Permit C ITY OF TI GARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES
- PERMIT #: ELR2006 -00185
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/3/2006
PARCEL: 2S 102AC - 01101
SITE ADDRESS: 12562 SW MAIN ST ZONING: CBD
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Low voltage for security alarm.
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:
HAMMOND, DAVID E + CHRISTINE N AMERICAN VETERANS
3015 SW 116TH 8301 SW 135
BEAVERTON, OR 97005 BEAVERTON, OR 97008
Phone: Contact #: PRI 503 319 - 4754
FAX 503 808 - 9018
Reg #: ELE 34 - 501 CLE
FEES LIC 135086
Description Date Amount
[ELPRMT] ELR Permit 8/3/2006 $75.00
[TAX] 8% State Surcha 8/3/2006 $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 copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: L_ ` gL-f Permittee Signature: � .
OWNER INSTALLATION ONL
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. •
k_.• Electrical Permit ApplicatiRECEIVED FOR ofFici- LiSE ONLY
City of Tigard 6 3 2006
Received 3 r
Date./13 3 ° Permit No. � - & -00 •
.7 ° 13125 SW Hall Blvd., Tigard, OR 97 Plan Revie
• Phone: 503.639.4171 Fax: 503.59 Date/B . Other Permit:
Pr( OF TIGARD
T 1 G n It ID Inspection Line: 503 BUILDING DIVISION Date Ready/By. 1 / ® See Page 2 for
Internet: www.tigard or.gov Notified/Method Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction 4ddition/ 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.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 - and 2- family dwelling rCommercial/industrial ❑ 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", "I -2 ", "1 -3 ",
Job no.: Job site address: / 2 5 Z S` to mA /.v or more. occupancy.
Six or
❑ Six or more residential units. ❑ Recreational vehide parks.
City/State/ZIP: 77 6 olvisD ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: t2 C / etr .r' 5 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
J
Cross street/directions to job site: Description I Qty. I Fee. I Told I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or "less 145.15 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 • 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 ' 2
S £ e-v4 , t, A 40.2/Jr 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
Name: 401 amps to 600 amps 160.60 2
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: ( ) I 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 599 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: . B. Fee for branch circuits
without service or feeder fee, 46.85 2
Contact name: first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
. _ dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting , 53.40 2
Signal circuit(s) or limited -
Business name: £// 0.4,N // e7r 5 energy panel, alteration, or
Address: $' 30 / SW / 3 �'n'r ifi • ( extension. Describe: ( Page 2 2
City/State/ZIP: 0£ ' /i `2 � 2u , ark( 97 00 S. Each additional inspection over allowable in any of the above
/ Per inspection 62.50
Phone: (53) 3 I I ,. % 7 $'' _I "_5 s p• Of O Investigation per hour (1 hr min) 62.50
CCB Lic.: / 3 car6, I Electri ic.: 3V-sad CL Su . Lic.: zZ ?7L C/'{— Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: �yf /C�-�l y 1 / 1 v $ Subtotal: I
Print name: .. 7 0 A A i Ae4C / Date: 11, 3 _,6, Plan review (25% of permit fee):
State surcharge (8% of permit fee):
Authorized signature: 1 t��sL 5, TOTAL PERMIT FEE: O (, GY9 �
Ay AI / / + / 7 I qr This per application expires if a permit is not obtained within 180
d
Print name: C L Date: G days after it has been accepted as complete.
• Number of inspections allowed per permit
t:\ Building \Parnits\ELC- PamitApp.doc 0523/06 410.4615T(11 /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*
El Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
El Vacuum Systems*
❑ Other.
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system .
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
El Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
El HVAC
El Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
pX "Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Pamit,\ELC- PamitApp.doc 03/23/06
T
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2006 -00186
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 8/3/2006
Phone: (503) 639 -4171 VI
Inspection Requests (24 Hrs.): (503) 639 -4175 _.. :VII?'
INSPECTION WORKSHEET FOR DATE: 4/24/2007 TIME: 7:01AM PAGE: 45
SITE ADDRESS: 12562 SW MAIN ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: MAX'S FANNO CREEK BREW PUB
DESCRIPTION: Low voltage for security alarm.
OWNER: HAMMOND, DAVID E + CHRISTINE N, PHONE #:
CONTRACTOR: AMERICAN VETERANS PHONE #: 503-319-4754
6141 o-1
Inspection Request Scheduled For: Date: Q7 Pour Time:
Code # Inspection Description Confirm`# - _ Contact # Message
135 . a.e 047012 -01 ■ ' - '5Q3- 330 -4090 N
00 - 814036 • - - - • tions: - - - -- - -
R•€ - c -L- FNt 11 S ION ,
` 1
. • V • - 11 ..
4
•
-1 0
G-. NOa
i?•55 - 'AM
st*'\' ❑ PARTIAL APPROVAL X CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: I R to L-E Date: 41 Q'! Phone #: (503) 718- 7-44