Permit A CITY OF TI CARD ELECTRICAL RESTRICTED ENERGY PERMIT
�6 DEVELOPMENT SERVICES PERMIT #: ELR2005 -00127
, .� �� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 5/20/2005
PARCEL: 2S 102AA -04100
SITE ADDRESS: 12230 SW MAIN ST ZONING: CBD
SUBDIVISION: MORINS ADDITION LOT: JURISDICTION: TIG
Project Description: Installation of limited energy for voice and data.
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:
INTEGRITY INVESTMENTS INC TELECOMM MANAGEMENT INC
2229 NE BURNSIDE SUITE 86 15611 PARTRIDGE DR
GRESHAM, OR 97030 LAKE OSWEGO, OR 97035 -3121
Phone: Phone: 503- 639 -8209
Reg #: ELE 3- 463CLE
LIC 135355
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 5/20/2005 $75.00
[TAX] 8% State Surchart 5/20/2005 $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 w' • • :1 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you ollow rules a• • pted by t - Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
thr %ugh OA 952 -001.0 • 0. • may ob = in copies of these rules or direct que ns UNC - 503- 246 -6699.
Is ued By: �∎ _ �� �� / . Permittee Signature:)(
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
Received ` (��' J V - 7iCJ /P 7
City of Tigard Re e ive J Q j P emvt No.: f
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 62711t,I W I '� Date/By: Other Permit:
Inspection Line: 503.639.4175 n'' I1 Date Ready/By: J See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: / /(7 H Supplemental Information
TYPE OF WORK PLAN REVIEW
�ew construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑ Other: ❑Service over 225 amps, comm'l ❑Hazardous location
['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATERY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling Ei 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
['Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: Job site address: I Lai 0 56.../ y4� N ❑He 2 -care of plans ❑above.
Submit 2 sets of plans with any of the above.
City/State /ZIP: / / G f1t20 DK q 7 Z Z 3 The above are not applicable to temporary construction service.
/
Suite/bldg. /apt. no.: Project name: CRow./ 0,44-0--F5 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'! 500 sq. ft. or portion 33.40 1
Limited energy, ram- 75.00 2
Tax map /parcel no.: �
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK • Each manufactured or modular
_ l7 dwelling, service and/or feeder 90.90 2
U 0 (G R�nR 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 /ZlP: 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 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'! 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- p
CONTRACTOR energy panel, alteration, or
r extension.. De rib • Page 2 2
Business name: T,,eCtol ..,l 04 o t y me 1 '—wG
Address: St'' � I a ,�,, `�Se Each additional inspection over allowable in any of the above
1 'fit 1/4/-c_.
Per inspection 62.50
City/State /ZIP: LcLif-Q- Q,SW eau J OIL 91-0 Investigation per hour (1 hr min) 62.50
Phone: ( SU3) 6 3 q — g 2,50( Fax: ( ) -- (4�3CL� 1 ioy hour Industrial plant per ho 73.75
3 1 I ELECTRICAL PERMIT FEES*
CCB Lic.: I"35-3SS Electrical Lic.: C Suprv. Lic.: Subtotal
Suprv. Electrician signature, required: — — Plan review (25% of permit fee)
-
Print name: Date: State surcharge (8% of permit fee) t p
Au 1 p El i 5 — 9 -0 S TOTAL PERMIT FEE V , dv
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:\ Building \Perrnits\ELC -PermitApp.doc 12/03 440- 4615T(10 /02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
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
_� r
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005-00127
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 5/20/2005
Phone: (503) 639 -4171 / 0# / t/i a :'
Inspection Requests (24 Hrs.): (503) 639 -4175 .�' '— `_
INSPECTION WORKSHEET FOR DATE: 6/6/2005 TIME: 7:13AM PAGE: 46
SITE ADDRESS: 12230 SW MAIN ST CLASS OF WORK:
SUBDIVISION: MORINS ADDITION LOT #: TYPE OF USE:
PROJECT NAME: CROWN CARPET
DESCRIPTION: Installation of limited energy for voice and data.
OWNER: INTEGRITY INVESTMENTS INC, PHONE #:
CONTRACTOR: TELECOMM MANAGEMENT INC PHONE #: 503 - 639 -8209
Inspection Request Scheduled For: Date: 6/6/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 008525 -01 503 -481 -3767 Y
Corrections /Comments /Instructions:
ts
(.../
I
•
13kPASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 6 y Phone #: (503) 718 -
u
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005 -00127
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/20/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 -_ `__.
INSPECTION WORKSHEET FOR DATE: 5/23/2005 TIME: 7 :08AM PAGE: 47
SITE ADDRESS: 12230 SW MAIN ST CLASS OF WORK:
SUBDIVISION: MORINS ADDITION LOT #: TYPE OF USE:
PROJECT NAME: CROWN CARPET
DESCRIPTION: Installation of limited energy for voice and data.
OWNER: INTEGRITY INVESTMENTS INC, PHONE #:
CONTRACTOR: TELECOMM MANAGEMENT INC PHONE #: 503 - 639-8209
Inspection Request Scheduled For: Date: 6/23/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 007489-01 503-481-3767 N
Corrections /Comments /Instructions:
1_ ,
T N 6 EE c Avc (D R, --11^/A To Jeii6 ,
R■ A.`C.(AikAd k 5f 3 , (a Iv _ ) ),3
11 V "
nr /i
1
7 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
111 FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
iii Inspector: � � Dates '— °z ----. Phone #: (503) 718 -
;s