Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
�� I DEVELOPMENT SERVICES PERMIT #: ELR2005 -00160
F 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/21/2005
PARCEL: 2S 102DA -00401
SITE ADDRESS: 13125 SW HALL BLVD PD ZONING: CBD
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Correct wiring and change smoke detectors. Police dept. and City Hall.
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:
TIGARD, CITY OF METRO SAFETY AND FIRE INC
13125 SW HALL 7055 NE GLISAN
TIGARD, OR 97223 PORTLAND, OR 97213
Phone: Phone: 231 - 2999
Reg #: LIC 63651
ELE 26- 1154CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 6/21/2005 $75.00
[TAX] 8% State Surchar€ 6/21/2005 $6.00
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. ATTENTIO : Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set fort n AR 952 - 001 -0010
through OAR 9 001 -0100. You y obtain copies of these rules or dire questions to 0 C 77}_ 503- 246 -6699.
Issued By: s e 6 7 -(7e - Permittee Signatur• • Vi/ ' I�
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 �/ f / Permit No: • Z'Y�
13125 SW Hall Blvd., Tigard, OR 97223
Date/By. '/ C / `, 1 /�
Phone: 503.639.4171 Fax: 5035'9 \ 96) 1 2005 / »,s of c i DateBy ew Other Permit:
Inspection Line: 503.639.4175 _Ai. el Date Ready/By: effli ® See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: Supplemental Information
BU(LDIFII Pub IFAI}'k PLAN REVIEW
•
❑ New construction X] Addition/alteration /replacement Please check all that apply:
•
❑ Demolition ❑ Other: 0 over 225 amps, comm'l ['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 X Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other: El 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: " L5 at O ❑Health -care facility ❑Other:
5 W 14.40 df Submit 2 sets of plans with any of the above.
City / State/ZIP:
-r1?-,b The above are not applicable to temporary construction service.
I D R 9 ZZ 3 name: / PO� IC e /Ct'Ly l- II FEE* SCHEDULE
Suite/bldg. /apt. no.: Project
Description I Qty. I Fee. I Total I *'
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'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
DESCRIPTION OF WORK Each manufactured or modular
//��
_ _ I dwelling, service and/or feeder 90.90 2
CeR Q''=�T W 1 1(t t it 4- (A A S NO R-S Services or feeders installation, alteration, and /or relocation •
. (YI, rig-e- Al 4-i -M SYS4-c!441 • 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: 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 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each
•
Business name: / M �/ E T R.0 S p „ { -- tz„ r j ..4..4.- r
it k t;: 1 'roc branch circuit 6.65 2
�� ��^^� I B. Fee for branch circuits
/
Contact name: r r /A2C l-/tS a / without service or feeder fee, 46.85 2
• Address: 705S' Al r i.s..1 S7-• each branch branch it
Each add'I branch circuit 6.65 2
City/State/ZIP: P g I c h S D OK q7 z 13 Miscellaneous (service or feeder not included)
I
Phone: (37:8 ) t 1_294'9 Fax: : (S1)3 ) ate -'' '9/ Pump or irrigation outline lighting t i ng e 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
CONTRACTOR . energy panel, alteration, or
extension. Describe: I Page 2 2
Business name: ,�.e_
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: Investigation per hour (I hr min) 62.50
Phone: ( ) .f —' — O 1 Fax ( ) • - 7 - I .D to Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES* •
CCB Lic.: (,3 cps- / Electrical Lic.:0 (,_ICSt, Lic.: :R331 L Subtotal
Suprv. Electrician signature, required: ' , Plan review (25 %ofpermit fee)
Ir Ake-- S " Date: I _ State surcharge (8% of permit fee)
Print name:
7 / ( - 2 t -08 TOTAL PERMIT FEE gl , D0
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.
i:\Buitding\Permits\ELC- PermitApp.doc t2/03 440- 4615T(10 /02/COM/WEB
•
1
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
1- 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
System*
❑ Vacuum Systems*
❑ Other:
- COMMERCIAL- WORK ONLY:
•
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems •
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
•
❑ HVAC .
❑ Instrumentation •
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Permits\ELC- PermitApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR20000160
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/21/2005
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 95
SITE ADDRESS: 13125 SW HALL BLVD PD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: POLICE DEPARTMENT
DESCRIPTION: Correct wiring and change smoke detectors. Police dept. and City Hall.
OWNER: TIGARD, CITY OF, PHONE #:
CONTRACTOR: METRO SAFETY AND FIRE INC PHONE #: 231 -2999
Inspection Request Scheduled For: Date: 6/30/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
136 Low voltage 010471 -01 503 - 231 -2999 N
Corrections /Comments / Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C' N (e L Date: b 13'10E
Phone #: (503) 718-