Permit Er CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00166
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/4/2007
PARCEL: 2 S 102 DA -00401
SITE ADDRESS: 13125 SW HALL BLVD ZONING: CBD
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: CITY OF TIGARD
Project Description: Signal circuit for card reader at interior lobby door at the Niche Building (see other).
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: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: ACCESS X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
TIGARD, CITY OF SELECTRON INC
13125 SW HALL 7225 SW BONITA RD
TIGARD, OR 97223 TIGARD, OR 97224
Phone: Contact #: PRI 503 639 - 9988
FAX 503- 684 -4357
FEES Reg #: ELE 26- 497CLE
LIC 64341
Description Date Amount SUP 3645LEA
[ELPRMT] ELR Permit 6/4/2007 $75.00
[TAX] 8% State Surcha 6/4/2007 $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 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 direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: J/ h / A/ • / /
v Permittee Signature: 3.... Afflircdiayl
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.
' lec . ical Permit Application f ,, •: i 3 .FOR.�
. _ E USE ONLYf 3 ,,, � ax s
� . 4-.. 3 a .,. . 4 ,,.. . .,..
City of Tigard Date/B y . / • Permit No. ELL 24. -- 60
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 e t +(yir sa l l,h Date /By. Other Permit:
Inspection Line: 503.639.4175 ■ y !. •ll 1 Date Ready/By: tn�s: 8 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method. I Supplemental Information
E `" TYPE , OF , _W R I C.� �- +. " "v c.. _<_. 'ELAN�`RES'IEWt - �` - �
❑ New construction Addition/alteration /replacement Please check all that apply:
CI Demolition Other: ❑Service over 225 amps, comm'l ❑Hazardous location
CATEGORY % =0F' " : N TRU DTI N''r. � `=iY R
OService over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
, - _;��,� _ - ,,, �, ,,_ CQ ,S C O r _ ..M;� 1 �,c of 1 -and 2-family dwellings 4 or more new residential
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building El System over 600 volts nominal units in one structure
❑ Multi - family Master builder ❑ Other: ❑Building over three stories ❑Feeders, 400 amps or more
ti- _ , l ❑Occupant load over 99 persons ❑Manufact structures or
¢, - . " JOB;SIT,E�rINFORMATION AND LOCATION , �_ ❑E /li plan RV park
Job no.: (: Job site address: I'3I -..s SW F6.11 -I ■1.4 ❑Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City /State /ZIP: The above are not applicable to temporary construction service.
Suite /bldg. /apt. no.: Project name: r 04_ m and r} 1 P. .- -FEE * "SCH CI . '' �� t z,'. ''''''''.1''
Description i tion Fee. Total
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.:
. {y , . _ - Limited energy, non - residential 75.00 2
, t ,.t., ,` 5' rDESCRIPTION?OF "WORK;. -. y',a ,•gA` > ,„,,:-
,
,> ,�JJ I _ . _a_,,. ". ':�w _ , . � Wit° -• Each manufactured or modular
C ek rt '�' &t�l 4 V l (iv) ( a+
dwelling, service and/or feeder 90.90 2
In � Services or feeders installation, alteration, and /or relocation
NI ■ `Igt \ 200 amps or less 80.30 2
' - ., r..° 201 amps to 400 amps }.., , -N - -. ti. : - ;,f -', ;:,. _'p ,4 ,
, -F: ',-- ; 1 'i;s
,s P P 106.85 • 2
= � PR - ,. - ,. ❑ TENANT
401 amps to 600 amps 160.60 2
Name: 601 - amps to 1,000 amps 240.60 2
Address: - Over 1,000 amps or volts 454.65 - 2 -
Reconnect only - 66.85 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 600 amps I I 133.75 1 1 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
`i A . Fee for branch circuits with
' ` . ... ICAiVT:'. , ' x G ®,'eCONTAGT: <.P. ERSOIV ;k «. s
-•- _ � _.... .. ..� , ., -�:. u,.- . �,�. ; c > <� * � , „t .. . - � , .... .. � =ate .,
Business name: branch circ 6.63 2 uit
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)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax :: ( ) Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
01 _ ..:.:�- ....:s�. .�."::_�::. ,,.,. e,tr ;,v' `,`:' *',.� - energy panel, a lteration
_ � , ;. , ..-,_ ... .,,;�.,_ .: , . .. , ._ = .CONTRi1GTOR <``% -` - : %:�� =I:�„. _ energy P , or
extension. Describe: I Page 2 2
Business name: SeIe_c — Irby, l h(_
-] "� C 1�� Each additional inspection over allowable in any of the above
Address:
5 3),d Per inspection 62.50
Gity /State/ZIP: "R_ . U i Z C 7) 4 Investigation per hour (1 hr min) - 62:50 -
1 ��]
Phone: 60 )� 1'I Fax: (5(5) ( o�S� _; 1 "s`-) Industrial plant per hour 73.75 ,_ '4 t l ug y° ` 4
,:::. __.`:ter: �; ? ETJ~ C TRICAL;P•ERMrI?� ".FEES�:,�_,,. ,,, 0.
CCB Lie.: Li..-(34.i 1 - - Electrical Lic.: 3<—ii Suprv. Lie.: Subtotal 6
Suprv. Electrician signature, required. o Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee) �, . DO
Ic11� CYI■
TOTAL PERMIT FEE I
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board
. ** Number of inspections per permit allowed.
1:\ Building \Permits\ELC -Penn itApp.doc 12/03 440 -4615T(1 0/02/COM/WEB
CITY OF TIGARD y
BUILDING DIVISION PERMIT #: ELR2007 -00166
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/4/2007
Phone: (503) 639 -4171 "lo i
Inspection Requests (24 Hrs.): (503) 639 -4175 . ' ' ..
INSPECTION WORKSHEET FOR DATE: 7/5/2007 TIME: 7:03AM PAGE: 5
SITE ADDRESS: 13125 SW HALL BLVD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: CITY OF TIGARD
DESCRIPTION: Signal circuit for card reader at interior lobby door at the Niche Building (see other).
OWNER: TIGARD, CITY OF, PHONE #:
CONTRACTOR: SELECTRON INC PHONE #: 503-639 -9960
Inspection Request Scheduled For: Date: 7/5/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
1 35 Low volt ge 051481 -02 503 - 670 -5216 N
\°\\ 1 --,
Corrections /Comments/ Instructions:
Ck5 Y /ERJ
Ro d - SL\
PASS El PARTIAL APPROVAL n CANCEL I I NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ' (e Date: • V" 01 Phone #: (503) 718- 2-44 v