Permit 'cC ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
.41i DEVELOPMENT SERVICES DATE PERMIT #:
: E 4/2005
`"' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S 135AA -01901
SITE ADDRESS: 10225 SW HALL BLVD 102 ZONING: C -N
SUBDIVISION: METZGER ACRE TRACTS LOT: 037 JURISDICTION: TIG
Project Description: Low voltage for phone and speaker wiring.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: X INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA /TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: :
TOTAL # OF SYSTEMS: 2
Owner: Contractor:
GERIG, WAYNE L. OWNER
10225 SW HALL BLVD #101
TIGARD, OR 97223
Phone: 503 244 - 1004 Phone:
Reg #:
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 3/14/2005 $150.00
[TAX] 8% State Surchart 3/14/2005 $12.00
Total $162.00
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 da ATTENTION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those r es e set forth in OAR 952 - 001 -0010
through OAR 9 001 -0100. You may obtain copies of these rules or direct ue,. i I rrs to 01‘.1 at 503 - 246 -6699.
Issued By: _ A . . /_ ;.„ Permittee SignatureK 1 ( d
OWNER INSTALLATION ONLY L
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 igicalimiVE . - .. holz OFFICE USE ONLY
City of Tigard Received Date/B . + 6 Permit No: �' . 05 -3
13 125 SW Hall Blvd., Tigard, OR 97223'',( 2005 Plan Revie
Phone: 503.639.4171 '' Fax: 503.598.1960 / / r� ,r ('l'` DateB , Other Permit:
Inspection Line: 503.639.4175 CITY OF TIGARD °� Ii DateReadyBy: H See Page tfor
w.
Internet: wwci.tigard.or.us BUILDING DIVIs I� nl Notified/Method: FM Supplemental Information
..
TYPE OF WORK PLAN REVIEW ,
❑ New construction ►: Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l 0 Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION . of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling 'I Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Multi - family ❑Master builder Other: ❑Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB_SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: Job site address: 1022.5 QM- Hall Su 4e-13 ❑Health -care facility ❑Other:
i p Submit 2 sets of plans with any of the above.
City/State/ZIP: T i 9 aV d J ®R 9 72 23 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no :: •J Project name: Tot I o Hai r S . os, FEE* SCHEDULE
9 Description I Qty. I Fee. I Total I"
Cross street/directions to job site: Halt N . to Oak ac reS5 New residential single- or multi- family dwelling unit.
/ Includes attached garage.
Frew) R O X15 b"i 14A I ( 1,000 sq. ft. or less 145.15 4
Subdivision: J Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: • Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
Low DESCRIPTION OF WORK Each manufactured or modular
L ow VD(t &g a.F Sre¢r tjifre, 4- s'peakQrs' jba dwelling, service and/or feeder 90.90 2
J Services or feeders installation, alteration, and/or relocation
drop cettFh.g 4- Looms, PGlohe. (IMe' 1h pa
Sce. -S /A we 200 amps or less 80.30 2
PROPERTY. OWNER . ❑ TENANT. 201 amps to 400 amps 106.85 2
1`, 401 amps to 600 amps 160.60 2
VY
Name: Q NG G eir -- Redwood C .e� f et. 601 amps to 1,000 amps 240.60 2
Address: 1 5 3 c S, W, ;c b while C j Y' Q Over 1,000 amps or volts 454.65 2
P.. Reconnect only 66.85 2
City/State /ZIP: Bea V6V 4-OI I 0 , Temporary services or feeders installation, alteration, and /or
Phone: (5 570 - 02.03 ( &? ( ) 244 • I 004 Cbds relocation -
/ 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
, ❑ APPLICANT • ❑ CONTACT PERSON A Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit _
B. Fee for branch circuits
Contact name: 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: ( ) Fax: : ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
CONTRACTOR I energy panel, alteration, or
Business name: �/ fyt o •-. f �
Feel W O ,d C extension. Describe: A Page 2 / t5) - 2
Address: 1 0 2 2 5 s W �a B (v a Each additional inspection over allowable in any of the above
'��-• Per inspection 62.50
City / State/Z1P: ! I C{ ap d , OR 9-72'13 23 Investigation per hour (1 hr min) 62.50
Phone: 0•)
2-44— I O04 Fax: ( ) • Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: Electrical Lic.: Suprv. Lic.: Subtotal / ) F 6 94
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee) /9 00
TOTAL PERMIT FEE r 6 , 00
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
�
Print name: V lye G• e , r 1 , 3 t p.0, Date: 3 [`ii ( OS * Fee methodology set by Tri- County Building Industry Service Board
** Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PemnitApp.doc 12/03 440- 4615T(l0 /02/COM/WEB
•
s
Electrical Permit Application - City of.Tigard
Page 2 - Supplemental Information r i
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
Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning •
•. �.�.a
System* ,
*;f:, e
- ,. , ,. • ' • • r,.
❑ Vacuum Systems* f.. ' 1 1 ,r , .
•
❑ Other:
COMMERCIAL WORK ONLY:::- . 7' s. ,,; - �.. y; .a •
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260) : r : c, � ; �t n t n .: ..., , j ; _ 1 '4.! ' ` ..a •.0 'r. r:, „ 1; ", + � .� • •
Check Type of Work Involved: . ,
tilt i n §•� is �� v:r f)
❑ Audio and Stereo Systems °'
111 Boiler Controls G ' ° ', `'' • `'` (3
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical „.,.
e � ;
❑ Nurse Calls "”' t
El Outdoor .y c' �... �►, • • y t .. •
or Landscape Lighting* ' ' `
.3 Cs ;t :.-; 'C
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations ' :.i ,' ' . ' r • c.o.„` t„ " 1 t3 `
i:\ Building\Permits\ELC- PermitApp.doc 04/03
•
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: ELR2005 -00053
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/14/2005
Phone: (503) 639 -4171 i 474 yp1 i i
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/2!2005 TIME: 7:10AM PAGE: 19
SITE ADDRESS: 10225 SW HALL BLVD 102 CLASS OF WORK:
SUBDIVISION: IvIETZGER ACRE TRACTS LOT #: 037 TYPE OF USE:
PROJECT NAME: TAGLIO HAIR SALON
DESCRIPTION: Low voltage for phone and speaker wiring.
OWNER: GERIG, WAYNE L, PHONE #: 603-2441004
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 5/2J2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
136 Low voltage 005809 -01 503- 452 -2557 Y
Corrections /Comments/ Instructions:
N
J
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED '
r— --- Inspector: — Date , 0' 2 ' — ( 5 Phone #: (503) 718-