Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
''g ' COMMUNITY DEVELOPMENT PERMIT #: ELR2006 - 00312
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/26/2006
PARCEL: 2S 101 AA -08200
SITE ADDRESS: 12455 SW 68TH AVE ZONING: MUE
SUBDIVISION: WEST PORTLAND HEIGHTS LOT: 029 JURISDICTIO (IG
Project Description: McGee Financial. Protective Signal. 5� 1) B
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER: .
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
rii
ROTH, JACOB TIMOTHY JR + THERESA REIGN COM INC
12600 SW 72ND AVE #200 11954 NE GLISAN STE. 232 � ,.
TIGARD, OR 97223 PORTLAND, OR 97220 1111". ) ( , J EZJ10
Phone: Contact #: PRI 503- 262 -9335 311: O v
FAX 503- 256 -7813 C . 0
)e ` O
FEES Reg #: ELE 26- 1009CLE Cr"
LIC 129318 S
Description Date Amount 0
[ELPRMT] ELR Permit 12/26/200E $75.00 0
[TAX] 8% State Surcha 12/26/200E $6.00 REQUIRED ITEMS AND REPORTS CO
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 or 1.800.332.2344.
Issued By: ,..„:.:,.-3‘ A t -'� Per 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:� r '; 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.
INSPECTOR'S SIGNATURES ARE NOT
Inspections Required for: ELR2006 -00312 REQUIRED ON GREEN INSPECTION CARD.
✓ Code I Inspection Description I PASS Date I By ✓ Code I Inspection Description I PASS Date I By
BUP - Building Permit ELC - Electrical Permit
405 Excavation 105 Underground/slab cover
410 Fill 110 Temporary electrical service
415 Grading 115 Electrical service
205 Footing 120 Electrical rough -in
805 MFG - Structure grading/footing 125 Wall cover
210 Foundation walls 130 Ceiling cover
215 Footing drain 135 Low voltage
220 Slab 140 Sign installation
310 Crawl drain 145 A/C or heating unit circuit
225 Post/beam structural 150 Hot tub /spa/pool
230 Underfloor insulation 195 Misc. inspection:
235 Shear walls /anchors 199 Electrical final
240 Exterior sheathing
245 Firewall
250 Roof nailing ELR - Restricted Energy Permit
255 Wtr proofing basement walls X 135 Low voltage
260 Tilt -up panel 195 Misc. inspection:
265 Masonry X 199 Electrical final
270 Reinforcing steel (rebar)
275 Framing
810 MFG- Structure set-up MEC - Mechanical Permit
280 Insulation 605 Post/beam mechanical
285 Drywall nailing 610 Gas line
287 Suspended ceiling 615 Mechanical rough -in
295 Misc. inspection: 620 Hydronic piping
899 MFG - Structure final 625 Duct work
498 Grading final 630 Fire damper
299 Final inspection 635 Smoke detector shutdown
640 Exhaust hood
695 Misc. inspection:
699 Mechanical final
BUP - Fire Protection System Permit
905 Sprinkler underfloor /slab PLM - Plumbing Permit
910 Sprinkler rough -in 305 Plumbing underslab
915 Fire alarm rough -in 310 Crawl drain
920 Suppression trip test 315 Post/beam plumbing
995 Misc. inspection: 320 Plumbing rough -in
998 Alarm final 322 Shower pan
999 Sprinkler final 330 Water service
335 Rain drain
340 Storm drain
SIT - Site Work Permit 505 Sanitary sewer
405 Excavation 345 Culvert/catch basin
410 Fill 350 Septic tank
415 Grading 395 Misc. inspection:
205 Footing 399 Plumbing final
210 Foundation walls
215 Footing drain
420 Sprinkler supply lines SWR - Sewer Permit
495 Misc. inspection: 505 Sanitary sewer
498 Grading final 595 Misc. inspection:
• 499 Final inspection 599 Final inspection
\Building \Inspection Cards \Forms \AOP- InspCard- B1ank.doc 12/09/2005
CITY TIGARD I ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2006 - 00312
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/26/2006
PARCEL: 2S 101 AA - 08200
SITE ADDRESS: 12455 SW 68TH AVE ZONING: MUE
SUBDIVISION: WEST PORTLAND HEIGHTS LOT: 029 JURISDICTION: TIG
Project Description: McGee Financial. Protective Signal.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
ROTH, JACOB TIMOTHY JR + THERESA REIGN COM INC
12600 SW 72ND AVE #200 11954 NE GLISAN STE. 232
TIGARD, OR 97223 PORTLAND, OR 97220
Phone: Contact #: PRI 503- 262 -9335
FAX 503- 256 -7813
FEES Reg #: ELE 26- 1009CLE
LIC 129318
Description Date Amount
[ELPRMT] ELR Permit 121261200E $75.00
[TAX] 8% State Surcha 12/26/200E $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 or 1.800.332.2344.
