Permit =' :- -;' CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00054
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/13/2008
PARCEL: 1 S135CA -02600
SITE ADDRESS: 11130 SW GREENBURG RD ZONING: R - 12
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: GOOD NEIGHBOR CENTER
Project Description: Installation of (2) low voltage systems, fire alarm and data. Job No. 1508
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA /TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: X OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
GOOD NEIGHBOR CENTER ACS ELECTRIC LLC
11130 SW GREENBURG RD 19325 EDY RD
TIGARD, OR 97223 SHERWOOD, OR 97140
Phone: 503 -443 -6084 Contact #: PRI 503- 442 -3938
FAX 503 -625 -1862
FEES Reg #: ELE CLE102
LIC 175877
Description Date Amount SUP 2564LEA
[ELPRMT] ELR Permit 3/13/2008 $150.00
[TAX] 12% State Surch 3/13/2008 $18.00 REQUIRED ITEMS AND REPORTS
Total $168.00
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 d' - que •ons t. ' UNC at 503.246.6699 or 1.800.332.2344.
Issued : : I `` ' / ' �� Permittee Signature: ,A�ji A �1�,4
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.
El ' +:,trical Permit Applicatio I ' L. R eceived DIJ Q ' � _ FOR-OFFICE-USE - — -�
' ONLY - - - —
City of Tigard A ' �
� pf
Permit No.: �S c - / � 9do U�t/J�
° 13125 SW Hall Blvd., Tigard, OR 972 1 6 R 1. 3 " LOUD
DDate/By: :
0 Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1 Date/By:
T7 GARD w B E � Inspection Line: 503.639.4175 CITY OV- TIGP RD Date Ready/By: �J HI See Page 2 for
Internet: ww.tigard- or.gov lonL®% lvl GDIVIS'O Notified/Method:
Tie/ Supplemental Information
TYPE OF WORK .. PLAN REVIEW
❑ New construction Addition/alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more El 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
El 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ElFire 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 ", "1 - ", "1 - ",
Job no.:1� 7 Job site addres /f�)a ee�bC I occupancy.
� ,er ❑ Six or or more more e resisi dential units. ❑ Recreational vehicle parks.
City/State/ZIP: / 7 7/7l� -V `f Z / ❑ Haz Hazardous fcai io ❑ Supply voltage for more than
600 volts nominal.
Suite /bldg. /apt. no.: (Project name:
C v
/ Hazardous locations.
• / _ Service or feeder a
‘4 ��� 9 h �7 e r ❑ Si fd 600 or more. FEE^ SCHEDULE
Cross street/directions to job site: 0Ifeek -Min KC / .7 1 1 Description I Qty. I Fee. 1 Total I •
f New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION O WORK (with above sq. ft.) 75.00 2
OF
u "/ Limited energy, multi - family
4a at WeirAJ` Ired e . J 57 e,.. 0,01 residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
a 5i i# J6 ID 6X6//'e. SYS1'fri4 200 amps or less 80.30 2
ZI -PROPERTY OWNER A' 201 amps to 400 amps 106.85 2
Name: ` t 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: ‘ \30 - -� yelkAt3 V Over 1,000 amps or volts 454.65 2
City/State /ZIP: L 9 7 1 Tempoary services or feeders installation, alteration, and/or
C t ((( I relocation
Phone: ( ) U I 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 I ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: 1�° e6 - 32 tl c �L B. Fee for branch circuits
without service or feeder fee,
first branch circuit 46.85 2
Contact name: ice e
Address: /93? S 1— ,¢, Each add'l branch circuit 6.65 2
Y A Miscellaneous (service or feeder not included)
City/State /ZIP: 6 l e-W C*7 t(4 0 Each manufactured or modular
L V K 2_3935--- � I (S3)6Z `__ � a � ^ dwelling, service and /or feeder 66.85 2
(S5 ) `
Phone: Fax:: �J L J Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
O CTOR Sign or outline lighting 53.40 2
R..0_, Business Signal panel, er or limited -
Business name: Q C �- �� ! energy panel, alteration, or /� oO
Address: Qn io `e cr: �p.91, �( Page 2 J �j�' 2
Each additional ibe: s inspection over ( a al l ll llo l wable in an
City/State /Z1P: P any of the above
Per inspection 62.50
Phone: ( ) 1 / ? Fax: ( /p l
l � $ Investigation per hour (1 hr min) 62.50
CCB Lic.: 175-8 I Electrical Lic.: 01E / A Z .rv. L 2,5392 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required � t i p J ; - Subtotal: /c0 .
Print name: a 'gill Date: 0 c 9 Plan review (25% of permit fee): �
_ State surcharge (12% of permit fee): / g • 00
Authorized signature: " ` ,a TOTAL PERMIT FEE: l (p $ .00
` This permit application expires if a permit is not obtained within 180
Print name: 4,hec—`\ — ( ` 1� s � Date: "3) 13
Vv ) a days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp doe 05/23/06 4454615T(I I /05 /COM /WEB
Electrical Permit Application - City of Tigard . -- ' 1,, 4
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: r
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY: •
Fee for each commercial $75.00
system .
