Permit Fr i CITY O F TI GARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00004
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/5/2009
PARCEL: 1 S135CA -02600
SITE ADDRESS: 11130 SW GREENBURG RD ZONING: R - 12
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: GOOD NEIGHBOR CENTER
Project Description: Install low voltage for audio /video.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: X 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: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: :
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
GOOD NEIGHBOR CENTER PROCOM COMMUNICATIONS INC
11130 SW GREEN BURG RD 2316 SE CLATSOP
TIGARD, OR 97223 PORTLAND, OR 97202
Phone: Contact #: PRI 503- 233 -8037
FAX 503- 233 -8052
Reg #: ELE 3- 397CLE
FEES LIC 109929
Description Date Amount SUP 1172LEA
[ELPRMT] ELR Permit 1/5/2009 $75.00
[TAX] 12% State Surcha; 1/5/2009 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
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 - set.forth in OAR 952 - 001 -0 010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503.246.6 99 or 1.806 33 344.
Issued Permittee Sign: ure:f:,/'"��1■._
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.
t
1/5/2009 9:41 AM FROM: Procom Procom TO: 5035981960 PAGE: 002 OF 003
Electrical Permit Appli EC EIVED FOR' OFFICE USE ONLY ' -
It City of Tigard Received i , q p itNo.. Ia./100 ./�/
tY g DareiB
• 13125 SW Hall Blvd , Tigard, OR 97 0 5 2009 plan Review
'• Phone: 503.639.4171 Fax: 503 598`791' Date/Bv. Other Permit:
f , 1 t:A RT.) inspection Line: 503 63 4175 A �TY OF TIGARD Date ReadyiBy: 0 See Page 2 for
Internet: www.ti 8 and or. ov 4 OF e1 trI NotifiedNethod: Supplemental Information
. ' IMI NG DIVISION PLAN REVIEW ,;
❑ New construction ® Addition /alteration /replacement Please check all that apply (submit 2 sets of plans wiitems checked below)
❑ Service or feeder 400 amps or more ❑ Building over three stones
❑ 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
❑ Multi - 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", ''I-2", "1 -3 ",
Job no.: Job site address: 11130 SW Greenburg Rd. IOO11P or more. occupancy.
❑ Six or store residential units- ❑ Recreational vehicle parks.
City /State /ZiP: Tigard /OR/ ID Health-care facilities ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: Good Neighbor Center ❑ Service or feeder 6011 amps or more
. FEE SCHEDULE.
I Cross street/directions to job site: oeeriwi °a I (r I Fee. I T L
New residential single- or multi - family dwelling unit.
includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 -
Ea add'l 500 sq. ft or portion 33.40 I
Tax map /parcel no.: Limited energy, residential
75.00 2
' DESCRIPTION OF ;WORK (with above sq. t )
Limited energy, multi - family 75.00 2
Audio / Video residential (with above sq. tt.)
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
/�
401 amps to 600 amps 160.60 2 —
Name: Ovon t3 tto, t4- P�Q et0 it
601 amps to 1,000 amps 240.60 2
Address: ' 1 1 30 Q-.2eE.r3 fb /Z, D Over 1,000 amps or volts 454.65 2
City/State /ZIP: '' ` , R.") QQ q7 A 3 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
Owner signature; Date: Branch circuits- new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee,
2
each branch circuit 6.65
Business name: ProCom Communications, inc. B. Fee for branch circuits
Contact name: Shawn Giles
without service or feeder fee, 46 05 2
first branch circuit
Address: 2316 SE Clatsop Each add'I branch circuit 6 65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Portland /OR/97202 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (503) 2.33-8037 Fax: : (503) 233 -8052 Reconnect only 66.85 2
E -mail: shawng @procomcommunications.com Pump or irrigation circle 53.40 2
. CONTRACTOR • Sign or outline lighting 53,41) 2
Business name: ProCom Communications, Inc. Signal circuits) or limited-
energy panel, alteration, or
1
Address: 2316 SE Clatsop extension. Describe: Page 2 75.00 2
City/State /ZIP: Portland /OR/97202 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 233 -8037 Fax: (503) 233 -8052 investigation per hour t1 he min) 62.50
CCB Lie.: 109929 Electrical Lie.: 3- 397CLE Suprv. Lie,: 1172LEA Industrial plant per hour 73.75
Suprv. Electrician signature, required: tl / /.� - a� 7 X 4 ;ELECTRICAL: PERMIT Subtotal: . Subtotal: 75.(x1
Plan review (25% of permit fee)'
Print name: Shawn Giles Date: 1/5/09 State surcharge (12% of permit fee)' 9.00
Authorized signature: r � TOTAL PERMIT FEE. 84.00
This permit application expires if a permit is not obtained within ISO
Print name: Shawn Giles Date: 1/5/09 days after it has been accepted as complete.
• Number of inspections allowed per permit.
1\Building'Permits\EI.C.Permil App don 05/23/06 440-4615T( 1 I /o51COM/WEa
CITY OF TIGARD
BUILDING DIVISION PERMIT #: i .I R"00c9 -00004
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/6/2009
Phone: (503) 639 -4171 noo 0 1 l r l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: . •I /12oo2009 TIME: 7 :00AM PAGE: 6 •
SITE ADDRESS: 11130 SW GREEWBURG RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: GOOD NEIGHBOR CENTER
DESCRIPTION: Install low voltage for audio/video.