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: �L 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 Application , FOR OFFICE usr. ONLY •
City of Tigard UT y; re d ' , /, / 6 7 t Permit No.: (( A., e cup; , r
. ° 13125 SW Hall Blvd., Tigard, OR 9122r— Plan Review
=
'
C v c
Phone: 503.639.4171 Fax: 503.598.1Qr C 2, S Z0 D /B Other Permit:
TI G A I: D Inspection Line: 503.639.4175 �R® Date Ready/By. 65 See Page 2 for
Internet: www.tigard or.gov C fri ,fir Ti V ` S ION N otified/Method Supplemental Information
PE OF ��I.� « PLAN REVIEW
El New construction Addition/alteration/replacement VI Please Bieck all that apply (submit? sets of plans wltems checked below):
El Demolition ❑Other ❑ Service or feeder 400 amps or more ❑ Building over three stories.
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
❑ 1- 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 ", "I -2 ", occupancy.
"I -3 ",
Job no.: Job site address: /Z9( r S C_.) t /ft ),4 IOOIIP or more. 0 iP
❑ Six or more residential units. ❑ Rec p anonal vehicle parks.
� u'
City / State/ZIP: / ❑ Health-care facilities. ❑ Supply voltage for more than
I ) °71222-3 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: Project name: Ili d r�4 / h ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qtr. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
�,� �, / L energy, multi - family
>i'2?s.�v/ a l - oQ I f �ce_42 -zs v �c / residential (with above sq. ft.) _ 75.00 2
Services or feeders installation, alteration, and/or relocation
I 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: ( ) 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,
) each branch circuit 6.65 2
Business name: � 1 2 ( J. yr / , j J C B: Fee for branch circuits
�/� t- � without service or feeder fee,
Contact name: / �/ /Ai ( -i ! 4 first branch circuit 46.85 2
Address: // 5 � 6 � ,) , 772,_ z.3 Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not Included)
City/ State/ZIP: / J 2 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( )
Reconnect only 66.85 2
E -mail: Pump or irrigation circle . 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: M .zioyv� - -L /ll Signal circuit(s) or limited -
energy panel, alteration, or
Address: () J � extension. Describe: / Page 2 2
City /State/ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (3) 2z _ 9 33 $ Fax: ( 5)3 2 _ f g(' Investigation per hour (t hr min) 62.50
CCB Lie.: )Z93/25 Electrical Lic.:24 - j Suprv. / Lic.: (4•762,A_ Industrial plant per hour 73.75
11.. ? ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 304 Subtotal:
Print name: C:�{> e / /Vf C/( Date: (2/z4, 94
Plan review (25% of permit fee):
State surcharge (8% of permit fee):
Authorized signature: TOTAL PERMIT FEE:
Print name: Date: This p ermit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• I :rBhdiding PamibtELC -Pe nMpp.doc OS/23 /06 Number of inspechoos allowed per permit.
MOJ6I ST'(1 I /OS/COINAV®
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
❑ 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
El Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
j s4 rotective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\&rildmg \Pemiu\ELC- PamitApp.d« 03/23106