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Permit C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT ot�n DEVELOPMENT SERVICES PERMIT #: ELR2005 -00376 I I I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/28/2005 PARCEL: 2S 103D D -00800 SITE ADDRESS: 13815 SW PACIFIC HWY 110 ZONING: C -G SUBDIVISION: LOT: JURISDICTION: TIG Project Description: Low voltage for voice /data. Job No. 054227 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: Owner: Contractor: D.W. SIVERS COMPANY ESP TECHNOLOGIES 4730 SW MACADAM AVE 7929 SW BURNS WAY STE. F #101 WILSONVILLE, OR 97070 PORTLAND„ OR 97201 Phone: Phone: 503 628 - 4195 Reg #: LIC 73872 ELE 34- 269CLE FEES Description Date Amount REQUIRED ITEMS AND REPORTS [ELPRMT] ELR Permit 10/28/200E. $75.00 [TAX] 8% State Surchari 10/28/200E $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 start= : • • • 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires yo, to follow rule- adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 t ough OAR 952 -061 -0100. . : obtain copies of these rules or direct questi ns to OUNC at 503-246-6699. Is ued By: .' I .� , / Permittee Signature: K. cQ� 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. - • \1' \ Electr P Application FOR OFFICE USE ONLY Received , Da O Ir. Permit No.: �.JG 1C. A �14�O r �(�� LIFY 1t/16 City of Tigard 13125 SW Hall Blvd., Tigard, OR 97223 Plan ta Revi ew Phone: 503.639.4171 Fax: 503.598.1960 / �"" ^ - Date/B : Other Permit: - ,t -� ... Inspection Line: 503.639.4175 c-'�!�/ = Date Ready/By: � ® g Internet: www.ci.tigard.ores or.us Notified/Method: Supplemental See Pa e 2 Information f' , x 43jh I,- 4h ev ,dW; *' ��Y; idw r Y "2, , 1 r 4.� , 1` o. y,�y 4 • ��`, -. Y - . ❑ New construction ❑ Addition/alteration/replacement Please check all that apply: , .Zr�4k r�. h)J'11'8ft) ¢ .r,. ( '%' ':r i v 'l •�• ,T '{�UB[( }(J�•t e t n, ..t: i : „. '' x._ e.1'J• 0 � Pd5 Y C� `�'•`• •"��� �AIP n .�n+ ~ ❑ Demolition ❑ Other ❑Service over 225 amps, comm'l 0 Hazardous location 1� r+ y dwellings Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., if + r . �...4 ..IFy�.... .0. 4x - +R r , l� ,,, `' / *p l � .,r n g14 ?rr , -q i dpi, ,iJ w• e , 1,,4a. ❑ of 1- and 2 -famil dwellin 4 or more new residential . - J,.r ww'. ,. a"F, .a -r , a. uar p .r, �'7•it "�..4nA�°°.1!re4..' 4h� y,. � .e_ El 1 - and 2 - family dwelling , :11 ❑S over 600 volts nominal units in one structure ommercial/industrial ❑Accessory building ['Feeders, 400 amps or more ❑ Building over three stories ❑ Multi - family ❑ Master builder ❑ Other: DOccupant load over 99 persons ['Manufactured structures or E '-T�N1 `Z791 " : t y l 1 . , ,,q/.1 "„ ; 9 ).-a r '1;11':!;""'". e ' ; N�` {� ❑Egress/lighting plan RV park t, 17�, w :,,_. ,..+'' .:� s-: -� u - ..:�-- -' - ❑Other: Job no.: �t� y Job -'�i� / ❑Health -care facility t 5 2r�• Jb site address: ( /, 4� � � 4 i ( Submit 2 sets of plans with any of the above. City/ State/ZIP: � . DR C/ The above are not applicable to temporary construction service. •• Suite/bldg. /apt. no.: I Project name:(�,r(ee �Jz.��. Descripdon l 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: I Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 Tax map /parcel no.: Li mited energy, non - residential 75.00 2 Each manufactured or modular # ,,x,„,1, •.* • ¢ eo k 0 1 e N „ E �Y . w .� ' `, �' ' „ ' ; pY.Ji'u"'*�i _ .ate '= ,y.a.k N a . I /, • dwelling, service and /or feeder 90.90 2 �5 i Ce, (�"/ \ Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 Cm ... vim ,,m� =,'DRIP, , ,, - -,: 201 amps to 400 amps 106.85 2 1 ' e 8 7 . ° • --,� ' ' d " C 401 amps to 600 amps 160.60 2 (7/ Name: /.i .0 L V l 11� 601 amps to 1,000 amps 240.60 2 Address: /3 15 15 _516 /'54';' l / Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/State /ZIP: / 7 Q• � � (�` Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) j 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 1'., �� °'" �i. A. Fee for branch circuits with *oe lr'h ® �Jl a] .r• .an N^SBi�••yi � '+X 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 each branch circuit Address: Each add'! branch circuit 6.65 2 City /State/ZIP: Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 2 Phone: ( ) I Fax:: ( ) Sign or outline lighting 53.40 2 E - mail: Signal circuit(s) or limited- ° �f °' .IaRgi " T... a o ",'ne..