Permit r
C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
�
r � DEVELOPMENT SERVICES PERMIT #: ELR2006 - 00233
1 � ,.� �I DATE ISSUED: 9/26/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S135BD - 01100
SITE ADDRESS: 09780 SW SHADY LN 110 ZONING: C - G
SUBDIVISION: SHADY LANE OFFICE LOT: JURISDICTION: TIG
Project Description: Voice & Data low voltage.
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:
LEWIS, GLORIA M + ALLPHIN COMMUNICATIONS INC
LEWIS, GLORIA M TRUSTEE + 23220 SW BOSKY DELL LANE
LEWIS, ANDREW M ET AL WEST LINN, OR 97068
PORTLAND, OR 97225
Phone: Contact #: PRI 503- 698 -9000
FAX 503- 638 -9100
FEES Reg #: ELE 3- 406CLE
LIC 107548
Description Date Amount
[ELPRMT] ELR Permit 9/26/2006 $75.00
[TAX] 8% State Surcha 9/26/2006 $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 95 401 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: Permittee Signature: 41,"�
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.
ctr
J iial Permit Applica l�l,CE�V roil OFF USEONL1 Received City of Tigard S F P 2 6 2006 Deem . -/ 4 o. Permit No.:, t 006 --02•)33
13125 SW Hall Blvd., Tigard, OR 17223 Dal Revi . Plan
• Phone: 503.639.4171 Fax: 503 .8rI 4F TIGARD �� Other Permit:
T I G A It l7 Inspection Line: 503.639.4175 BUILDING DIVISION Date ReadyBy: tuff: ® See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
•
TYPE OF WORK PLAN REVIEW
❑ New construction $'Addition/alteration/replacement Please check all that apply (submit 2 sets of plans wtitems checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling W Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family, - ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ `A ", E ", "1 -2 ", "I -3 ",
Job no.: 1 Job site address: � I I P IOOHP or more. occupancy. 3 �/ � � � n J ,v ❑ Six or more residential units.
0 Recreational vehicle parks.
City /StaterZ)P:TI nn I ❑ Health -care facilities. ❑ Supply voltage for more than
7 -7 2 2 3 ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: I b 0 Project name: ❑ Service or feeder 600 amps or more.
job site: Description FEE SCHEDULE
Cross street/directions to
J I Qty. I Fee. I Total
New residential single- or multi- family dwelling unit.
includes attached garage.
• Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
V ( Le. i fat,},¢ , residential (with above sq. ft.)
/ 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
•
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 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 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
• each branch circuit
Business name: 13. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'I branch circuit _ 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E - mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: Li p(,3) ,, r'e.yr}av i
__ ff W ,, r S 1 - #) G energy panel, alteration, or
Address: 23,) 10 jt:J ee+jt ' °cif_ L/{/ extension. Describe: / Paget "I 2
City/State/ZIP: tti1 (._ I.. (,..,,,,/ o glove Each additional inspection over allowable in any of the above
d p ' Per inspection 62.50
Phone: co ) 6 35 b oa, Fax: Ki ; ) 6 3 O % 1 ! OO Investigation per hour (1 hr min) 62.50
CCB Lic.: I b, S q 0 Electrical .: (2L()0 (,�- Suprv. Lic.: /i Industrial plant per hour 73.75
( ELECTRICAL PERMIT FEES
Suprv. Ele • 'an signature, required: IP a�� Ct!� Subtotal: 7
Print name. ' //f-G �� f Date: cif Ce/ 4 Plan review (25% of permit fee):
State surcharge (8% of permit fee): 6,
Authorized signature: TOTAL PERMIT FEE: ' ' I -
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
• I: t Building tPermits \ELC- ParnitApp.doc 05/23/06 4 �� 4404615T(II /05 /COM/W®
— 1 — I — oe
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*
El Burglar Alarm
El 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 -
El Boiler Controls
❑ Clock Systems
zi Data Telecommunication Installation
El Fire Alarm Installation
El HVAC
. El Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
•
❑ Nurse Calls
.
E l Outdoor Landscape Lighting*
❑ Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
• for all other installations
I: Building \Pamits\ELC- PermitApp.doe 0323106
CITY OF TIGARD ` '
BUILDING DIVISION PERMIT #: ELR20Q 002 ;�3
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 9/26/2006
Phone: (503) 639 -4171
A , i
Inspection Requests (24 Hrs.): (503) 639 -4175 . ' F '� I�
INSPECTION WORKSHEET FOR DATE: 9/28/2006 TIME: 7 :02AM PAGE: 40
SITE ADDRESS: 09780 SW SHADY LN 110 CLASS OF WORK:
SUBDIVISION: SHADY LANE OFFICE LOT #: TYPE OF USE:
PROJECT NAME: EDGE FINANCIAL
DESCRIPTION: Voice & Data low voltage.
OWNER: LEWIS, GLORIA M +, PHONE #:
CONTRACTOR: ALI-PHIN COMMUNICATIONS INC PHONE #: 503. 698 -90Q0
Inspection Request Scheduled For: Date: 9/28/2006 Pour Time: 9 D.
/
Code # Inspection Description Confirm # Contact # Message -2y 2
199 Electrical final 037297 -01 503-807 -1810 Y
Corrections /Comments /Instructions: ? \�
J_ :— : P ,A
■
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 1\1 Lam" Date :9 2 W Phone #: (503) 718- *it__