Permit •
CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 - 00228
eel II DATE ISSUED: 8/10/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S101 DC - 03800
SITE ADDRESS: 07190 SW SANDBURG ST 20 ZONING: I - P
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Data /telecom installation.
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:
MCCORMACK, WILLIAM L + DARLENE T BROADWAY ELECTRIC - COCHRAN INC
7415 FAIRWAY LOOP 626 SE MAIN
WILSONVILLE, OR 97070 PORTLAND, OR 97214
Phone: Phone: 503 - 234 -6564
•
Reg #: LIC 72942
SUP 3447S
FEES ELE 37 -546C
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 8/10/2005 $75.00
[TAX] 8% State Surcha 8/10/2005 $6.00
Total $81.00
•
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires ou to follow rules adopted by the Oregon,
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 00 011 ' . u may obtain copies of these
•
rules or direct questions to OUNC at 503 - 246 -6699.
r u -
Issued By: Permittee Signature: .��
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: .. DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO: •.
Call 503- 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
Electrical Permit App aai� ';\`\ /7H P FOR OFFICE USE ONLY
of Tigard City Received _
tY g DateJB : _ O .: _ �1
13125 SW Hall Blvd., Tigard, OR 97223 1_, � -, -,'' Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 are 1N ... 1 \ Date/B Other Permit:
Inspection Line: 503.639.4175 < I Date Ready/By: ® See Page 2 for
Internet: www.ci.tigard.or.us ail ��` "k'Je' > • Notifed/Method: Supplemental Information
- .. Vtl _ _ �n
e,,,,. ' rr,- 2,1,t' i,',„ „,$,..,z, d i 5 1C . �F-4`,'.s: -. ,,.;. ,,_ - r. a ,, •1,1, o %i';._:. _ '..':iC
+II � ,
�V _� }:
Y , _ M1" , ,, " l '- _ a • ..iii,. ' �; ' l:n : f ... :1 :: :,,, ' 5"..
�fi J . � � ��r, • � - � � ' � .+� • `S' � _ _..� . i:: ( -� .: � .. =v} .- ri " 3�1�. _ .
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ['Service over 225 amps, comm'l ❑Hazardous location
['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
-*-r i 1 • . • rw . - ". . y `•hil 4 -: Fi7., -4-=
�,�, ,p 3;:asi :��: ._= of 1- and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi family ❑ Master builder ❑Building over three stories ❑Feeders, 400 amps or more
� ,�„ _ ❑ Other: ['Occupant load over 99 persons ['Manufactured structures or
" a `�.t . 0 i f 4 t e �r�ys ` 41 t e ' ` c > *- . > t ❑ /lightingplan RV park
_+,. v mi (F..- .-'..4 -: - . asst . L ".
Job no.: 555 icy Job site address: 1 1- L cS
0 C� V h ❑Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City/State/ZIP: l (J Ci 7t 2 _> _The above are not applicable to temporary construction service. 41Aft
Suite/bldg. /apt. no. Project name: N 0 e�eu � �� ��.
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
Subdivision: I Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
. "r..:,.t ? � ° A 1.2, -41' - "'tl- `7:.' Each manufactured or modular
• dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
�LL - . r =. y M, -,• ag,:y,, .rry,•', - . ..ifi ryry' -,�r r 1,. a u�yw .i 201 amps to 400 amps 106.85 2
.. .tU C>aB Al.,. 3 a
u.`'�3 __ iUl l'JII .�Yw Ir ;`-.......f' ; : x
` " 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
Phone: ( ) i Fax: ( ) relocation
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
r
'.5 a r f ( -v `: f;', 3. , � f V'iF ; r "_ A . Fee for branch circuits with
_.s _r,J A ::r:,, •, L3 _s,° F:Ye i__•e.s� �=e,. 7 service or feeder fee, each
Business name: s i ec. l Y l•( branch circuit 6.65 2
B.
��` /// Fee for branch circuits
Contact name: �® Si - OYS �� without service or feeder fee,
46.85 2
A �/� �r each branch circuit
Address: (03, <� I `�l�l.l l 7 Each add'l branch circuit 6.65 _ 2
City/ State/ZIP: lL CI ne.-. C I 72- y Miscellaneous (service or feeder not included)
Phone: (aTj 234 ( (.4 1 Fax: : (6 2 Lcr g Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: - • 0 10 CC-t • I Yak') • "(1C .0 CY Y " Signal circuit(s) or limited -
i ` " energy panel, alteration, or
_' F d "`t " ? ° extension. Describe: / Page 2 1S - 2
Business name: (Sril t C S G l s c ab .D rL tY)S Ik
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
a i ,. rF.:cs:'
CCB Lic.: • / 2 C era_ Electrical Lic.: ST br,1 Suprv. Lic. L-kl..ri5 Subtotal -7s,
.
Suprv. Electrician signature, required: � = \ Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee) t -
e� 4\ TOTAL PERMIT FEE g I --
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.
i:\ Building \Pemits\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:
�.�![A! V C°. ^y ' ; � 1 `5171 'in4 .3.^' : 'ry )ti..
,.t! "i;l5o`6�_����5�Fi �.2H ��1.�.OL I��`,��`�� t i �iJ�.. s��'e�' a�. �h'�.
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System* •
❑ Vacuum Systems*
❑ Other:
� `'C ' ^� �` ( �9 \ i`_�Fa§,S'Cst.j: II:5A L. '"a' -'•r'-Ileab`?1: -u :-
� n �" A.;3:s� . . �� _� � . $75.00
Fee for each commercial system
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting* •
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i \Pmniu\ELC- PmnitAPP.doc 04/03
1
1 'ttTY OF TIGARD • '~
BUILDING DIVISION PERMIT #: ELR2005 -002 28
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 8/10/2005
Phone: (503) 639 -4171 47, ri i i
Inspection Requests (24 Hrs.): (503) 639 -4175 AL
INSPECTION WORKSHEET FOR DATE: 8/ 11/2005 TIME: 7 :09AM PAGE: 64
SITE ADDRESS: 07190 SW SANDBURG ST 20 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: MCCORMACK BUILDING
DESCRIPTION: Data/telecom installation.
OWNER: M - 'CORMACK, WILLIAM L + DARLENE T, PHONE #:
CONTRACTOR: BR 0 ;DWAY ELECTRIC - COCHRAN INC PHONE #: 503 - 234 -6564
Inspection Request Scheduled Date: 8/11/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 013335 -01 503 -307 -9413 Y
1q °I E J N4aC -- )
Corrections /Comments /Instructions:
C.' 1 1 . - I \ . 0 `7 2 ® l • CE }lam
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: N 0 B v Date: t Phone #: (503) 718- _