Permit 7 '
CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2006 -00034
�� DATE ISSUED: 1/26/2006
. 41; ' --- " : '' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S113AD-01700
SITE ADDRESS: 16920 SW 72ND AVE ZONING: C -G
SUBDIVISION: ROSEWOOD ACRE TRACTS LOT: 030 JURISDICTION: TIG
Project Description: T -stats and wiring to existing roof -top units. Excludes new unit installed by others. Value:
$19,500
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: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: .
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
BRIDGEPORT LAND LLC PROTEMP ASSOCIATES INC
3939 NW ST HELENS RD 9788 SE 17TH AVE.
PORTLAND, OR 97210 PORTLAND, OR 97222
Phone: 503- 224 -2676 Contact #: PRI 503- 233 -691 1
FAX 503- 238 -9767
FEES Reg #: ELE 26- 1063CRE
LIC 38868
Description Date Amount
[ELPRMT] ELR Permit 1/26/2006 $75.00
[TAX] 8% State Surchart 1/26/2006 $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 rules are set forth in OAR 952 - 001 -0010
through OAR 95 -001-0100. You ma obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: ,_i ,, ) Permittee Signature: ,f_ j -- '
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:
Cali 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.
I .. -,. _. ' f (? LUL /II ^a'^^ ) + r' w i it F Ja � ,. 'y rr..,
Eiec* rival Permit Application 4 , . I. t )l /I I c l ' ( Sl t� i\' I l ° a+� v ;, . a xwµ
City of Tigard 1 JAN 2 6 2006 Received b Permit No. D06 _04 Dateiv . -a,(, -06
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 50 `� ,
L Date/By Other Permit:
Inspection Line: 503.639.4175 �� � x Date Ready/By: 1 El See Page 2 for
Internet: www.ci.tigard.or.us � �� DlNG DIM: j . Notified/Method: tJ Supplemental Information
TYPE OF WORK PLAN REVIEW .
❑ New construction t Ea t ddition/alteration/replacement Please check all that apply:
ID Demolition ❑ Other: ❑Service over 225 amps, come! ['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 yif Commercial /industrial ❑ Accessory building CI System over 600 volts nominal units in one structure
1:3 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
❑Health -care facility ❑Other:
Job no.: i'g' /2__ Job site address: i‘ 52 6 Si.! '2_4+�) Submit 2 sets of plans with any of the above.
City / State/ZIP d f (� The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: 1 �.S'P� r �' 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.: Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
. • . DESCRIPTION OF WORK - Each manufactured or modular
./ ` n ! f l � - dwelling, service and/or feeder 90.90 2
. kk sip A/`jD1 --� u; /i" /ms t Services or feeders installation, alteration, and/or relocation
E )C ( sc , s f 7 dp i 7� 200 amps or less 80.30 2
13 PROPERTY OWNER _ . ❑ . TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or 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 ❑ CONTACT PERSON • A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: /> T '7 ASS6 to 1l —es branch circuit
� B. Fee for branch circuits
Contact name: t1L� titht a,<<", without service or feeder fee, 46.85 2
first branch circuit
Address: 9 7 ''j se_ / 7 r ( Each add'l branch circuit 6.65 2
City / State/ZIP: oa-r L / � d � t 7 L) Miscellaneous (service or feeder not included)
Phone: (,"03) t' 6 i c Fax: : (sd3) zge -7 7� ? imp or irrigation circle 53.40 2
S �=l 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: sA�f AC 44 1
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
• ' ELECTRICAL PERMIT, FEES* .
CCB Lic.3M Si Electrical Lic.: /b�LJ/ 7 � Suprv. Lic.:J,c6 Subtotal
Suprv. Electrician signature, required: n " - ,'� Plan review (25% of permit fee)
Print name: R
o.`� VG Date: /--„2‘ State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: �� J This permit application expires if a permit is not obtained thin 180
days after it has been accepted as complete
Print name: iSe Vim, �Ne--tti Date: u. • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Building \ Permits \ELC- Pe,mitApp.doc 12/03 440.461ST(10/02/COM/WEB
.r.
Electrical Permit Application - City of Tigard
Page.2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
P RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ 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
❑ Boiler Controls
❑ Clock Systems
El Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i.\ Building \Pennits\EL.C- PennitApp.doc 04/03
4 CITY OF TIGAR® .. .
BUILDING DIVISION PERMIT #: p7,006 -- COO 3 e
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED:
Phone: (503) 639 -4171 11114 Alll
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: /, r 2, o 7 ), 4 , 14 / 44 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3- - .0: Pour Time: / (1- 7 11
Code # Inspection Description Confirm # Contact # Message
ri,e_ 4-q
LI q - 7 0
Corrections /Comments/ Instructions:
A PASS U PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
FAIL H CALL FOR INSPECTION 1 1 ADDITIONAL FEES ASSESSED
Inspector:
0 Date: 3 Q Phone #: (503) 718- 2i ix
crry OF TIGARD
. .
BUILDING DIVISION PERMIT #: ElJ 2oO& Oo034
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/26,120W:;
Phone: (503) 639-4171 Arali •
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 2/9!200G TIME: 7:04AIVI PAGE: 53
SITE ADDRESS: 1V0.0 SW "2ND AVE CLASS OF WORK:
SUBDIVISION: 1:ws[7 ACRE TRACTS LOT #: 030 TYPE OF USE:
PROJECT NAME: [)SW SHOES
DESCRIPTION: T•stats and wiring to exiling roof-top units. Excludes iew unit inalled by alms. Value: 11,160
OWNER: 131:1DGEPORT LAND LLC, PHONE #: 224.2676
CONTRACTOR: PROTEMP ASSOCIATES INC PHONE #: 503-233.E:91 I
Inspection Request Scheduled For: Date: 2/9/2006 Pour Time:
Code # I • -4- i - i stion - • # Contact # Message
136 ' _ow voltage 02656401 503-109.1314
Corrections/Comments/ nstructions:
CA)
•
PASS ri PARTIAL APPROVAL 111 CANCEL NO ACCESS
1 FAIL III CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: C_Y • ( NS Date. N3 oe' • 41 Phone #: (503) 718-
(j___A___