Permit • A 7
CITY TI GARD ELECTRICAL RESTRICTED ENERGY PERMIT
i DEVELOPMENT SERVICES PERMIT #: ELR2005-00150 X1 11 DATE ISSUED: 6/9/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S126CA-01000
SITE ADDRESS: 09009 SW HALL BLVD 142 ZONING: C -G
SUBDIVISION: WASHINGTON CIRCLE PLAZA LOT: JURISDICTION: TIG
Project Description: Alarm system.
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: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WASHINGTON SQUARE PLAZA AMERICAN VETERANS
BY THE CAFARO COMPANY 8301 SW 135
P 0 BOX 422 BEAVERTON, OR 97008
FLORHAM PARK, NJ 07932
Phone: Phone: 503 319 - 4754
Reg #: ELE 34 -501 CLE
LIC 135086
FEES SUP 2227JLE
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 6/9/2005 $75.00
[TAX] 8% State Surcharl 6/9/2005 $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. ATTENTION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules Je set forth in OAR 952 - 001 -0010
through OAR 952 - 001 -0100. You may obtain copies of these rules or direct qu= - ions to O t 3- 246 -6699.
Issued By: , ,4 r Permittee Signature:
OWNER INSTALLATION/O Y
The installation is being made on property I own which is not inteded 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.
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!Electrical Permit Apti'�,n .. `FOR'OFFICE� 4 `.. -
t a -
Received }
City of Tigard 1005 Date/By: Permit No.: .G��Qa� pp ,�
13125 SW Hall Blvd., Tigard, OR 97223 fur, ® 9 Pl Review
Phone: 503.639.4171 Fax: 503.598.1960 A'm l ' ?� Date/B : Other Permit:
Inspection Line: 503.639.4175 t% ;• : !
. Date Ready/By: Juris: H See Page 2 for
Internet: www.ci.tigard.or.us TY pp
7 Notified/M Supplemental CY �- 1-11\11S
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❑ New construction I: Addition/alteration /replacement Please check all that apply:
❑ Demolition El Other: ['Service ['Hazardous over 225 amps, com'l Hazardous location
EService over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
�- nom- . ' <: Ct.4 ;EG(TR ° O G 8 R GTTO � 111# x, i Y g
;.���� � , r• � I 0 �' I � L��� ` �,. �r.~ ....�,r?� of 1- and 2-family dwellings 4 or more new residential
,
�:.:;,s;;�„ro,r?aa °? x,::rcc; , :�. • �s�4> ��,:. kx:; i x � ` : " a ''�-�'".i�`���ka�s��'.�v $,`%iv;::�*,.'ii
❑ 1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ['Building over three stories ['Feeders, 400 amps or more
❑ Other: ['Occupant load over 99 persons ['Manufactured structures or
� TO B. IT t . O A3il1 QC , ON '� s.,,,,,&,, ❑Egress/lighting plan RV park
irs.v... `,,,s1"4,,,,04,4 .� ,E.�: �.�..a, °;.c�- k.�'.„e� �s� -»tea _ it '�S` ._,la�'i`
Job no.: Job site address: 9, 00 $ SCE ,, y , c.,A ❑Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City/State /ZIP: '�7 b / 7 22 3 e i The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: r Proj6ct name: pi fix/ C s r� g 0 - ---, FE; * S�;C I D tk E ' �' ` .
Description Qty. 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
Tax map /parcel no.: Limited energy, residential 75.00 2
' ms`s:,: ; irP,w,.;ifi, �e'.x. s.; _: _ zA: .:;s :� Limited energy, non- residential 75.00 2
al.M'I g'•''m`... '41,"" rg ,q v DES II2I:'TI ,O WOT2t " Each manufactured or modular
G 47,2_,/7 � dwelling, service and /or feeder 90.90 2
/ /// Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
.; .. -a : - ,.MM ,-.,� - '..,;4, :ale= ,- : t �. w r>, w-tw; oo 201 amps to 400 amps 106.85 2
,,,, _ ,, , ar 1 ET2 � � " � . "TEI\ T , "
'�, �= ;� 'a- xr a :�. ... ri'" i„.:': du' xr ..,..; . , -
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
3i :riv °.,'° -_ - .as'^ve `..w...: xr- 'R:. '% �,;;; . ''a.±.. «S3i:Z,;:eY+` 'mss -" "^e 3"
-�z �,." � ` " �°�"r >� �� , _ ° ' "' '�'` " ° `:'�' .,, �'- A. Fee for branch circuits with
rub • ` t * - 4, ,P,Y, ,, ° "'r; . .�: k ; -. ' ,QNv O, ERS® ;a
:..,rw a. �"a�` ,x..��.�.it+'�. . > „r::.mTi'��,_,�.....° `�� .3n �3�`. �-. 1' �. k4- .-:��,._Aa^.,n.... �' �z.;- �a.�i • Via,. t,
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits •
. Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address:
Each add'1 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 -
.i�'ta.� :'s'.ct..s�« qy =�.xc; �"4'i+7�5^`'€ "£i�, ., '" sc'd�;;: »^�,. s:x s,
9,111. gtal '`,B t " , a ` ` energy panel, alteration, or
vim. , a u ;: .. ,h, tt, 1s
Business name: 797 Fkei C13� I J
i" 7 I, S
5E C extension. Describe: Page 2
Address: • 01 SA) 13:r7/ „G,/� t- Each additional inspection over allowable in any of the above
Per inspection 62.50 _
City /State /ZIP: 72i G L %F2 2 72 Investigation per hour (1 hr min) 62.50
Phone: ( ):5/' 2 - L( 7S Z/ / Fax: ( . ) Industrial plant per hour 73.75 % W
CCB Lic.:1 Os - 17? - 6 Electrical Lic.: 3��5O /CL 5 Suprv. Lic.: 2 2 7 , f',¢- Subtotal
Suprv. Electrician signature, required: /6 Plan review (25% of permit fee)
f State surcharge (8% of permit fee)
Print name: V ` 4 V _. ate: / - >'__ s
TOTAL PERMIT FEE
Authorized signature: r C �
/6 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: PLi .4t K V Date: to -- J (/7.' S - * Fee methodology set by Tri- County Building Industry' Service Board
** Number of inspections per permit allowed.
is\ Building \Pemuts1ELC- PermitApp.doc 12/03 440- 4615T(10 /02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ A udio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
•
n Vacuum Systems*
n Other:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
n A udio and Stereo Systems
❑ Boiler Controls
n Clock Systems
❑ D ata Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
•
n 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- PetmitApp.doc 04/03
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