Permit \
14 :1V. ' II CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° .:ri COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00210
DATE ISSUED: 6/19/2007
TI.94 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
n >. PARCEL: 2S104AC - 14000
SITE ADDRESS: 12902 SW HILLSIDE TERR ZONING: R - 4.5
SUBDIVISION: HILLSIDE ESTATES LOT: 005 JURISDICTION: TIG
PROJECT: HILLSIDE ESTATES
Project Description: Low voltage for new SF.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: X AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: X BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: OMMUNICAT : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
ASCEND CONSTRUCTION INC QUADRANT SECURITY INC
16142 SW POLLARD LN PO BOX 14833
TIGARD, OR 97224 PORTLAND, OR 97293
Phone: 503- 484 -8581 Contact #: PRI 503- 234 -5558
FAX 503- 236 -2322
FEES Reg #: ELE 26- 565CLE
LIC 96806
Description Date Amount
[ELPRMT] ELR Permit 6/19/2007 $75.00
[TAX] 8% State Surcha 6/19/2007 $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 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: /1,/,/ 0 • _ - 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: 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 6 ; F rb ` ti i o Folz OFFICE USE ONLY
City of Tigard Received �� Permit N o.:
DateB : /S 0 7 2 ECR,WO 7 •0 ' / 0
' 13125 SW Hall Blvd., Tigard, OR 97223
g Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 JUN 1 9 2007 ' I' DateB • O - 9O 3'?
Inspection Line: 503.639.4175 "!! Date ReadyBy: Juris: J See Page 2 for
Internet: www.ci.tigard.or.us cr ry )f 1 i a• Tj 2 Notified/Method: Supplemental Information
1Y:x.t1'�It'f1 -PLAN REVIEW • ' '
New construction ❑ Addition /alteration/replacement Please check all that apply:
Demolition
0 ❑Service over 225 amps, comm'I ['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
- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑ System over 600 volts nominal units in one structure
12 Multi- family ❑Master builder ❑Other: ❑Buildin over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION R park
❑Egress lighting plan P
Job no.: Job site address: I a01(2 T t 1i \ f Health -care facility ❑Other:
r Submit 2 sets of plans with any of the above.
City/ State/ZIP: 5 s —c 0K...., The above are not applicable to temporary construction service.
Suite/bldgiapt. no.: Project name:�� C C 1 fA l 13� l FEE* SCHEDULE
Description I Qty. I Fee. I Total
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: I Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential t 75.00 --73 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
/�� j � r dwelling, service and/or feeder 90.90 2
l l j Services or feeders installation, alteration, and/or relocation
l 0 200 amps or less 80.30 2
❑ PROPERTY OWNER 1 . _ ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: /1-se -�� (/ ) N S ZGf c-770 Al , 601 amps to 1,000 amps 240.60 2
Address: /6 /yes , Cu} A4 G G /VI G/I Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP:
T /G ,9/� / - /L 9 7a Temporary services or feeders installation, alteration, and/or
( -� ) / f y G I ( ) relocation 00 ams
Phone: d(� / a Fax: 200 am 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 , • ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
Contact name: B. Fee for branch circuits
without service or feeder fee, 46.85 2
Address: each branch circuit
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: ( ) I Fax: ( ) Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited-
CONTRACTOR - energy panel, alteration, or
� . extension. Describe: Page 2 2
Business name: ( %i - n-�- C J -
Address: PO dJ03c.. ' L' Each additional inspection over allowable in any of the above
L Per inspection 62.50
City/State/ZIP: hG /- -`7 l f /�O ��. . ) q 3 Investigation per hour (I hr min) 62.50
Phone: (03 ) 3 Li - 555(K Fa (5() 3 )3L2 --a cQ Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
State surcharge (8% of permit fee)
CCB Lic.: �bc�. // Electrical Lic.:a(� I Suprv. L j J5 ! f Subtotal 75
Su Electr sign lure, required' Plan review (25 %ofpermit fee)
/"� -7
Print name: :1n 9 ) L I Z.) 1 J _2,��c I Date: `C � j C� l'L/ �
TOTAL PERMIT FEE t) ` ` ��
Authorized signature: � % t I1) /� This permit application expires if a permit is not obtained within 180
k / y x - / days after it has been accepted as complete
Print name: ii ,I� `. , Ali Date: I • Fee methodology set by Tri -County Building Industry Service Board
• • Number of inspections per permit allowed.
1:\ Building \Permits\ELC- PermilApp.doc 12/03 4404615T(10/02/COM/WEB
CITY OF TIGARD Ee4 a 06 —00a/ b
BUILDING DIVISION PERMIT #: M T20$r 3311
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3f'3t?f 2007
Phone: (503) 639 -4171 Are ^ij�l
Inspection Requests (24 Hrs.): (503) 639 -4175 s `�:_.._
INSPECTION WORKSHEET FOR DATE: 6/20/2007 TIME: 7:04AM PAGE: 3f
SITE ADDRESS: 12002 SW HILLSIDE TERR CLASS OF WORK:
SUBDIVISION: HILLSIDE ESTATES LOT #: 005 TYPE OF USE:
PROJECT NAME: HILLSIDE ESTATES
DESCRIPTION: New SF.
OWNER: ASCEND CONSTRUCTION INC, PHONE #: 50:3484-8581
CONTRACTOR: ASCEND CONSTRUCTION PHONE #: 503 - 484 -8581
Inspection Request Scheduled For: Date: 6/20/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 050566 -01 503- 484 -8581 N
Correcti ns /C mrients /Instructions:
AA Mehl p/U,Vidi
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1.,,-- l2 CDO 7- t)2./ w
I I PASS 1 1 PARTIAL APPROVAL n CANCEL NO ACCESS
U FAIL 1 1 Cke_L FOR INSPECTION n ADDITIONAL FEES ASSESSED
l� V
Inspector: D ate: Phone #: (503) 718-