Permit C ITY OF T I GA R D ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: E-00069
DATE ISSUED: 4/4/2006 4/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 2S101DB
SITE ADDRESS: 07145 SW VARNS ST ZONING: C -P
SUBDIVISION: VARNS ACRES LOT: 012 JURISDICTION: TIG
Project Description: DATA AND PHONE
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:
HOA PHAM CORNERSTONE ELECTRIC LLC
12840 SW RIVER RD 6700 SE 72ND AVE
HILLSBORO, OR 97123 PORTLAND, OR 97206
Phone: 503- 628 -0422 Contact #: FAX 360 - 604 -3055
PRI 360 - 798 -3039
FEES Reg #: ELE 26 -1203C
LIC 158917
Description Date Amount SUP 4199S
Total REQUIRED ITEMS AND REPORTS
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: A Permittee Signature: v
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
Electrica _ Permit 1 `1,f, .1 i- _ - -. rt�1i c�rh Ic I:.ust: cmL�`
City of Tigard Received y . ../ / "36 Permit No. 2..p06_ p0 i -
13125 SW Hall Blvd., Tigard, OR 97223 pp 0 4 2006 Plan Review
Phone: 503.639.4171 Fax: 503.598.194,PK : f'�'• Date/By Other Permit ),096 •••00:116 Inspection Line: 503.639.4175 ' e'l I . . Date Ready/By. turfs ® See age 2 for
Internet: www.tigard- or.gov f i l i / i lJ f r l(` t_ w Notified/Method: Supplemental Information
`1 ��,,��� 1 VyIgN W6AWII` PLAN REVIEW • .
❑ New construction ' '! A ddition/alteration /replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l 0 Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
. CATEGORY OF CONSTRUCTION - of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling gCommercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
El Multi - family ❑ Master builder ❑Other: ❑Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: Job site address: -7 c 4'3 f i i i....4\15- ❑Health -care facility DOther:
Submit 2 sets of plans with any of the above.
City/ State/ZIP: — 1 - 16-1}4,9.0 o-p 1 '- 2) The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: v orit_. ")S w 2t..) NA._ FEE* SCHEDULE
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: Lot no 1 Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: \ Limited energy, residential I X 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
f
P D �R t At 4 Pots t'i _ tke,x) SP dwelling, service r fe 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: 91216t= 1/!4t, 4, 19t4 AAL LL(_ 601 amps to 1,000 amps 240.60 2
Address: -1 0.4<-- c v ►IttL -■f 9,„.-r Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State/ZIP: T/ {"A c iz_ , LLS Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) ' ? ` , _ ' 3 `FO Fax: ( ) 200 amps or less 66.85 I
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 S 447, 449, 670, an 701. 401 amps to 600 amps 133.75 2
Owner signature: ` Date: 4 a 4, Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT ' I ❑ CONTACT P ON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: ' y I , qy 4 Qo 1,4_,c_. 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 , - energypanel, alteration, or
extension Describe: ( Page 2 2
Business name: )23-- 1 ay \it.— .. _ .- ._
Address: 170 (GO x 4 1 S 3 — Each additional inspection over allowable in any of the above
j Per inspection 62.50
City /State/ZIP: 0/Q._ - 9 'a/ lJ d Investigation per hour (I hr min) 62.50
Phone: l 3 - - 1 .1 5 '-6g80 Fax: 6753) 541 —D112.-- Industrial plant per hour 73.75
i r 7v t.., I ELECTRICAL PERMIT FEES*
CCB Lic.: i5ggi1 1 Flectrical Lie.: Suprv. Lie.: Subtotal 7S '
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee) G
TOTAL PERMIT FEE CO
Authorized signature: c ----, T his 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\EL.C- PermitApp doe 12/30/05 440- 4615T(10/02/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:
El Audio and Stereo Systems*
El Burglar Alarm
❑ Garage Door Opener*
El Heating, Ventilation and Air Conditioning
System*
El Vacuum Systems*
El Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system. $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
❑ l Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
El Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
•
El Outdoor Landscape Lighting*
❑ Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1 \Bwlding\Permrts\ELC- PermnApp doc 11/30/05
CITY OF TIGARD
BUILDING DIVISION `, PERMIT #: ELR200G -0006
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/4/200
Phone: (503) 639 -4171 A Inspection Requests (24 Hrs.): (503) 639 -4175 .�' `'ll�
r : INSPECTION WORKSHEET FOR DATE: 9/1/2006 TIME: 7 : 01AM PAGE: 37
SITE ADDRESS: 07145 SW VARNS ST CLASS OF WORK:
SUBDIVISION: VARNS ACRES LOT #: Al2 TYPE OF USE:
PROJECT NAME: VARNS CORNER
DESCRIPTION: DATA AND PHONE
OWNER: PHAM, HOA PHONE #: 503-628-0422
CONTRACTOR: CORNERSTONE ELECTRIC LLC PHONE #: 360 -798 -3039
- Inspection Request Scheduled For: Date: 911/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 035944 -01 503- 597 -2425 N
Corrections /Comments /Instructions:
bo m001 e vE& cT11..:i■4
w ■1i A �� , ,i 1 Rsw L. '�'s
w1 lv ELU 200 6 ,
On ,
t,, .
0 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Ci y W Vp Date: Q 1 -60 Phone #: (503) 718- 2-44
it
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR200G 00069
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/412U6
Phone: (503) 639 -4171 4
Inspection Requests (24 Hrs.): (503) 639 -4175 „O°1IL
INSPECTION WORKSHEET FOR DATE: 5119/2006 TIME: 7:01AM PAGE: 35
SITE ADDRESS: 07145 SW VARNS ST CLASS OF WORK:
SUBDIVISION: VARNS ACRES LOT #: 012 TYPE OF USE:
PROJECT NAME: VARNS CORNER
DESCRIPTION: DATA AND PHONE
•
OWNER: PHAM, HOA PHONE #: 503 620 - 0122
CONTRACTOR. CORNERSTONE ELECTRIC LLC PHONE #: 36079+3.3039
Inspection Request Scheduled For: Date: 5/191200; Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 030203 -01 503-740-0125 N
Corrections /Comments /Instructions:
s‘-)ppc, ,v im/ c IN
LI per, ,arz"7{ C 171
N b CE L c,N *
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
774 FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Tht D� w Date: 6`"19 ' 640 Phone #: (503) 718 - ►^'
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR200v 0001 ;9
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/4 /2006
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET' FOR DATE: 4/12/2006 TIME: 7:04AM PAGE: 76
•
SITE ADDRESS: 07145 SW VARNS ST , • CLASS OF WORK:
SUBDIVISION: VARNS ACRES LOT #: 012 TYPE OF USE:
PROJECT NAME: VARNS CORNER
DESCRIPTION: DATA AND PHONE
OWNER: PHAM, HOA PHONE #: 503-628 -0422
CONTRACTOR: CORNERSTONE ELECTRIC LLG PHONE #: 360
Inspection Request Scheduled For: Date: 4/12/2006 Pour Time:
Code # ' Inspection Description Confirm # Contact # Message
135 Low voltage 027812 -01 503-740.7340 N
Corrections /Comments /Instructions:
(W PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 7 _ / 2- -06 Phone #: (503) 718-