OWNER: GOOD NEIGHBOR CENTER, PHONE #:
CONTRACTOR: PROCOM COMMUNICATIONS INC PHONE #: 503-233-0037
Inspection Request Scheduled For: Date: 1/22/2009 Pour Time:
Code # Inspection Description Copirm # Contact # Message
13E I )flag# o 9927 -01 503.490 -1990 N
►- e ct i ons /Co /IIn uctions:
\ —
\.'\
\\. -r-N\
F / PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: G NI 08 I-S Date: 1 7i2. '9r Phone #: (503) 718- 1tP
0011/2010 11:15 503-691-8556 OREGON HEATING PAGE 01/03
lectrical Permit Application
City of Tigard Received
• 13 l l; _ _ Q~
DatelBv; Permit No.: Y`5~
125 SW Hall Blvd., T'igat'd, UK 9722=
ID EIeg \1r/y~ ate R -2-0 IG NM& Ian Review
Phone' 503.639.4171 Fax: 503.598.1960 ®l J' Otbet Pemit; (Y~~hiL
Inspection Lille: 503.639.4175 Date Ready/By; Tune: lz See Page 2 for
Internet: wwrw.tigattl-or.gov Notified/Method: 5upplemeata1 information
❑ NCtV COnStruction ❑ gdditloa/altcrationh Please chcdc all that apply (submit I sets of plan; w/items checked beloev):
~gjaa TIGARD El Service or feeder 400 amps or more El Building over three ;tones.
❑ DCmo tion ❑ 'the', ISION where the available fault cutxent ❑ Matins and boatyards.
exceeds 10,000 amps at l50 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 0 Commercial-u- a Itora)
❑ 1-acid 2-family dwelling ElCommercial/industrial ❑ Accessory building amps for all other installations. buildisigg.
❑ Multi-family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA u,
❑ Pmer cnc system. ~ g Y Yla
rger separately derived syscan.
r.
71-777777 ❑ Addition of new motor load of 0 "A" "E" "1-2" "1-3' ,
.lob Z S~ l~Q~h+rt Ft 0 100HP or more. occupancy.
❑ Six cr more residential units, ❑ Recreational .chicle parks.
City--j Zz ❑ Health-cafe facilities. ❑ $uppiy voltage fof snore than
❑ Hazardoi:g locations, 600 volts nominal.
Suit.S /y ❑ Service or feeder 600 omp_ or mo+'e.
1
Cross street/directions to job site: De~cri tion H. fee. Toter
" New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. cl less 168.54 4
Ea. add'I 500 sq. 0. or portion 33 92 1
Tax map/parcel tio.: Limited energy, residential 67.84 2
with above 5 . R,
Limited wlergy, multi-family
M 67.84 2
7r residential with above s q- ft, _ Services or feeders installation alteration and/or relocation
200 amps or less 100,70 2
0 201 amps to 400 amps 133,56
1`Iame: 401 amps to 600 amps 240.37 2
601 amps to 1:000 amps 301.04 2
lddress: _ Over 1,U00 amps or volts 552726 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 i
Owner installation: This installation is being made on property that f orvn which is nut 201 amps to 400 amps 125.08 2
intelldeQ for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701- 401 amps to 599 arnps 168.54 2
Owner Signature: Branch circuits-new, alteration, or e'teasion, per panel
Date:
A. Fee for branch circuits with
above service or feeder fee, 7.42 2
each branch circuit
Business name: B, Fee for branch circuits
Contact name: without service or feeder fee, 56.18 2
C - first branch circuit
Address: Each add"I branch circuit 7.42 2
City/State/ZIP: _ Miscellaneous service or feeder not ine)uded
Each manufactured or modular 67 84 2
dw'el)in , service and/or feeder
Phone: ( ) Fax:: ( ) -
Reconnect only 67,84 2
E trail: Pump or irrigation circle 67,84 2
Sign 01' outline lighting 67.84 2
Business narnc: arrPr^io.ft ~-1e~ Signal circuit(s) or limited
energy panel; altcrration, or
Address: tmielf51Un. Describe: Paget 2
City/5tate/ZIP: 115 Each additional inspection over allowable in any of the above
Per inspection 66,25
Phone: (50"5) f cgjq(
.qq Fax: ( ~ )
A 755 Investigation per hour (i hr min) 66.25
CCB Lic.: 212 Electrical Lic.: t ~Q L+ Suprv. Lie.: Industrial plant per hour 78.18
awel M,
Supty. Electrician signatul•e, required; y-~ Subtotal: (Q
Print name: GV' eta o v D (~OO n I I Date: j 1 j lo Platt review (25% of pt:rmit fec):
State surcharge (12°b of permit fee): $.1
Authorized signature: TOTAL PERMIT FEE: I 75. Q~?
Print name: Date: This permit application expires if a perinit is not obtained within 180
days after it nas been accepted its complete,
Number of inspections allowed per peonit.
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$ 5cL X35 tXpk:~Y