Permit A -4 .
CITY t I GA R D ELECTRICAL RESTRICTED ENERGY PERMIT
Am, �� DEVELOPMENT SERVICES PERMIT #: ELR2005 -00202
— �J II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/25/2005
PARCEL: 1 S134AA -02100
SITE ADDRESS: 10300 SW NIMBUS AVE P ZONING: I -P
SUBDIVISION: SCHOLLS BUSINESS CENTER LOT: JURISDICTION: TIG
Project Description: Install limited energy for data telecommunications system. Job No. 60- 060553310
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:
ROBINSON, CONSTANCE A + BROADWAY ELECTRIC - COCHRAN INC
ROBINSON, LYNN + BELL, KAY ET 626 SE MAIN
BY INSIGNIA COMMERCIAL GROUP PORTLAND, OR 97214
BEAVERTON, OR 97008
Phone: Phone: 503 234 - 6564
Reg #: LIC 72942
SUP 3447S
FEES ELE 37 -546C
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 7/25/2005 $75.00
[TAX] 8% State Surchar€ 7/25/2005 $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 within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
yo ollow ru e - dopted by t e Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010
t r ough OA R 952 -00 -, 00 ou may obtain copies of these ru or direct uestions to OUNC at 503 -2' •i . •'
sued By: _id iti, ; : Permittee Signature: �, 4?d !
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.
Electe ' Permit Application FOR OFFICE USE ONLY .
City of Tigard n wla li!�'1L/j �� .� i� 5 j
r, Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 4/ ' e i�.i - ;` \ Date/By: Other Pe
Inspection Line: 503.639.4175 ■ ' Date Ready/By: Juris: la See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: �. Supplemental information
';', i�,'.'`;,HG7 r+T ^'�'�., . ^ •.. ;,;D•. .∎ . .2 W -tip,: - - . ?._ 'z : } _ n - • I
;r.� q ,r -_ _ k y , '5 �7'' � . i .�., `' ..� : • � :::7•_3.1• ';i. c; _'' • , _. a . , i , ,_
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►i New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: OService over 225 amps, corm OHazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
-1 , 4%, <` s y .,; ft \ r c. �y .. - cil - . d . ' 4 •''. f - `? of I- and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling 1i ommercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi - family ❑ Master builder 0 ❑Building over three stories ❑Feeders, 400 amps or more
__ ❑Occupant load over 99 persons Manufactured structures or
7 4.4 kt� -' - 1 t r 5 1 I 4� l : ! s '.. :i ; ; ;. ��I�i �ti 71 RV ark
',,.� , ; •_ s.. . _ .:.-4+- L rJ_ J L ti ,1 y!VT. M1 tr :: '�.,.: RV plan P
~ --�� •_ - � ._... �' .. � � :..4 ❑Other:
O - O - O 5 ❑Health -care facility
Job no.: s 3 ° 3 -
3 t o Job site address: p 3 pp S f J N t .+ L„ /3l 4,7 p Submit 2 sets of plans with any of the above.
City /State/ZIP: ([ es Zzr r� v 12 The above are not applicable to temporary construction service.
Suit Idg./apt.no.: C_ Project name: Mel i312 0 rS�u , sorS �~
Description I Qty. I Fee. I Total
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'l 500 sq. ft. or portion 33.40 I 1
i Limited energy, residential 75.00 { 2
Tax map /parcel no
,ms's Limited energy, non - residential I 75.00 2
,.. �r _^r c r 3' •- 6 -DTeitJ c1 g ti off • :: [c :, r-t ` :
- „ ? r t,r�L : ,S -� x: 2 _' 1 • _- ; ,••. _ �y/-' r - Each manufactured or modular I I
^'� r dwelling, service and/or feeder 90.90 2
V 7,1 / 7t_ \ e C o s- Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
• 1i
. � �' 4 ( ', a"i i T x +-: ,a 2 Y." I ti ` ..,',- : :, 201 amps to 400 amps 106.85 2
Name: C.:- nn
` '' ` - ` 401 amps to 600 amps 160.60 2
/U -el t z A V i S 0.i-' 601 amps to 1,000 amps 240.60 I 2
Address: Q O 1,000 amp or vo l t s 454.65 2
�( 7S S I.J � r u e �z � -�-J�
Reconnect only 66.85 I I 2
City/State /ZIP: t q ..7,,...a, / relocation
6 2 9'7 z 2 3 I Temporary services or feeders installation, alteration. and /or
Phone: ( ) f Fax: ( )
200 amps or less I 66.85 I 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps L 100.30 I 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 as to 600 amps I 133.75 I 2
Owner signature: Date: Branch circuits - new, alteration. or extension, per panel I
r -, ,! ` `+-� .�' '� y. ri'
'E �f,N7p - 1 - .� tJ�sR_v 1 :� y , y ^ TE"� C 0 ( • �'t ..q.. •. r A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: � ((L� y ��_ ' (. branch circuit
Contact name: / B. Fee for branch circuits
without service or feeder fee, 46.85 2
Ina (� I t each branch circuit
Address:
`D3 �• ` � cu..i' u Each add'l branch circuit 6.65 2
City/ State/ZIP:
Pb t ( 1 72 1(1 1 Miscellaneous (service or feeder not included)
Phone: � 11 1' ( 01_1 Fax: ,� 2 gel g Pump or irrigation circle 53.40 2
(3 5 G�`3 (9 ll' t ("" � &. L�-' Sign or outline lighting 53.40 2
E - mail: _ 0 /0 C(x .1 Val.-) �(•1C- . ((f YY' Signal circuit(s) or limited -
i , .s , m n ti gy` ` . ,,,, cJ• ; c; `- 1- energy panel, alteration, or p o
i`� x .. ^i z ' - ir•tr . . .� —_:r .• .., _` . , ?u ' — „'o2..�.a : --e extension. Describe: I Page 2 � S 2
C c Ci
Business name: I iCQ -
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City/ State/ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
CCB Lic.: - "7 2_9 ti-2... Electrical Lic.: 37• bc Suprv. Lic.: 3` Subtotal 7 5 , 0 U
Suprv. Electrician signature, required: q ` Plan review (25% of permit fee)
Print name: e Date:
� State surcharge (8% of permit fee) 6 c (7 0
� � TOTAL PERMIT FEE O / , c 7 Q
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.
\ Build ing\Peimits\ELC- PcrnutApp doe 12/03 440.46 /02/COMJWEB
CITY OF TIGARD ‘ ,
BUILDING DIVISION PERMIT #: ELR2 OO2O2
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: *j 1 " 1 o �--
Phone: (503) 639 -4171 . rdl� ik t i
Inspection Requests (24 Hrs.): (503) 639 -4175 .�'!M- `:_..
INSPECTION WORKSHEET FOR DATE: 1 12g 10 C TIME: PAGE:
SITE ADDRESS: 10 300 SW 1.1111i80 (P3 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: LA W V60 ' •
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
CF%LiNe (AAA.. OJ 2 7 -01
Corrections /Comments /Instruc 'ons:
r V\' f I s 00
c / /L' _IAA/
I
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ' Date: if 21/01 Phone #: (503) 718 -