Permit i
C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 -00294
..� II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/20/2005
PARCEL: 1S135DD-03301
SITE ADDRESS: 11945 SW PACIFIC HWY 250 ZONING: C -G
SUBDIVISION: HOFFARBER TRACTS NO.1 LOT: 002 JURISDICTION: TIG
Project Description: CCTV
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:
INSTRUMENTATION: OTHER: CCTV X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
TIGARD PROPERTIES INC OREGON ELECTRIC CONST /GROUP
8320 NE HWY 99 1010 SE 11TH AVE
VANCOUVER, WA 98668 PORTLAND, OR 97214
Phone: 360 - 574 - 6255 Phone: 503 234 - 9900
Reg #: LIC 203
SUP 4460S
FEES ELE 26 -95C
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 9/20/2005 $75.00
[TAX] 8% State Surchart 9/20/2005 $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 952 -0 1 -0100. You may obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: . �GG 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.
•
., SEP -2005 02:44PM FROM -OR ELECTRIC SERVICE • 5035352763 T -053 P.002/003 F -306
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Ci 13125 SW Hall Blvd., Tigard, OR 97 of Ti and J) v 6/ q .
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223 C i
Finn Rev w COW rennin
Phone_ 503.639.4171 Pax 503.598.1 E 4 " 1 O ' a �. e ' ( ' `
Inspection Line; 503.639.4175 ; !,; '' I -, Date ReadyBy: a H See Page 2 for
rn
Inteet www.ci.ligard.or.ua SEP 1 7 2� ' NotiSed/Methad: �EA SupplementalInlbnnauun
TYPE OF ` W ' � O��RE , & RD _ PLAN REVIEW
® New a arlsCV Ctitin ❑ A dditiccte[ttttQ n 6 tt Please check all that apply:
❑ Demolition ❑ OtherSU'Lp1N ❑Service over 225 amps, coming ❑Hazardous locution
❑ Service over 320 amps — rating ❑ Buildng over 10,000 sq. II.,
CATEGORY OF CONSTRUCTION di- and 2 -family dwellings 4 or more new residential
❑ 1 - and 2 family dwelling 12 ComIItercialiindustrial ❑ Accessory building ['System over 600 volts nominal units in one &actum
❑ Building over three stories CI Feeders, 400 amps or more
❑ Multi faintly CI Master builder 0 Other
❑Occupant loud over 99 persons ❑Manufacuud Sttuctufes or
JOB SITE INFORMATION AND LOCATION ClEgress/lighting plan RV park
Job no.: 66120 I Job site address: 11945 SW Pacific awn= e) ❑Health -core facility ['Other.
R Submit 2 seta of plans with any of the above.
City /State/ZIP: Tigard, OR 97223 The above arc not applicable to temporary constitution service.
Suite/bldg. /apt no.: I Project nam ,1414.4- FEE' SCHEDULE
besrialea 1 QV. - I Fm I Tina I ••
Cross street/directions to job site: Cornell New residential single - or multi - family dwelling ®it.
Includes attached garage
1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Ha addl 500 sq. ft or portion ' 33.40 1
Tax Limited energy, residential 95.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
Install Cameros — dwelling, service and/or feeder 90.90 2
Services or feeders installation. alteration, and/or relocation
200 amps or less 80.30 2
Y OWNER I ❑ TENANT 201 amps to 400 amps , 106.85 2
401 amps to 600 amps 160.60 2
N e: &anus Fabri 601 amps to 1.000 amps 240,60 2
Address: 11945 SW Pacific Hwy Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: Tigard, OR 97223 Temporary services or feeders Installation, alteration, and/or
Phone: ( ) I);ax ( ) relocation _ 200 amps less 66.15 1
Owner installation: This installation is being made on property that I oam minch is not 201 amps to 400 amps 100.30 2
intended for sale, lease. rent. or e.\change. 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. Far for branch circuits wall
service or feeder fee, each 6.65 2
Business name: Oregon Electric Group branch circuit
B. Fee for branch circuits
Contact name: Steve Carl without service or feeder fee,
each branch circuit 46.85 2
Address:
__ Each add'1 branch circuit 6.65 2
City /Stalt:/LIP• Miscellaneous (service or feeder not included)
Phone: (503) 546-6008 I Fax:: ( ) Pump or irrigation circle 53.40 2
I sign or outline lighting _ 53.40 2
E Signal circuit(s) or limited.
CONTRACTOR energy panel, alteration, or
extension. Describe Cameras Page 2 2
Business name: Oregon Electric Group
Address: 1010 SE Ilth Ave Each additional inspection over allowable in any of the above
Per inspection . 62.50
City/State/ZIP: Portland, OR 97214 Investigation per hour (1 hr rain) 62.50
Phone: (S03) 234 -9900 I Fax: (583) 535.2763 Industrial plant per hour 73.75
ELECTRICAL PERMIT PEES"
CCB Lic.: 203 I_ Elwtrical Lic.: 2'/ S , : . is 4460S Subtotal Suprv. Electrician signature, required: � ! Plan review (25% of permit foe)
Print name: M aik. V . K I L : to: °I Ltd,
, tom State surcharge (8% (8% of permit fee)
, TOTAL PERMIT FEE
Authorized signature: - F This permit application expires if a permit is not obtained within Into
days atter it hta been a:copied es complete
Print name: 1- `ay k Q - eiv wP n /OS • Fee lo by Tri- County Building Indwy Service pool me Number of Meoectione oar permit allowed
lie
CITY -OF TIGARD
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: ELR200S - 00294
Phone: (503) 639 -4171
A ji 9/20/2005
Inspection Requests (24 Hrs.): (503) 639 -4175 , ' "_
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
116
SITE ADDRESS: CLASS OF WORK:
SUBDIVISION: 11945 SW PACIFIC HWY 250 LOT #: TYPE OF USE:
PROJECT NAME: HOFFARBER TRACTS NO.1 002
DESCRIPTION: JO -ANN FABRICS
CCTV
OWNER: PHONE #:
CONTRACTOR: TIGARD PROPERTIES INC, PHONE #: 360- 574 -6255
OREGON ELECTRIC C'IWIST /'POLIP 503 23 Q0
Inspection Request Scheduled For: Date: Pour Time:
9/30/2005
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 017024 -01 503-849.3658 Y
Corrections /Comments /Instructions:
•
�f\
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
AI q /
Inspector: N �� L- Date: ` US Phone #: (503) 718- J W V