Permit e
"
CITY F T I GA R D ELECTRICAL RESTRICTED ENERGY PERMIT
A!!
& DEVELOPMENT SERVICES PERMIT #: ELR2006 -00196
1 3125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/18/2006
PARCEL: 2S 101 AD -03100
SITE ADDRESS: 06950 SW HAMPTON ST 210 ZONING: MUE
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Voice and data cabling.
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: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WESTON INVESTMENT CO PROGRESSIVE TELEPHONE SYSTEMS
2154 NE BROADWAY 710 NE CLEVELAND # 120
PORTLAND, OR 97232 GRESHAM, OR 97030
Phone: Contact #: PRI 503- 665 -4900
FAX 503- 655 -4830
FEES Reg #: ELE 26 -1 117CLE
LIC 150175
Description Date Amount
[ELPRMT] ELR Permit 8/18/2006 $75.00
[TAX] 8% State Surcha 8/18/2006 $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 ies f these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: � Permittee Signatur ' � C� �
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 PermitAMicationliNdu '. FOR OFFICE USE ONLY
City of Tigard a vni f 40 NTT') Received,, {t) Permit No .,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie t,
Phone: 503.639.4171 Fax: 503.598.19900) I 9 n 4 ./ t r,t9pr .S ( ''� Date/By: Other Permit:
Inspection Line: 503.639.4175 ��++V t� J I I Y - ■ ira�+ o• Date Ready/By: EN 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
( � lF *OR1 PLAN REVIEW
• ❑ New construction Adiirtio h l i alt e ration / .re I Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'I 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 J Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi - family 0 Master builder 0 Other:
❑Occupant load over 99 persons 0 Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: Job site address: 695-6 5L'-- q m prod ❑He 2 -care facility
fp ay ❑ Othee.
Submit 2 sets of plans with any of the above.
City /State /ZIP: The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg. /apt. no.: g ) Project name: .l D. 4-r .
�N5oD C,t {.k USr Description I Qty. I Fee. I Total
Cross street/directions to job site: �e/ --/ )J AS �,e 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
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION' OF WORK Each manufactured or modular
V D 1 LL + f7Ai'Yl dwelling, service and/or feeder 90.90 _ 2
D( (_. ��j 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: 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 ❑ 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
, ` -1 (
CONTRACTOR , . , i . �J�� energy panel, alteration, or
V 7.5 extension. Describe: Page 2 . 2
Business name: �5 OA
Address: Each additional inspection over allowable in any of the above
D /06. c _ L €v t_` A, '� Per inspection 62.50
City /State /ZIP: IZCS1 4,4 / bQ q -7030 '•O Investigation per hour (1 hr min) 62.50
Industrial lant per hour 73.75
Phone: (553) L‘5" (4? o e, Fax: ( 5:3 ) 66s _ ,..... 0 P P
ELECTRICAL PERMIT FEES*
CCB Lie.: / .... Electrical Lie.: 2.4)- / / /- 7C Lic.: age Leo Subtotal
7J
Suprv. Electrician signature, required: _eA Plan review (25% of permit fee)
Print name: ,J Date: 1 State surcharge (8% of permit fee) G STS - VF .� !J i✓G/t! tJs I I v 1 O(o TOTAL PERMIT FEE 1 0 %
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: 57�va rid !� Q C le_l'v f Date: l��//66 * Fee methodology set by Tii-County Building Industry Service Board
/ '• Number of inspections per permit allowed.
i:\ Building \Pennits\ELC- PennitApp.doc 12/03 440- 46I5T(10 /02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2- Supplemental Information
LIMITED ENERGY PERMIT FEES:
1 RESIDE'NTIAL`WORK ONLY: - - -- a -- — 7'77
Fee for all residential systems combined $75.00
•
Check Type of Work Involved:
El Audio and Stereo Systems*
❑ Burglar Alarm
El Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
El Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY: 7
Fee for each commercial system $75.00
• (SEE OAR 918- 260 -260)
Check Type of Work Involved:
El Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
En Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
•
Total number of commercial systems: f
*No licenses are required. Licenses are required
for all other installations
•
i:\ BuildingPennits \ELC- PennitApp.doc 04/03
CITY OF TIGARD �.
1
1
BUILDING DIVISION PERMIT #: ELI" 200&0019
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 811812006
Phone: (503) 639 -4171 . N/u1 t -
Inspection Requests (24 Hrs.): (503) 639 -4175 _ -3.11■
. INSPECTION WORKSHEET FOR DATE: 0/24/2006 TIME: 6:59AM PAGE: 43
SITE ADDRESS: 06950 SW HAMPTON ST 210 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: INSUR. CO OF THE WEST
DESCRIPTION: Voice and data cabling.
OWNER: WEST ON INVESTMENT CO, PHONE #:
CONTRACTOR: PROGRESSIVE TELEPHONE SYSTEMS PHONE #: 503 - 665 -4900
Inspection Request Scheduled For: Date: 0/24 /2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
„) ..M, ,,, 035477 -01 503- 665 -4900 N
IC q �r � l�
.f /Comments /Instructi• s:
9
PASS n PARTIAL APPROVAL ❑ CANCEL NO ACCESS
❑ FAIL n CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: ®V bfil Date: $' $ Phone #: (503) 718 -2-