2007
Phone: (503) 639 -4171 . 4, 2 „, 4001 iI
Inspection Requests (24 Hrs.): (503) 639 -4175 ...„_.,
INSPECTION WORKSHEET FOR DATE: 13J31/2007 TIME: 7 :00AIVI PAGE: 1
SITE ADDRESS: 12353 SW GRANT AVE CLASS OF WORK:
SUBDIVISION: GRANT AVE ELITE CARE EXTEND RE LOT #: 045 TYPE OF USE:
PROJECT NAME: GRANT STREET ELITE CARE
DESCRIPTION: Low voltage for fire alarm.
OWNER: ELITE CARE:, PHONE #: 871 - 506 -0151
CONTRACTOR: CASCADE LIFE & SAFETY SYSTEMS INC PHONE #: 503-315-2204
Inspection Request Scheduled For: Date: 12131/2007 Pour Time:
Code # Inspection Description Confirm - # — Contact # Message
135 Low voltage O 01 503.2.098805 Y
Corrections /Comments /Instructions:
1- • WI & 76 6143 (wc..51)
-15 U
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\, \ &'' S c N 1, . I
1 1 \ 1 6 4 0IJ 2 6F 2--
PASS tArARTIAL APPROVAL n CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ' .--1 1
t ) L( Date: lib/ Phone #: (503) 718- 1-11%
CITY OF TIGARD _
BUILDING: DIVISION PERMIT #:E12001•OO I
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
• Phone: (503) 639-4171 4 004
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: j 2,• LS _0+), TIME', PAGE:
SITE ADDRESS: I 2. 35 3 S W G/ZQNT AVE ■ CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: Fi2s. AI_gcz,Ylf\._
OWNER: PHONE #:
CONTRACTOR: `` , S • s I iAG PHONE #:
Inspection Request Scheduled For: Date\2.2,b -Or) Pour Tinie:
Code # Inspection Description Confirm # Contact # Message
13 �' LovJ V0 ni i LE 5 0 3 . 2 0° 1-• 8 %6
Corrections /Comments / Instructions:
r ■ ROeI 1J4 v �� � a Li • lk a :. C� I_ • IP
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W P•6 5 G-�c� cm� 3 �1.�6� 1 66 155
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•
•
• PASS I1 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G - Q 1" b� Date 2' 2 Z' O 1 Phone #: (503) 718 - )14,'