Permit I .
ELECTRICAL RESTRICTED ENERGY PERMIT
a CITY OF TIGARD
},./ 114 : COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00342
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 9/12/2007
PARCEL: 2S113AB -00300
SITE ADDRESS: 16045 SW UPPER BOONES FERRY RD ZONING: I -
SUBDIVISION: FANNO CREEK PLACE LOT: JURISDICTION: TIG
PROJECT: FANNO CREEK PLACE
Project Description: Bldg C Data telecommunications.
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: •
OPUS NORTHWEST BERGELECTRIC CORP
1500 SW FIRST AVE 6026 NE 112TH AVE
PORTLAND, OR 97201 PORTLAND, OR 97220
Phone: 503 -519 -4715 Contact #: PRI 503- 255 -1818
FAX 503- 255 -1919
FEES Reg #: ELE 37 -682C
LIC 110521
Description Date Amount SUP 5121S
[ELPRMT] ELR Permit 9/12/2007 $75.00
[TAX] 8% State Surcha 9/12/2007 $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 00. Y, u may obtain copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344. /
, , - - - g
Issued By: Permittee Signature:
_Zggir(
7 2---71'
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 Applic .ii ,
City of Tigard � �� � FOR OFFICE USE ONLY
Date d 9 �a
Perm
7 Permit No
4 _ ° 13125 SW Hall Blvd , Tigard, OR 9EP 2 /[ii `,' 62/2.2007 _ oI � '
Phone. 503 639 4171 Fax: 503.54 196 / Daeview
OtherPermitauP_ ,,0 00
TIGARD Inspection Line' 503 4175 CITY OF [IG! R® Date Ready /By runs ® See Page 2 for
Internet www tigard-or.gov B UR.Uni( fl VlStON Notified/Method Supplemental Information
TYPE OF WORK PLAN REVIEW ,
lJ ew construction ❑ Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w/items 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 Commercial /industrial ❑ Accessory building amps for all other installations buildings
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system
❑ Addition of new motor load of ❑ "A ", "E "1 -2 ", "I -3 ",
Job no.: 1. ` W /3 Job site address: J W 10OHP or more, occupancy
(031-15 pC �3 F!' h� ❑ Six or more residential units ❑ Recreational vehicle parks
City/State /ZIP: W (y 6 / a� 3 / / ❑ Health -care facilities 12 Supply voltage for more than
1 / // I ❑ Hazardous locations 600 volts nominal
Suit /bldg./ pt. no.: C P ro j ect name: - ee l(Ni Co f I ❑Service or feeder 600 amps or more.
` ( FEE SCHEDULE
Cross street/directions to job site:
� ham Ni. AbOry5 pri,, Description I Qty. I Fee. I Total I •
«�
J New residential single - or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 145 15 4
Ea add'l 500 sq ft or portion 33 40 1
Tax map /parcel no.: Limited energy, residential 75 00 2
• . DESCRIPTION OF WORK - (with above sq ft )
/ Limited energy, multi - family
frk�'�°rn-rI /,Y tu-)/�'G_ k�S 7�_3 /(rC✓✓✓ ��, � residential (with above sq ft ) 75.00 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ' ❑ 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: ( ) I 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
' .I&APPLICANT I . fi4 CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: Bergelectric Corp. B Fee for branch circuits
Contact name: ' Ph / l � without service or feeder fee, 46 85 2
I 1 r r e first branch circuit
Address: 6026 NE 11 112tli Ave. Each add'I branch circuit 6 65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Portland, OR 97220 Each manufactured or modular 9090 2
dwelling, service and/or feeder
Phone: ( ) 503- 255 -1818 I Fax: : ( ) 503 - 255 -1919 Reconnect only 6685 2
E -mail: ? (,llt y� / /5 f p f e C. ( ? �) Pump or irrigation circle 53.40 2
/ CONTRACTOR Sign or outline lighting 53.40 2
Business name: Signal circuit(s) or limited -
Bergelectric Corp. energy panel, alteration, or
Address: 6026 NE 112th Ave _ exte D escji( � Page 2 2
City /State /ZIP: Portland, OR 97220 Each a inspection over allowable in any of the above
Fax: Per inspection 62 50
Phone: ( )
503-25-1818 I ( ) 501-755-1919 Investigation per hour (1 hr min) 62 50
CCB Lic.:1 1 0 5 21 Electrical Lie.: 37 S ic.: 2/5 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: , �� Subtotal- 75 —
� Plan review (25% of permit fee):
Print name: SoiR° Am_ . ck Ng_L1 Date: 9 ///O o '—
State surcharge (8% of permit fee)• &
Authorized signature: a , u / ' i f / A C c , TOTAL PERMIT FEE. g
"7 This permit application expires if a permit is not obtained within 180
Print name: e t '/ I /, / � / e ? Date: 9/ ! / ^_ Q days after it'has been accepted as complete.
1/ / / • Number of inspections allowed per permit
1\Bmlding�Permus\ELC -Permn pilot 05/23/06 440 -4615 (11/05 /COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR200 1-00342 •
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/12/2007
Phone: (503) 639 -4171 01111
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 9/24/2007 TIME: 7:00AM PAGE: 61
SITE ADDRESS: 16045 SW UPPER BOONES FERRY RD CLASS OF WORK:
SUBDIVISION: FANNO CREEK PLACE LOT #: TYPE OF USE:
PROJECT NAME: FANNO CREEK PLACE
DESCRIPTION: Bldg C Data telecommunications.
OWNER: OPUS NORTHWEST, PHONE #: 503-519-4715
CONTRACTOR: BERGELECTRIC CORP 0n4 PHONE #: 503
Inspection Request Scheduled For: Date: 9/24/2007 Pour Time:
Code # Inspection Description 7 Confirm # Contact # Message
'135 Low voltage 056123 -01 971-246-9032 Y
IA el F041,
•�
Corrections /Comments /Instructions:
itd
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
[j] AIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
•
Inspector: C am , 1'V�� Date: 2 1 V I Phone #: (503) 718- 1'1040