Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a ' DEVELOPMENT SERVICES PERMIT #: ELR2005 -00405
` ��' II 13125 SW H all Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11/22/2005
PARCEL: 2S112AB -02300
SITE ADDRESS: 14150 SW MILTON CT ZONING: I -L
SUBDIVISION: BONITA INDUSTRIAL PARK LOT: 005 JURISDICTION: TIG
Project Description: Fire 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: X OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
SHEININ- MENDENI - TALL LLC I FIRST RESPONSE SYSTEMS GROUP
BY PARROTT PARTNERHIP 4970 SW GRIFFITH DR
12725 SW 66TH AVE #202 BEAVERTON, OR 97005
PORTLAND, OR 97223
Phone: Phone: 503 207 - 5300
Reg #: LIC 111713
ELE 26 -956CL
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 11/22/200`. $75.00
[TAX] 8% State Surcharl 11/22/200: $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 • • •ays of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to ollow rules a• • •te• - he Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010
throw, h OAR .52- 001 -1 10. • Tnay obtain opies of these rules or direct questions to 03- 246 -6699.
Issue • By: j , , �j ;• _ 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 Applic5'e i% D FOR O' FFI C I USE ON LY
" ZO i Date/By: / / �� L � Q �o�,VV� Iy 65 Received ' Cif t Tigar f " Permit No.:
13125 SW Hall Blvd., 1 igard, OR 97223 %.1 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 ,,,, 'l`illil�y;! ('( A Date/By: Other Permit:
Inspection Line: 503.639.4175 Gror O(- - (1 ",'+F- P Date Ready /By: Juris L fa See Page 2 for
Internet:.www.ci.tigard.or.us p Notified/Method: 'j ).. Supplemental Information
9,1111_01N G
TYPE OF WORK PLAN REVIEW
❑ New construction ' .ddition/alteration/replacement Please check all that apply:
❑ Demolition ❑ Other: ❑ Service over 225 amps, comm'l Hazardous location
['Service over 320 amps — rating DBuildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
❑ I- and 2- family dwelling 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
❑Health -care facility ❑Other:
Job no.: Z27(, t/ Job site address: /4//50 s(,I/ NAM- G'f. ; Submit 2 sets of plans with any of the above.
City/State /ZIP: r Q O r � 0A. 9 7 2 2 The above are not applicable to temporary construction service.
y *.
Suite /bldg. /apt. no.: Project name: N/4/ c f 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
1 Ea. add'l 500 sq. ft. or portion 33.40 1
Subdivision: I Lot no.: q� o
p
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
A ' / 1 dwelling, service and/or feeder 90.90 2
A��GLI GtO(d/T -r; re- ,� p �O��
-.I Services or feeders installation, alteration, and/or relocation
�J J 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 I
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
❑ APP' JCANT 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,
each branch circuit 46.85 2
Address: 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
: extension. Describe: / Page 2 7 2
Business name: �" . /S4j kroW —C2
Address: '�9 7c. S C7 /- / T1" . ` L /fir. Each additional inspection over allowable in any of the above
li I !J Per inspection 62.50
City /State /ZIP: 6y/,K og. ct 700 5 Investigation per hour (I hr min) 62.50
Phone: (�0) 207 5300 Fax: (,rpy) 20 7 -530/ Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: J //7/ 3 Electrical Lic.: 24 956 Suprv. Lic.: 3/?/ L E4 Subtotal
Suprv. Electrician signature, required: // / / Plan review (25% of permit fee)
Print name: „.#,A,_ // A/ v e/J Date: / /ms State surcharge (8% of permit fee) 6
/" TOTAL PERMIT FEE g
Authorized signature: This permit application expires if a permit is not obtained within 1811
9�� "�� '..14110". days after it has been accepted as complete
Print name: � e e� � rs� , s Date: /� j • Fee methodology set by Tri- County Building Industry Service Board
�/ •• Number of inspections per permit allowed.
i.\ Building \Permits\ELC - PermitApp.doc 12/03 440- 4615T(I0 /02ICOM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005-00405
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/22/2005
Phone: (503) 639 -4171 14 Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 12/8/2005 TIME: 7:00AM PAGE: 40
SITE ADDRESS: 14158 `'W MILTON CT CLASS OF WORK:
SUBDIVISION: BONITA NDUSTRIAL PARK LOT #: 005 TYPE OF USE:
PROJECT NAME: NW MEDI ■ • L TEAMS
DESCRIPTION: Fire alarm.
OWNER: SHEININ- MEND. NHALL LLC I, PHONE #:
CONTRACTOR: FIRST RESPONS. SYSTEMS GROUP PHONE #: 503-207-5300
Inspection Request Scheduled For: Date: 12/8/2005 Pour Time:
(edde # Insp -:.'in Description Confirm # Contact # Message
35 Low voltag = 023125.01 503-969-3792 N
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Co -ctions /Comments /Instru« ions:
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'' PAS. ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
• FAIL IN CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: i/ L/ D ate: Phone #: (503) 6
P ( ) 718 - 1