Permit "p CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00104
Ti ARD: 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/29/2008
G.
PARCEL: 2 S 102 C B -0010 0
SITE ADDRESS: 12850 SW GRANT AVE ZONING: R -12
SUBDIVISION: CF TIGARD ELEMENTARY LOT: 041 JURISDICTION: TIG
PROJECT: BROADWAY ROSE THEATRE CO
Project Description: Installing (1) low voltage data system.
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:
TIGARD TUALATIN SCHOOL DIST. #23 PAVELCOMM INC
6960 SW SANDBURG ST 1640 NW 14TH AVE
TIGARD, OR 97223 PORTLAND, OR 97209
Phone: Contact #: PRI 503- 223 -5008
FAX 503- 223 -0104
Reg #: ELE 26- 559CLE
FEES L1C 63963
Description Date Amount SUP 699LEA
[ELPRMT] ELR Permit 4/29/2008 $75.00
[TAX] 12% State Surch 4/29/2008 $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 direct questions to OUNC at 503.246.66• • .0 ,800.332.2344.
00.332.2344.
Issued B — — Permi ee 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.
�7 Tam^' 1.Y � 137,19'c ,`r".•r. `lf ,Pl'4i rL .n L vr ', y i. V;
T
F1Q�lkr' ;C81 Permit Application c t E i, , i i " ' +l i ' t ,, C t l It :t rf 1r It • - 1 i i �l 1 I'+ ti 3 ' f
_ ytt ® l} r ix 1 �Id w17' Sf " ca LW a F�SNGtlf4'9� v w } aLfil w iu Anrrss° of & .iu . -l+
ia; •''' City of Tigard -' Ott, v tc/Dx enmtNo.: , &• l/l )
1315 SW Hall Blvd., Tigard OR 2 Pl Review y
i y r ® Other Permit: V W
Phone: 503.639A171 Pate: 503.595.1960 r $ 2�Q Dnte/13Y:
r +, n nN Inspoetirut Lane, 503,639. p,PR 1 ) Data.Rc.dy /I0y: mat: C to t:Q rage :mr
xv a ,R :, m' • M (mum: WwW.CI(jaid -01.gaV ��1 Neti�.ad /Marhedt SuFPlefoeecfelba�ormellun
rgP>y OF W i'�1J- ... .
New cotlstfltctimn ❑ _____:__....___,:_l
Additi /alte inert Please cheek all that apply (submit a eels or plans w/itcme checked below):
❑ ' y-• ) , _ El &mica or seder 00 amps or mew ❑ Building over thfn. ease.&.
0 Demolition 0 Other: alters tin uvalloble fault current O marinas and boatyards.
CATEGORY O CONSTRUCTION ' exceed° 10.000 amps of 150 volts m 0 Plondngbta&ings.
tens to mend. er exceeds 14.000 0 Co amacint agricultural
0 1- and 2- family dwelling XCommerrial /industrial 0 Accessory building amps flat all other:nstallatians. buildings.
0 Multi - family 0 Master builder ❑ Outer• 1 CI Pita porno. 0 'mutilation 0(75 XVA er
CI Ementency system- lager separately derived system
• . • JOB SUE INFORMAnoiN AND WCA?ION [1 Addition of new motor Ind of ❑ "A " "0'. "1-2"."1-3'.
1 0070' or more. oft o y'• :
Job no.: ' Job site , • dress: fila ROWNIPWrit ❑ 6:. er more residential units. El Recreational vehicle parks.
My/State/ZIP: I / 1:3 lr zard f ides. ❑ Supply voltage for mart than
il r MO _ 0W zardwts locations. 600 volts notninnl.
Suite/bldg. /apt. no.: 1 Project name_ 1 as / / ' 0 / _ D Service ar feeder 600 amps or mein.
w� '• ;' •
Cross street/directions to job site: / I ir / 'art aen ` - rot"t •
New raildential single- or multi- family dwelling Unit
includes attached garage.
