Permit C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00320
•tGARD. 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/18/2008
g PARCEL: 1S135DA-03500
SITE ADDRESS: 11481 SW HALL BLVD 101 ZONING: C - P
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: HEALTH TOUCH
Project Description: Low voltage for HVAC.
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:
L N PROPERTIES, LLC WILLAMETTE HVAC
12725 SW 66TH AVE 3075 SW 234TH AVE. #206
PORTLAND, OR 97223 HILLSBORO, OR 97123
Phone: Contact #: PRI 503 - 628 -6841
FAX 503- 848 -2597
FEES Reg #: ELE 34- 346LHR
LIC 56951
Description Date Amount SUP 4025LEB
[ELPRMT] ELR Permit 11/18/200E $75.00
[TAX] 12% State Surch 11/18/200E $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
issuanc= , or if work! uspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility otification Cente . T - rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rule- or direct questions t. •UN 03.246.6699 or 1.800.332.2344.
/L. 0.‘,029-yEtion
Issu By: / / �� / j _ 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.
.y ° T a * �;f* —;, -- - b y. ", i s '4 -- .'4 sir's 't `'titA o, � t• ":.
Electrical Permit Application �i t ;. ' 1 -: 'FOR O USE ONL ` <-
Electrical RECEIVE. ° `° r ,z ,. - , . ...
Received ���
City of Tigard
syg� Permit No.: „` ? •
'✓ g Date/13y. r � . � �/ i '�� •
'� I ii
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
;- ;' ri Phone: 503.639.4171 Fax: 503.598.1960 NOV V 1 8 2008 Date /By: Other Permit
''',''� A 'I' Ins p ection Line: 503.639.4175 Date Ready /By: Juris: 171 See Page 2 for
aTIGARD;
, !:;;, mint, Internet: www.tigard- or.gov CITE' OF TIGAR 1 Notified /Method: Supplemental Information
TYPE OF WO1&UILDING DIVISION 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
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E", `1 -2 ", "1 - ",
Job no.: Job site address: 11481 SW Hall Blvd I001 -IP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: 101 Project name: Health Touch ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. I Fee. l Total 1
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'! 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
Relocate T -stat residential (with above sq. 0.)
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
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 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 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ 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'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
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: Willamette HVAC Signal circuit(s) or limited- ,- energy panel, alteration, or
Address: 3075 SW 234 Ave Ste 206 extension. Describe: 1 Page 2 7 2
City /State /ZIP: Hillsboro, OR 97123 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 628.6841 Fax: (503) 848.259, Investigation per hour hr min) 62.50
CCB Lic.: 56951 t Electrical Lic.: 36346CR S Irv. Lic.: 4025LEB Industrial plant per hour 73.75
/ ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: , c
Plan review (25% of permit fee) J ,...B- --
Print name: Mike Sicard Date: 11/14/08 p
1 State surcharge (12 %ofpermit fee): l . DU
Authorized signature: • TOTAL PERMIT FEE SL( .00
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 inspectionsallowed per permit.
t: \ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(! I /05 /COM/WEB
F TIGARD
DING DIVISION PERMIT #: El.R2000. 00320
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/18/2008
Phone: (503) 639 -4171 j
Inspection Requests (24 Hrs.): (503) 639 -4175 "�I
INSPECTION WORKSHEET FOR DATE: 1/5/2009 TIME: 7 :01AM PAGE: 23
SITE ADDRESS: 111181 SW HALL BLVD 101 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: HEATH TOUCH
DESCRIPTION: Low voltage f or HVAC.
OWNER: L N PROPERTIES, LLC, PHONE #:
CONTRACTOR: W1(,LAM(TTE HVAC PHONE #: 503-628.6841
Inspection Request Scheduled For: Date: 1/5/2009 Pour Time:
Code # Inspection Description Confirm # - -' Contact # Message
. 199 Electrical final 07935401 971 -9913 ?908 N
1 ....=.---,
Corrections /Comments /Instructions: \
4*.: thg. r ■ - 1 \ 1 1 1 ` + '
\Ai! \ i
V
1 , PASS ❑ PARTIAL APPROVAL CANCEL ❑ NO ACCESS
■ ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector:, ' 0 Date: 1 " (5• e f Phone #: (503) 718- .2,11/b
OF TIGARD
B ILDING DIVISION PERMIT #: ELR2008- 00320
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/18/20(8
Phone: (503) 639 -4171 • Ate
Inspection Requests (24 Hrs.): (503) 639 -4175 e1' _ I ..
INSPECTION WORKSHEET FOR DATE: 11/20/2008 TIME: 7:00AM PAGE: 15
SITE ADDRESS: 11481 SW HAIL BLVD 101 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: HEALTH TOUCH
DESCRIPTION: I...ow voltage for HVAC.
OWNER: L N PROPERTIES, LLC, PHONE #:
CONTRACTOR: WII-I-AtiMn rE HVAC PHONE #: 50:s•G28 -8341
Inspection Request Scheduled For: Date: 11/20/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
196 Mir::c. inspection 07831302 971.998"2908 Y
Corrections /Comments / Instructions:
ry
L-1/
/140k; e / eyc '/
PASS •
❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
g24I Inspector: Date: / 1 " .LO - f Phone #: (503) 718-