Permit C ITY OF TI GARD ELECTRICAL RESTRICTED ENERGY PERMIT
4 ll DEVELOPMENT SERVICES PERMIT #: ELR2005 -00168
A 13125 S Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/24/2005
PARCEL: 2S10100-01202
SITE ADDRESS: 07930 SW HUNZIKER RD ZONING: I -L
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Data and phone wiring. (this job not part of the TI)
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:
COE MANUFACTURING COMPANY KJB INC
P.O BOX 520 14 PEAKNESS CT
PAINESVILLE, OH 44077 LAKE OSWEGO, OR 97035
Phone: Phone: 503 - 788 - 1444
Reg #: LIC 113596
ELE 3- 538CLE
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FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 6/24/2005 $75.00
[TAX] 8% State Surchar€ 6/24/2005 $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. A ' ENTION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules ..r: o forth in OA - 952 - 001 -0010
through OAR 9 - 001 -0100. You ma obtain copies of these rules or direct qu- o , o OUNC 7 503 - 246 -6699.
Issued By: � Permittee Signature /4 %r
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 Pel rnt>tt�pp on� FOR OFFICE USE ONLY -
City of Tigard Receiver • � , z t7 i P ermit No.:
1- y/
r R n 2005 Date/B, ' �✓ ..� .,
13125 SW Hall Blvd., Tigard, O ® Plan Revi • w 0���
Phone: 503 - 639.4171 Fax: 503.598. / ��"m /�rj� y '. j " " "\ Daze /By Other Permit:
Inspection Line: 503.639.40ffY Ot- T `GARD _ t Date Ready/By: VI See Paget for
Internet: www.Ci.ti DIVISION ISION Notified/Method: 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 ❑Hazardous location
❑Service over 320 amps - rating ❑ Buildn over 10,000 sq. ft.,
CATEGORY „OF CONSTRUCTION of 1 -and 2- family dwellings 4 or more new residential
. ❑ 1- and 2- family dwelling 01. 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
0 Occupant load over 99 persons ❑Manufactured structures or
;JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: Job site address: 79 .k 3 W 1-10 N 2.t ❑Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City /State /ZIP: , , e- � f 0 (2 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: (Q C. M NF I G FEE *.SCHEDULE' : .
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'l 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
��� ��� W (� G dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
' • 0 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: K - 3 Q I'LL D Q � _ ~-r-vi,E i-arJ 4 M A to Ni c_- branch circuit
• "� B. Fee for branch circuits
Contact name: ip S 1.c.-- rt M I r•- q-- without service or feeder fee, 46.85 2
Address: ` ?� A_ k t' STS C.-T
each branch circuit
_�((� Each add'I branch circuit 6.65 2
City/State/ZIP: �-A-K r O SW r &o LJ 2 q 70 5 Miscellaneous (service or feeder not included)
Phone: GO 3) .o Fax: (5�3) q
Pump or irrigation circle 53.40 2
cl I �-� 6 . ( 1 9 / y Z Sign or outline lighting 53.40 2
E -mail: pe p pe Y C C O '1'1.\ C, a„ S e: . h E' Signal circuit(s) or limited-
1 - CONTRACTOR. energy panel, alteration, or
N Business name: extension. Describe: Page 2 2
Address: / L( T ZE A V<K) 2 ES CT Each additional inspection over allowable in any of the above
Per inspection 62.50
tl. City/State /ZIP: Likkc` OS w L G-0 / 0 9.7 ° 7 T' 3 Investigation per hour (1 hr min) 62.50
Phone: J ) 78 2 ti LC-.4 I Fax: ( ` 3 " ) 6 9 C l �/ c' t/, Industrial plant per hour 73.75
`��� I C" T Z , ELECTRICAL PERMIT FEES*
t (�� Q8 LE A_ Suprv. 28 LEA S --
L. CCB Lic.: G // E lectrical Lic. Su rv. Lic.:
1 \D � Subtotal
Suprv. Electrician signature, require p g C� , t t Plan review (25% of permit fee)
T- s'V1.' • _. (C�
Print.name: * State surcharge (8% of permit fee) 6
i Jo s "� ?1 A , D ate: (2y/0 5" TOTAL PERMIT FEE /, 00
• Authorized si ature: e�� This permit application expires if a permit is not obtained within 180
J days after it has been accepted as complete
Print name: J OS M E Ni T if Date: 6/ i ({ ` 9 S � * Fee methodology set by Tri- County Building Industry Service Board
((( ( ** Number of inspections per permit allowed.
is\ Building \Permits\ELC- PermitApp.doc 12/03 440- 4615TOO /02/COM /WEB
rr
• Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESOYENTIAL WORK ONLY :. , 1
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 \Peimits\ELC - PermitApp.doc 04/03
CITY OF TIGAR ~�
BUILDING DIVISION PERMIT #: ELR2llifa- 001613
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/24/2005
Phone: (503) 639 -4171 / : //010 9 ,0/ / i"
Inspetion Requests (24 Hrs.): (503) 639 -4175 -9- __
INSPECTION WORKSHEET FOR DATE: 8/9/2005 TIME: 7:05AM PAGE: 86
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SITE ADDRESS: 07930 SW HUNZIKER RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: COE MANUFACTURING
DESCRIPTION: Data and phone wiring. (this job not part of the TO
OWNER: COE MANUFACTURING COMPANY, PHONE #:
CONTRACTOR: KZ INC PHONE #: 503.788 -1444
Inspection Request Scheduled For: Date: 819/2005 Pour Time:
Code # Inspection Description Confirm # Contact # • Message
199 Electrical final 013117 -01 503 -788- -1444 N
Corrections /Comments/ Instructions:
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PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: DatetP ac Phone #: (503) 718-