.......-- Lot no_: 1.000 sq. ft. err less 145.15 4
Subdivision : ��. Fa. adell 500 aq. ft. orr portion 33.40 1
Tax map /parcel no.: Limited energy, rzsidential 75.00 2
DESCRIPTION. OF WORK ,_,�s_h above sq. 7t3 :
l,i rttivad energy_ multi-family
75,00
r a o residential (with allow', it -)
• Services or feeders installation. alteratton Radler reletstion
+ L . / . 200 amps or less 80.30 2
0 .: pp y � • D TENANT 201 amp to 400 amps 106.85 2
Nome: 40 ]. amps to 600 amps 160.60 2
601 amps w 1.000 amps 240.60 2
Address: OVCr 1.000 amps or valtt 454.65 2
temporary services or lecdcra iesmrtation, olteisition, ana%t[r
City/State/ZiP: relocation M Phone: ( ) Fax: ( ) 200 amps or leas 6G.8$ 1
201 amps lb 400 am. S 10030 2
OWner installation: This installutti is being made on property that 1 own which is not 133.75 2
intended for sale, lease, rent, or exchange, according m 401 amps to 400 ORS 447, 449, 670, and 701. >, Rranel euita —toew alterati e: tc 1S3.7 . er tartans
Owner signature: Datc: - A,Pec for branch circuitls with
• • ❑ APPLICANT "' • " Q CONTACT PERSON above service Or Seeder fox, 6.65 2
each branch circuit
Busincos name; B. Fcc for branch oircvit ,
without =mine or realer fee, le. S5 2
Contact name: first branch circuit
Each add'I branch circuit j ' 1 6.65 r
Address: Miscellaneous (service or kcdcr not included) .
City /StatdZtP: Each manun!ctwvd or modular 90 -40 2
dtio111n , an
carvice d/or frcd
Fax: ( ) Reconnect only 66.10 2
Phone: ( )
'
E - mail; Pump or irrigation circle 53. 2
CO : CTOR timd-
Sign or outline lighting 53,40 ., 2
. r ' j / 'Signal circuit(F) or ite
Business name. L � (,_ energy panel- alteration, or
Address:
� '' ; , a. / Li e:Rension. Dear ibe: / Page 2 2
• 1Eueh additional Inspection over avowable in anporthe above
City/sane/zit , � _ • • Per inspection 62.5
P , ,�' NI r el. F;•. ) _ 41 Iaveftigavon per lam (1 hr mill) 62 50
� , r ` .1 Industrial . ant per hour 73.75
CCB Lis: /� /�� Electrical '. � ' LIB 'al' � L rig I / �� • �,EtcuuCa,�, rERlvltr . —
Suprv, Electrician signature, requi •���i...-/�L / / l r / . a Su ' -
v _ Plan ttview(2of permitfee): 07
Print name: Ay rV
es I C.i Data: r 4 u Staid surcharge (112 °!a % of permit fee): 00
Anitllnrized sig nature: — TOTAL PERMIT P . : • I Or r
This permit application expires ir! permh Is not obtained within Ian
Print name• , Date: days liter is We boa aectotul eamptete-
J' - Number of instteationa nllowrd jr e satrap.
1: 1. 0aldlitcg 'ermit5bLC- r'ermhp0P,dnc ntAllio6 4i 41lisnilieS /COMrMtFA
Received 04 -25 -2008 02:39pm From To- PAVELCOMMI INC Page 001
9171-d E00/100 d 1171 -1 P010E22E03 ONI 11110013AVd -woad we5b:80 8002-82-P0
CITY OF TIGARD
'l . 2U 3?
BUILDING DIVISION PERMIT #: FLF2C)U8 0(litl�i
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4p9/200
Phone: (503) 639 -4171
Ai, / i F,II
Inspection Requests (24 Hrs.): (503) 639 -4175 s . .
INSPECTION WORKSHEET FOR DATE: 1271/2088 TIME: 7:0OAM PAGE: 20
SITE ADDRESS: 121#60 SW GRANT AVE CLASS OF WORK: i"
SUBDIVISION: Cr' TIGARD ELEMENTARY LOT #: (y,11 TYPE OF USE: /' I
PROJECT NAME: BROADWAY ROSE THEATRE CO
DESCRIPTION: Installing (1) IOW voltage data system.
OWNER: TIGARD TUALATIN SCHOOL DIST. #23, PHONE #:
CONTRACTOR: PAVELCOMM INC PHONE #: 503-223 -501)8
Inspection Request Scheduled For: Date: 12/1/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 070614.01 5113 -223- 5000 Y
Corrections /Comments/ Instructions:
A "~ „.eak-:-ice :...L111W:� 411a
-- - V
(ejl,' �-.• ' A A PPROVAL ❑ CANCEL ❑ NO ACCESS
❑ CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: Mi Date: / z — / -- 'zP Phone #: (503) 718-