Permit ' Il .111
CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
�i�NA DEVELOPMENT SERVICES DATE ISSUED: 4/21/2006
NA °-- � 'j' A-- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PERMIT #: ELR2006 - 00090
PARCEL: 1 S134BC -00200
SITE ADDRESS: 12198 SW SCHOLLS FERRY RD ZONING: C -
SUBDIVISION: GREENWAY TOWN CENTER LOT: JURISDICTION: TIG
Project Description: Voice /data
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:
SLH ENTERPRISES LLC OES LLC
12198 SW SCHOLLS FERRY RD 5285 NE ELAM YOUNG PKWY # A600
TIGARD, OR 97223 HILLSBORO, OR 97124
Phone: 503- 224 -6791 Contact #: PRI 503- 693 -6000
FAX 503- 693 -8660
FEES Reg #: ELE 34 -572C
LIC 159395
Description Date Amount SUP 4587S
[ELPRMT] ELR Permit 4/21/2006 $75.00 •
[TAX] 8% State Surcha 4/21/2006 $6.00 REQUIRED ITEMS AND REPORTS
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 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: 1�(� Permittee Signature: Xt,�1 i/ `!�� -'
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.
•
'lectr>ICaI Permit Appl', . - (` E FOR OFFICE USE ONLY o��
.
City of Tigard Received ddb ti 1111:=F4101 ,: __,O -0 .i
n 1312 SW Hall Blvd., Tigard, OR 97223 1 w C Plan Revie
C .: Phone: 503.639.4171 Fax: 503.5R8J11602, 1 200 Dale/By. Other Permit: •
T I C n IL I) Inspection Line: 503.639.4175 1 Date Ready/By Suns: El See Page 2 for .
Internet: www.tigard or.gov t ,, A 1 f•y— Notified/Method Supplemental Information
U
TYP (� QI � ∎, ( - " ' i 7 �� PLAN REV
❑ New construction AAddl�t bll/dlterati ll o '' n�/re ° ° placement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'I ['Hazardous location
❑Service over 320 amps – rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling IS Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Multi - family ❑Master builder ❑Other: ❑Building over three stories :Weeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑E plan RV park
Job no.: Job site address: // fig S GU, .fcyot�,(' 6--,,,,,,, d ❑Health -care facility ['Other:
Submit 2 sets of plans with any of the above. •
City / State/ZIP: --fi Aiz 0 ) 2 9 ..)„..1 The above are not applicable to temporary construction service..
Suite/bldg. /apt. no.: Project name: 0,44/6/4s 0 //jd - FEE* SCHEDULE
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: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 I
•
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
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, 46.85. 2
Address: first branch circuit
Each add'I 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: i9 ES C C G
Address: s �g n/ -�v Each additional inspection over allowable in any of the above
t /( Per inspection 62.50
City/ State/ZIP: 6_.. v Investigation per hour (I hr min) 62.50
Phone: ( ) • Fax: ( ) Industrial plant per hour _ 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: Electrical Lic.: Suprv. Lic.: Subtotal:
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: Date: State surcharge (8% of permit fee): •
TOTAL PERMIT FEE
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:V ilding \Pemtits\ELC- PesmitApp.doc 0323/06 410-4615T(I1/05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information .
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
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 •
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00 •
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
L'\ BuildingTermia\ELC- PmnitApp.doc 03!23106
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR70060(X33O
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: r1 /2 112000
Phone: (503) 639 -4171 'e�
Inspection Requests (24 Hrs.): (503) 639 -4175 'I � �
INSPECTION WORKSHEET FOR DATE: 5/1/2006 TIME: 7:00AM PAGE: 13
SITE ADDRESS: 12183 SW SCHOLLS FERRY RD CLASS OF WORK:
SUBDIVISION: GREENWAY TOWN CENTER LOT #: TYPE OF USE:
PROJECT NAME: DINNERS DONE RIGHT
DESCRIPTION: Voice/data
OWNER: GREENWAY CENTER LLC, PHONE #: 503 2240791
CONTRACTOR: OFS LLC PHONE #: 503 633 - (00U
Inspection Request Scheduled For: Date: 5/1/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low volt: •a 029040.01 503-860.7070 N
Iq ci
Corrections /Comments /Instruc •ns:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ��'�, N t e�E Date: 5 I t% Phone #: (503) 718- 2-44b j