Permit •
CITY OF TIGARD'
s ELECTRICAL RESTRICTED ENERGY PERMIT
PERMIT #: ELR2006 -00005
���� DEVELOPMENT SERVICES DATE ISSUED: 1/5/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S112BA -05900
SITE ADDRESS: 14058 SW MILTON CT ZONING: I -L
SUBDIVISION: BONITA INDUSTRIAL PARK LOT: 007 JURISDICTION: TIG
Project Description: Voice and data cabling.
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:
GOODHEAD, DAVID + JAN M UNITED COMMUNICATIONS
14058 SW M ILTON COURT 497 SW CENTURY DR
TIGARD, OR 97224 BEND, OR 97702
Phone: 503 -598 -8700 Contact #: PRI 800 - 800 -2007
FAX 503- 643 -4805
FEES Reg #: LIC 9- 271CLE
ELE 132948
Description Date Amount
[ELPRMT] ELR Permit 1/5/2006 $75.00
•
[TAX] 8% State Surchart 1/5/2006 $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 95 '•01 -0 00. You ma btain copies of these rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: A /! Permittee Signature: X 44 AL,
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.
El Permit AED FOR OI FICl USE O •
City of Tigard 1-i W E ® " Received
Date/B . n ' Permit No.:...- A // -- o 60 Date/B . o
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.5981 9
J� • L �t:,,6., 5 1006 .. , .
Other Permit:
� I "• DazeJB
d �
Inspection Line: 503.639.4175 �_ _,; '_ _I Date ReadyBy.. I� %L-_ ® See Page 2 for .
Internet: www.ci.tigard.or.us CITY OF TIGA Notified/Method Supplemental Information
BUILI �'ORK'
P N PLAN REVIEW
❑ New construction apAddition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'I ❑Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
❑ I- and 2- family dwelling RCommercial industrial ❑ Accessory building OSystem 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 RV
❑Egress/lighti park
Job no.: Job site address: jr 11660 5(,J M IOW C•01.4-1- ❑Health -care facility ❑tea
Submit 2 sets of plans with any of the above.
City/State/ZIP: `"T gi--Qp 0 e- The above are not applicable to temporary construction service. .
^ FEE* SCHEDULE
Suite /bldg. /apt. no.: Project name: (A ES'Tcp l t C,
Description I Qty. I Fee' I Taal 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: I Lot no.: Ea. add'I 500 sq. It or portion , 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
/ / dwelling, service and/or feeder 90.90 2
1 (5 ve(c, er..
eco( /6 C�( 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: 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 1 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: first branch circuit
Each add'l 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 -
CONTRACTOR energy panel, alteration, or
Business name 0011-6-1p, �
' 1 extension. Describe: Page 2 75. 2
0 P414 01,3 ff 1 CATI OAS ci 14c�.. V 1171 C-0 M
t Address: ej 16 6 .5 W A Ec - r( c, I Dwv E Each additional inspection over allowable in any of the above
M Per inspection 62.50
City/State/ZIP: 6 -A.vC( -per g_ 17 Investigation per hour (Ilirmin) 62.50
Phone: ( 'O3) Co `f3 _ Y 785 / Fax: ($6 7 ( - Z(gp5 Industrial plant per hour 73.75
l� ELECTRICAL PERMIT FEES*
CCB Lic.: t Z zigg Elect L/ic. q :32.3 Suprv. L 32 Sub total S Li ,
qua I ( e, s
Suprv. Electrician signature, required: , ' , 0.) . -f Plan review (25% of permit fee)
Print name: ,JI •
A State surcharge (8% of permit fee)
M Tr•/E W -S • -I EP- Da 01 5/04, TOTAL PERMIT FEE
Authorized
7/61(k This permit application expires if a permit is not obtained within 180
(CQ f days after it has been accepted as complete
Print name: /11 . 1'riE , ,..5. , 44Al Ef 15Q Date: 00 5 / 0 c • Fee methodology set by Tri -County Building Industry Service Board
• • Number of inspections per permit allowed
is BuiIding \Permits\ELC- PermitApp.doc 11!03 440- 4615T(I0/02/COM/W[B
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
El 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
El Boiler Controls
El Clock Systems
SID
Data Telecommunication Installation
El Fire Alarm Installation
El HVAC
El -Instrumentation '
❑ Intercom and Paging Systems
• El Landscape irrigation Control*
❑ - Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
0 Protective Signaling
El Other
Total number of commercial systems: I • ' _
*No licenses are required. Licenses are required -
for all other installations
i:\BuildingWmntt \ELC- Penn itApp.doc 04/03
CITY OF TIGARD ez_/{
BUILDING DIVISION • 3 PERMIT #: ,4.64,._ 6 D 0 D S
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 IL.
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
p� 4
SITE ADDRESS: / %05 O CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3- 3- 4 Pour Time:
Co. _ - Inspection Descripti. •nfirm # Contact # Message
199 & C - • Si o -36Z
—e - ions /Comments /Instructions:
o N i PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: CT 9 I Vo8 (.,e Date: 3 '3 06 Phone #: (503) 718- 2 4% •
CITY OF TIGARD
BUILDING DIVISION . _ ' %_ a PERMIT #: +82001 :0.00 ^
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 A ,, � 1 i
Inspection Requests (24 Hrs.): (503) 639 -4175 A.g. - '__..
INSPECTION WORKSHEET FOR DATE: ,1 ,n I o,6 TIME: PAGE:
SITE ADDRESS: 14 OS % w MI tTON C1 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: . PHONE #:
V N
CONTRACTOR: 1 1 o„�
�.� G 0 r fy\. PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
L6 vo Y 0 Nc bL PrdoW
ok A P 6
Corrections /Comments stru ions:
410 l'kerts( •. - caiaiste 11 Le P v i Q
Acs _ 6 *. a cks.
PASS ❑ PA: AL APPROVAL ❑ CANCEL ❑ NO ACCESS
1 1 ' ALL FOR , ; e ECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 0 V 6 LE
Date: 1 I _] 04 Phone #: (503) 718- Alik