Permit A
MP CITY TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00099
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/17/2007
PARCEL: 2S102AB -02200
SITE ADDRESS: 12525 SW MAIN ST ZONING: CBD
SUBDIVISION: ELECTRIC ADD. TO TIGARDVILLE LOT: 015 JURISDICTION: TIG
PROJECT: STONE GALLERY
Project Description: Data /tele
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:
JIM TOMA NORMANDIN ELECTRIC INC
26431 S BARLOW RD 51086 NW CLAPSHAW HILL RD
CANBY, OR 97013 FOREST GROVE, OR 97116
Phone: Contact #: PRI 357 -5380
FEES Reg #: ELE 34 -256C
LIC 69008
Description Date Amount SUP 3558S
[ELPRMT] ELR Permit 4/17/2007 $75.00
[TAX] 8% State Surcha 4/17/2007 $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 copies•of hese
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: LA , l( 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.
•
I • Electrical PermitApplica i . - " VEt FOR OFFICE USE ONLY
City Of Tigard p( ^ 2007 Dateiy
DaeBy: Permit No - 1 / , 09'2000 R 9
q 1'3125 SW Hall Blvd., Tigard, OR 9 3 Plan Review
• ' C Phone: 503.639.4171 Fax: 503. 6 D ate/By: Other Permit:
T 1 G n R D Inspection Line: 503.639.417K/11 I Ur 1111 11 Date Ready/By: Juris: ® See Page 2 for •
Internet:. www.tigard -0r. gol.� If' T . min nu r N Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
New construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: . where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
lrL,�, less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
' ❑ 1 - and 2- family dwelling CommerciaVindustrial ❑ Accessory building amps for all other installations. buildings.
• ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
_ / ./-7'7,-, , I OOHP or more. occupancy.
Job no.: Job site address: 5,-C C �/ r
/ 2 7 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /7_1P: t ❑ Health -care facilities: ❑ Supply voltage for more than
/ �`� f . , /� ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service orfeeder 600 amps or more.
G � //'�� FEE SCHEDULE
Cross street/directions to job site: ,(/ // l3/� / Description I Qty I Fee. I Total I •
'/ New residential single- or multi- family dwelling unit.
•
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential , 75.00 2'
DESCRIPTION OF WORK (with above sq. ft.)
// / Limited energy, multi - family 75.00 2
lilt ` t j�L , residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
•
. 200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 . 2
�- 401 amps to 600 amps 160.60 . 2
Name: L t /yam ! . -7.-,� 601 amps to 1,000 amps 240.60 2 •
Address: ' Over 1,000 amps or volts 454.65 ,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 ow which is not 201 amps to 400 amps 100.30 2
n•
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps•to 599 amps 133.75 2
Branch circuits _ new, alteration, or extension, per panel
Owner signature: Date: . A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON • above service or feeder fee, 6.65 2
�� each branch circuit
Business name:
5lss�, ,, • `7 ' e" 5 B. Fee for branch circuits
without service or feeder fee,
Contact name:
�!w/'G� A first branch circuit 46.85 2
Address: // , / / Each add'l branch circuit 6.65 2 .
a -� �� v �' / �''' Miscellaneous (service or feeder not included)
City/State /ZIP: 5 /e _ ������, . e=i1 h ley ' Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (;, './ _ -, -, ' Fax: : ( ) Reconnect only 66.85 2
E -mail: i„,...----€...„...„, i„,...----€...„...„, 1 , r 211,—/-- yJ�,.t,„.a - A"mp or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Signal circuit(s) or limited -
���i ->1 :• energy panel, alteration, or •
Address: extension. Describe: Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Per inspection . 62.50
Phone: ( ) I Fax: ( )
Investigation per hour (I hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, re 1 -- ---........... 1,------G--2.---- ` ���,..--1 Subtotal:
Print name: Ti ■ / Date: Plan review (25% of permit fee):
p �'� �� �� /� State surcharge (8% of permit fee):
Authorized signature: � „,r ,: er2---- C TOTAL PERMIT FEE:
( This permit application expires if a permit is not obtained within 180
Print name: 3 /� ��� Date: days after it has been accepted as complete.
/ • Number of inspections allowed per permit.
1:t Building \Permits\ELC - PermitApp.doc 05/23/06 440-4615T(II/05 /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* a
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other: P •
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 -260 -260)
Check Type of Work Involved:
Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
Data Telecommunication Installation
❑ Fire Alarm Installation
El 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:t Building \Permits\E.LC- PermitApp.doe 03/23/06 •
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007- 00099
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/17/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 I �..
INSPECTION WORKSHEET FOR DATE: 7/31/2007 TIME: 7:07AM PAGE: 76
SITE ADDRESS: 12525 SW MAIN ST CLASS OF WORK:
SUBDIVISION: ELECTRIC ADD. TO TIGARDVILLE LOT #: 015 TYPE OF USE:
PROJECT NAME: STONE GALLERY
DESCRIPTION: Data/tele
OWNER: TOMA, JIM PHONE #:
CONTRACTOR: NORMANDIN ELECTRIC INC PHONE #: 357 -5380
Inspection Request Scheduled For: Date: 7/31/2007 Pour Time:
Code # Inspection Description o • # Contact # Message
199 Electrical final 053030.01 503- 313 -2599 N
Corrections/Comments/Instructions:
XPASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C.7 • Is) t Date: "\(111 O Phone #: (503) 718- tf •
r
CITY OF TIGARD _ ,
BUILDING DIVISION PERMIT #: ELM011.601q
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1
Phone: (503) 639 -4171 Alt f
Inspection Requests (24 Hrs.): (503) 639 -4175 .&.. L .
INSPECTION WORKSHEET FOR DATE: LI 1 % f TIME: PAGE:
SITE ADDRESS: 12,52 s \A) MAID t 1. CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: 1,,b v.) V 6 t
1 PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description -Confirm #� Contact # Message
t 33' uov) VoLtc . 044;133.01
Corrections /Comments / Instructions:
eij Lkctr g nn - 2" 6 20 iN R'>k.■1 RIO
wry wiJ Lew Ni6 6 ILO
Nm PlstAft -ebisk•k)
cl c 11 3
%El Wgsmi120 tia-
!,-ottsi voaKv ABLE
Q30144t.i4 ..
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
F AIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ! Vt•L Date: L A Or7 Phone #: (503) 718 -'- 44