•'�,. ++ ",a rt � v , ; • ;.:, energy panel, alteration, or = �'�Kfr;., . r4';a ;• -> - x=&�:tiF_ t. etia extension. Describe: i Page 2 7io 2 Business name: s e l y . i n k5 1 z., _52, ` 7i c <6e) � vt1i 1 / Per inspection 62.50 Each additional inspection over allowable in any of the above Address: 7 g 1 / Eli r ltS / 5c4 t )< r City/ State/ZIP: e, )C ka,t.,,,R ()K 070 Investigation per hour (1 hr min) 62.50 L� ` I Industrial plant per hour 73.75 Phone: c5'(,13 )� 5��,�_ T l � L'J � Fax: .3 ) c . 7 ( 'roK74I+` ; 4 r, . _. , ti , 00 K -!I F "3dPM': ... CCB Lic.: 73 `6 - 7 Z I Electrical Lic.: 3 z j,ie e Suprv. Lic.: 2 2$/ Subtotal 175e. Suprv. Electrician signature, required: Plan review (25% of permit fee) _. State surcharge (8% of permit fee) t CO Print name: Date: TOTAL PERMIT FEE / f 60 Authorized signature: I ' 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. i:\ Building 'Permits\ELC- PermitApp.doc 12/03 440- 4615T(10 /02/COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: ay r t : / i N� ��i fQi 4 �h � 7 f!� Ell ° 1 a El i LC :713E I `i I I ,..�n ° T © o '»i:' s lx 6 7 .�! Fee for all residential systems combined........ • $75.01 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar larm ❑ Garage Door • : - er* El Heating, Ventilation • it Conditioning. System* ❑ Vacuum Systems* ❑ Other: ktak d 1 • 31 Fee for each commercial system $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems [3ata Telecommunication Ins • lation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging .ystems El Landscape Irrigatig Control* El Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: . - *No licenses are required. Licenses are required '•3' Y, . • for all other installations i: \ BuildingTrnnits \CLC- PermitAppdoc 04/03 CITY OF TIGARD BUILDING DIVISION PERMIT #: ELR200S-00376 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/28/2005 Phone: (503) 639 -4171 g0z, I I Inspection Requests (24 Hrs.): (503) 639 -4175 I I .. INSPECTION WORKSHEET FOR DATE: 11/22/2005 TIME: 7:02AM PAGE: 88 SITE ADDRESS: 13815 SW PACIFIC HWY 10 CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: • R • C k4SJ DESCRIPTION: Low vo age for voice/data. Job No. 054227 OWNER: SIVERS C5MPANY, D.W. PHONE #: CONTRACTOR: ESP TECHNI OGIES PHONE #: 503 -628 -4195 Inspection Request Scheduled For: Date: 11/22/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 022228 -01 503.604 -2447 N Corrections /Comments/ Instructions: • • A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: G 114 M L Date: Phone #: (503) 718 - CITY.OF TIGARD r - BUILDING DIVISION PERMIT #: ELR2005 -00376 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/28/2005 Phone: (503) 639 -4171 '' r° t"'� �11 j Inspection Requests (24 Hrs.): (503) 639 -4175 IL INSPECTION WORKSHEET FOR DATE: 11/21/2005 TIME: 7:13AM PAGE: 37 SITE ADDRESS: 13815 SW PACIFIC HWY CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: CARLTC Jfl"NSPIZZA) DESCRIPTION: Low v age for vo `�dat Job No. 054227 OWNER: SIVERS COMPANY, D.W. PHONE #: CONTRACTOR: ESP TECHNOLOGIES PHONE #: 503 - 628 -4195 Inspection Request Scheduled For: Date: 11/21/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 022024 -01 503-804-2447 N Corrections /Comments /Instructions: CArnN �,E W' c A� - ?(Le•v% ZIE ‹sz•Vail. 0-& 5 '<zoa. ke\/\(W - 4/ PVC., ❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: N0(45 L* Date: Al 2.4 'v Phone #: (503) 718 - iv CITY OF TIGARD BUILDING DIVISION • PERMIT #: ELR2005 -00376 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/29/2005 Phone: (503) 639 -4171 o re li Inspection Requests (24 Hrs.): (503) 639 -4175 I INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 59 SITE ADDRESS: 13815 SW PACIFIC HWY 110 CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: GARLIC JIMS PIZZA DESCRIPTION: Low voltage for voice/data. Job No. 054227 OWNER: SIVERS COMPANY, D.W. PHONE #: CONTRACTOR: ESP TECHNOLOGIES PHONE #: 503628-4195 Inspection Request Scheduled For: Date: 10/31/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 135 Low voltage 019821 -0 503-628 -4175 N Corrections /Comments / Instructions: S ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: /0 $ Phone #: (503) 718- _____,L_______