Permit I TY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00039
DATE ISSUED: 2/20/2008
TIGARD; 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S111AD - 03800
SITE ADDRESS: 08950 SW PINEBROOK CT ZONING: R - 4.5
SUBDIVISION: PINEBROOK TERRACE LOT: 035 JURISDICTION: TIG
PROJECT: HALL
Project Description: Installation of low voltage for audio /stereo wiring.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: X 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:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
ROBERT & LINDA HALL OWNER
8950 SW PINEBROOK CT
TIGARD, OR 97224
Phone: 503- 788 -6947 Contact #:
FEES Reg #:
Description Date Amount
[ELPRMT] ELR Permit 2/20/2008 $75.00
[TAX] 12% State Surch 2/20/2008 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
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 dir- . .. - - • _ • to OUN at 503.246.6699 or 1.800.332.2344.
•
Issued : / . &02.(1-Al 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.
� t >
a .bTa t. a ; �� 'fr`.!" +�lW e Zt- �+,*'&3';E 2"�.k?��5^ a % a--� ? ,
Electrical Permit Application ,-- 4 r FOR OFFIC ONLY sue, ,�;--
, 1-,,,:5;: ,--
Received n n C, Q
City of Tigard Date/By: NI d g i Permit No.: gis. 9 •19
q . 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
17 Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
f I C n R D Inspection Line: 503.639.4175 Date Ready/By, lu El See Page 2 for
. Internet: www.tigard or.gov Notified/Method: ((0. Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑Demolition ❑ Other: 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. A
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 - ",
Job no.: Job site address: q 100HP or more. occupancy.
` S V f L!/ /1:47
i ky , / ��,� ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: / ❑ Health -care facilities. ❑ Supply voltage for more than
"7 d� �` 7 Z ❑Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: ,/J / ? ❑ Service or feeder 600 amps or more.
// Y •16 t - / / G /A. FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total ) •
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 75.00 2
DESCRIPTION OF WORK. (with above sq. ft.)
// / Limited energy, multi - family 75.00 2
AZ ff'n `/ .(�/G�C/ / w Piv //ir �y �a ---/. -] residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
// �� /� 401 amps to 600 amps 160.60 2
Name:
��lr'r / < 601 amps to 1,000 amps 240.60 2
• Address: 8 � -jt ,-v 4-G.,1 C.-' Over 1,000 amps or volts 454.65 2
City/State /ZIP: / � ��� �12 Z� Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ?) 12 f ' 9 - 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 r branch circuits s with
❑ PLICAN ❑ " CONTACT :PERSON , above service or feeder fee 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
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: Signal circuit(s) or limited-
energy panel, alteration, or
Address: extension. Desc / Page 2 2
e e ,
�ubi o fF /
City/State /ZIP: Each additi nal inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 75 a
Print name: Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee): t;0
Authorized signature: TOTAL PERMIT FEE: "e-7. DU
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit. •
11Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard ..
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
F RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
udio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
l COMMERCIAL WORK ONLY: ' _
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1 \Building\Permits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: L LR200B- 010039
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2.00/20013
Phone: (503) 639 -4171 ,,'' ��i�����i i+
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3120/2008 TIME: 7:0 rAM PAGE: 42
SITE ADDRESS: 08950 SW PINE BROOK CT CLASS OF WORK:
SUBDIVISION: PUNEI3ROOK. TERRACE LOT #: 035 TYPE OF USE:
PROJECT NAME: HALL
DESCRIPTION: Installation of low voltage for audio/stereo wiring.
OWNER: HALL, ROBERT & LINDA PHONE #: 603-788-6947
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 3120/2008 Pour Time:
Code # Inspection Description ( - #, Contact # Message
135 Low voltage \ \ Ot 067008 -01 N \ 603-624-5688 N
1 G f it AL--. •
Corrections /Comments /Instructions: �
. �
a
,/f
\...
PASS n PARTIAL APPROVAL n CANCEL I I NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: N6V �i Date: * S - 10 • 01) Phone #: (503) 718- 2,91-lb