Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
�� DEVELOPMENT SERVICES PERMIT #: ELR2005 -00395
..� I I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11/7/2005
PARCEL: 1S136CD-00100
136CD -00100
SITE ADDRESS: 11705 SW PACIFIC HWY K ZONING: C -G
SUBDIVISION: PACIFIC CROSSROADS LOT: JURISDICTION: TIG
Project Description: Data /telecommunication.
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:
PACIFIC CROSSROADS PROPERTIES, I PTSC
BY WYSE INVESTMENT SERVICES CO 710 NE CLEVELAND
200 SW MARKET ST STE 345 GRESHAM, OR 97030
PORTLAND, OR 97201
Phone: Phone: 503 665 - 4900
Reg #: LTC 150175
ELE 26- 1117CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 11/7/2005 $75.00
[TAX] 8% State Surchari 11/7/2005 $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
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 -0100. You may obtain copies of these rules or direct quest. ns to OUNC at 503 - 246 -6699.
Issued By: 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.
y Electrical Permit FOR OFFICE USE ONLY
City of Tigard "'
Received 66 p ermit No /� L2.0O J c�
/f
Date/By: / �
13125 SW Hall Blvd., Tigard, OR 97223 Plan Reviev4 `
Phone: 503.639.4171 Fax: 503 8. 4 m- arratr I h Date/By: Other Permit:
Inspection Line: 503.639.417_'NOi V ( 2005 Ge = I_ Date Ready/By: lu ( 10 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
CITY OkY1111 .. PLAN REVIEW
El I�TT New constructi TT ii > 7 11 TCT 1i lacement Please check all that apply:
❑ Demolition V 1L�❑ Other: ['Service over 225 amps, comm 'l ['Hazardous location
['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling 0 Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi - family 0 Master builder ❑ Other:
['Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑E plan RV park
❑Health - care facility ❑Other:
Job no.: Job site address: /�
1 3 t .) Y Ac ► F lc_ 1.\' ' I Submit 2 sets of plans with any of the above.
City/State /ZIP: - rig A, rlJ� Ta The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: n Project name: H,_Q p L0c- FEE* SCHEDULE
I7K Description 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
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non- residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90.90 2
b A jA CA 6 V '` l 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 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 _
❑ 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,
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 � 2
Business name: + 7-�- s G r
Address: Each additional inspection over allowable in any of the above
/ b i E (- E v E LA ") D , '4) Cre ) Z-o Per inspection 62.50
City/State /ZIP: G ceS14 A M I L 2 9-203c. Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax: (953 ) 6� Industrial plant per hour 73.75
503 �5�� S _ ��® ELECTRICAL PERMIT FEES*
15° 1 ') 5 Electrical Lic.:
CCB Lic.: +o -, •i ce 24,,- ttnct:6 Suprv. Lic.: 3 24b LEA Subtotal s
Suprv. Electrician signature, required: , 1 i Plan review (25% of permit fee) -
Print name: _37�a � / v s Date: i i f y/o >� State surcharge (8% of permit fee)
L TOTAL PERMIT FEE Ri —
Authorized signature This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Steve 7 )., Date: 1 , , I • Fee methodology set by Tri -County Building Industry Service Board
•• Number of inspections per permit allowed.
i:' Building \Pennils\ELC- PennitApp.doc 12/03 440- 4615T(l0 /02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information, i
LIMITED ENERGY i ERMIT FEES:
RESIDENTIAL WORK 0 Y:
•
Fee for all residential syste ' combined $75.00
Check Type of Work Involve ' :
. ❑ Audio and Stereo Syste s* •
❑ Burglar Alarm
El Garage Door Opener*
El Heating, Ventilation and Air onditioning
System* •
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC •
El Instrumentation •
El Intercom and Pagi i : ystems
El Landscape I • gation Control*
❑ Medica
❑ Nu :e Calls
❑ Outdoor Landscape Lighting* •
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required •
for all other installations
i:\ Building \Pennits\ELC- PetmitApp.doc 04/03 •
CITY OF TIGARD - A -
BUILDING DIVISION PERMIT #: ELR2005.00335
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/7/2005
Phone: (503) 639 -4171 Ark
I
Inspection Requests (24 Hrs.): (503) 639 -4175 �'I I ..
INSPECTION WORKSHEET FOR DATE: 11/14/2005 TIME: 7:12AM PAGE: 85
SITE ADDRESS: 11705 SW PACIFIC HWY K CLASS OF WORK:
SUBDIVISION: PACIFIC CROSSROADS LOT #: TYPE OF USE:
PROJECT Av�ME, & R BLOCK
DESCRIPTION: Data/telecommunication.
OWNER: PACIFIC CROSSROADS PROPERTIES, I, PHONE #:
CONTRACTOR: PTSC PHONE #: 503-665-4900
Inspection Request Scheduled For: Date: 11/14/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135V Low voltage 021103 -01 503.489-2707 Y
Corrections /Comments /Instructions:
‘'\ S --- • \). l '-1 1 W\' \ \ \ 1
& i(
I</i
R PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Ni- c Date: J Phone #: (503) 718 -
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005-00395
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/7/2006
Phone: (503) 639 -4171 40e, 11,t ,I
Inspection Requests (24 Hrs.): (503) 639 -4175 �.
INSPECTION WORKSHEET FOR DATE: 11/8/2005 TIME: 7:00AM PAGE: 96
SITE ADDRESS: 11705 SW PACIFIC HWY K CLASS OF WORK:
SUBDIVISION: PACIFIC CROSSROADS LOT #: TYPE OF USE:
PROJECT NAME: H & R BLOCK
DESCRIPTION: Data/telecommunication.
OWNER: PACIFIC CROSSROADS PROPERTIES, I, PHONE #:
CONTRACTOR: PTSC PHONE #: 503-665.4900
Inspection Request Scheduled For: Date: 11/8/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
191 Electrical final y- 020563 -01 503-489-2707 N
Corrections /Comments /Instructions: LNL%
N _ ct ,,,,,,
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
AIL \� ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ,.4- 7----------( Date/ `r_ _ Phone #: (503) 718 -