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
O Clock Systems
71
Data Telecommunication Installation
Fire Alarm Installation
,❑ HVAC
n Instrumentation
❑ Intercom and Paging Systems
• n Landscape Irrigation Control*
❑ Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling •
n Other
• Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Building\Permits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION c
PERMIT #: ELR2008
13125 SW Hall Blvd., Tigard, OR 97223 1 DATE ISSUED: 3/13/2008
Phone: (503) 639-4171 iget el\
Inspection Requests (24 Hrs.): (503) 639-4175 A4s
INSPECTION WORKSHEET FOR DATE: 4/16120013 TIME: 7:00AM PAGE: 48
SITE ADDRESS: 11130 SW GREENI3URG RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: GOOD NEIGHBOR CENTER
DESCRIPTION: Installation of (2) low voltage systems, fire alarm and data. Job No. 150a
OWNER: GOOD NEIGHBOR CENTER, PHONE #: 503-443.6084
CONTRACTOR: ACS ELECTRIC LLC PHONE #: 503-42,3938
Inspection Request Scheduled For: Date: 4/16/2008 Pour Time:
Code # Inspection Description Confirmli Contact # Message
199 Electrical final 068422-01 503686-5230
Corrections/Comments/Instructions:
N \
\I V:1
PAS' Fi PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS
I I FAIL El CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: G to6e)1.** Date: ` I 6- M) Phone #: (503) 718-2- •
. . •
. . . .
CITY OF TIGARD
4. - c,i •
BUILDING DIVISION PERMIT #: aR2008-000:441
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: :.V13/2008
Phone: (503) 639-4171 44/48,0i#
Inspection Requests (24 Hrs.): (503) 639-4175 .44- 11!.
INSPECTION WORKSHEET FOR DATE: 4/15/2008 TIME: 7:02AM PAGE: 19
SITE ADDRESS: 11130 SW GREENBURG RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
' PROJECT NAME: GOOD NEIGHBOR CENTER
DESCRIPTION: Installation of (2) low voltage systems, fire. alarm and data. Job No. 1508
OWNER: GOOD NEIGHBOR CENTER, PHONE #: 503443.6084
CONTRACTOR: . ACS ELECTRIC LLC PHONE #: 503-442-3938 .
Inspection Request Scheduled For: Date: 4/1512008 Pour Time:
Code # Inspection Description G • Contact # Message
199 Electrical final 068395-01 W3-442-3938 N
. -- •
Corrections /Comments/ Instructions:
-
6 LI Nc 06)Q04(\i/ ...
,.7
tkNO 2. ftion■
106pR • 4et R-1261.q tmli/17inis) /164 zg-b06 j
4 04\ pi
fl PASS 7 PARTIAL APPROVAL 1 CANCEL 0 NO ACCESS
X FAIL CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: CI I \S 66 LT Date: i 1&" b b Phone #: (503) 718- ?Rift)
. .
CITY OF TIGARD
_
BUILDING DIVISION PERMIT #: ELR2008-00054
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/13/2009
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 4/14/2008 TIME: 7:00AM PAGE: 22
SITE ADDRESS: 11130 SW GREENBURG RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: GOOD NEIGHBOR. CENTER
DESCRIPTION: Installation ol (2) low voltage systems, fire alarm and data. Job No, 1508
OWNER: GOOD NEIGHBOR CENTER, PHONE #: 503-443-6094
CONTRACTOR: ACS ELECTRIC LLC PHONE #: 503-442-3938
Inspection Request Scheduled For: Date: 4/14/2008 Pour Time:
Code # Inspection Description infirm • Contact # Message
199 Electrical final 068290-01 503442-3939
Corrections /Comments/ Instructions:
RC) V 'RV VI-AtJK to■J'alZ.,& do*Yh(L. ML Lo
06"i L'Y 6 /AO (11 \) eN tar 10 fk
vi • -
IoVeZ tLet. 'kl(stL.
k1 c-ot o CAt,o
Qi teUka. (-134 It-
- K.0\w 1./364,0 r OGI Cvt,c,vi ako,tcs.
•E N\a-i\ 1 fil4
4 0 T - i t - I g l o o L A L , csuiii(U
0 PASS n PARTIAL APPROVAL 0 CANCEL pi NO ACCESS
FA FAIL CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: Q \-. Date: L i • 14-68 Phone #: (503) 718- PHI.
CITY OF TIGARD
BUILDING DIVISION 4 ' PERMIT #: ELR2008- 00054
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/13/2008
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3120/2008 TIME: 7:02Al PAGE: 15
SITE ADDRESS: 11130 SW GREENBURG RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: GOOD NEIGHBOR CENTER
DESCRIPTION: Installation zaf (2) Iow.voltage systems, fire alarm and data. Job No. 15088
OWNER: GOOD NEIGHBOR CENTER, PHONE #: 503 - 443-50114
CONTRACTOR: ACS ELECTRIC LLC RQ R I PHONE #: 503-4413938
Inspection Request Scheduled For: Date: 3/20/2008 Pour Time:
Code # Inspection Description • ' • Contact # Message
135 Low voltage ' 67045-01 503-442-3938 V
Corrections /Comments /Instructions:
PASS. n PARTIAL APPROVAL n CANCEL n NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: •' ' O C?
Date: 3 0 Th Phone #: (503) 718- Z� I