Permit 9,, , vg
C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
z r , � DEVELOPMENT SERVICES PERMIT #: ELR2006 -00051
�.� I� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 2/13/2006
PARCEL: 2S102CB -03101
SITE ADDRESS: 12950 SW PACIFIC HWY 265 ZONING: C -G
SUBDIVISION: HUDSON PLAZA LOT: 021 JURISDICTION: TIG
Project Description: 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:
HENDERSON, MARILYN DOROTHEA HENKELS & MCCOY INC
•
JENSEN HUDSON TRUSTEE 5000 NE 148TH AVE
11795 SW KATHERINE ST PORTLAND, OR 97230
TIGARD, OR 97224
Phone: Contact #: PRI 503 205 - 1720
FAX 503- 205 -1713
FEES Reg #: ELE 26- 895CLE
LIC 63699
Description Date Amount
[ELPRMT] ELR Permit 2/13/2006 $75.00
[TAX] 8% State Surchart 2/13/2006 $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 rul : s are set forth in OAR 952 - 001 -0010
through OAR 952 -00 -0100. You may obtain copies of these rules or dire• q estions to OU C - - 6699.
Issued By: _Air, _ � Permittee Sign • _ab! , /1 `� ih
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 • e r n FOR OFFICE USE ONLY
City of Tigard t Received �f /� / , �/J�/J
Date /B , 1 .7 fV 6 rv Permit No.: Y �,I per(/V ll U tK. ) I
13125 SW Hall Blvd., Tigard, OR 97223 Plan Rc cw (J
Phone: 503.639.4171 Fax: 503.598.19 ".111401,, Date /By: Other Pm
Inspection Line: 503.639.4175 �E� 1 2006 ,� °'l � Date Ready /By: Juris: E1 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: 4"] Supplemental Information
, L NIA fE � All wtz•Wr t t ( `� A PLAN REVIEW
['New construction ddiCibnTelterarYjpileenient Please check all that apply:
❑ Demolition ❑Other: ['Service over 225 amps, comm'l ['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 EfCommercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ 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.:5K1'987q Job site address: / USD Sts giCiA Ye..Ar M ❑Health -care facility ['Other:
Submit 2 sets of plans with any of the above.
City/State /ZIP: j i 10 / 9 1 Z z 3 The above are not tplicable to temporary construction service.
Suite /bldg. /apt. no.: 265 Project name: s t re j c. Vim FEE* SCHEDULE
1.......... 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.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90.90 2
1 ,'w p� C r��t �9 - Services or feeders installation, alteration, and/or relocation
v ` 200 amps or less 80.30 2
❑ PROPERTY OWNER 0 TENANT 201 amps to 400 amps • 106.85 2 • 401 amps to 600 amps • • • 160.60 2
Name:. .. . • 601 amps to 1,000anips - 240.60 2
Address: Over 1,000 amps qr 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,
first branch circuit 46.85 2
Address: Each add'I branch circuit 6.65 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax:: ( ) Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: 1 Page 2 2
Business name: (4-Q41CG4 f net e C� / ` �hG
�b O o ITV' ' Address: N C sr Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: O ,,-1.-- n I - 912-3 t0 Investigation per hour (I hr min) 62.50
Phone: ( cb3) OS - /1-w Fax: (92) 2215' ( 7 /3 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.:k? 6,gq Electrical Lie.: ,49s L(( Suprv. Lie.: Subtotal 15 ° P
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee) 40 i
TOTAL PERMIT FEE g
Authorized signatu • /ul ■ L- LLLL --��� - � p^ This permit application expires if a permit is not obtained within 180
L!� fit/ ` : 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 pennit allowed.
i:\Building \Permits \ELC- PermitApp.doc 1 440.4615T(10 /02/COM/WEB