Permit q►`-
C ITY O T I R ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES I PERMIT #: ELR2006 -10004
���I' DATE ISSUED: 3/1/2006
` 13125 SW HaII Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 25101 AA - 06400
SITE ADDRESS: 12323 SW 66TH AVE ZONING: C -
SUBDIVISION: WEST PORTLAND HEIGHTS LOT: 024 JURISDICTION: TIG
Project Description: All encompassing.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: X AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: X BOILER: ,ANDSCAPE/IRRIGAT:
GARAGE OPENER: X CLOCK: MEDICAL:
HVAC: X DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: X FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: LL ENCOMP : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: O IHER: :
TOTAL # OF SYSTEMS:
Owner: Contractor:
TING, ELON + SYLVIA DYNALECTRIC
BY WILLIAM R SOUTHARD 2904 SW FIRST AVE.
603 SE VICTORY AVE STE 100 PORTLAND, OR 97201
VANCOUVER, WA 98661
Phone: Contact #: PRI 503- 226 -6771
FAX 503- 226 -7720
FEES Reg #: ELE 26 -59C
LIC 64793
Description Date Amount SUP 4653S
[ELPRMT] ELR Permit 3/31/2006 $75.00
[TAX] 8% State Surcha 3/31/2006 $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 952 - 001 - 0100. You may obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: ` , , ` Permittee Signature: ..•• •/ /y ,,,
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or re i t.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: D TE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that busines day.
This permit card shall be kept in a conspicuous place on the job site until co pletion of the project.
Approved plans are required on the job site at the time of each i spection.
3— 1 -06; 9:53AM;Dynalectric service 603 226 . 7720 # 2/ 4
J etrifal Permit Appl rylit b i E V `)V f OR O I(_L'USL ONLY ., :•..,f;!=;;;!:.';
•ter , - �, �
- ?f
City 0t-Tigard Received
13125 SW Hall Blvd., Tigard, OR 97223 Date/13 : 3 • (7 '' Permit No.
Phone: 503.639.4171 Fax: 503.598.1960 t� /, //4,. Plan Review
Inspection Line: 503.639.4175 I 2� i ,*c!' Date/B OtherPernit:
_ Date ReadY/BY: 3u ® See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGA ,. • Notified/Method:
[�3} 1' rr}} r�(��ni� Supplemental Information
TYPY11CVW,ORK.11 /810f4.t PLAN REVIEW
❑ New construction Addition /alteration /replacement Please check all t .t apply:
❑ Demolition ❑ Other: ❑Service over 2 , 5 amps, comm'I ❑Hazardous location •
CATEGORY OF CONSTRUCTION ❑Service over 3 1 amps — rating ❑ Buildng over 10,000 sq. ft.,
of 1- and 2 -fa ly dwellings 4 or more new residential
❑ 1 and 2 family dwelling J Commercial /industrial ❑ Accessory building ❑System over 601 volts nominal units in one structure
❑Building over ree stories ❑Feeders, 400 amps or more
❑ Multi family ❑ Master builder ❑ Other:
❑
JOB SITE INFORMATION AND LOCATION Occupant load , ver 99 persons ❑Manufactured structures or
' ❑Egress/lighting •Ian RV park
Job noi/�4 ��Job site address: /A J� ❑Health -care foci ity ['Other: / �'� 3 �� '•"�" ' ' � _ Submit 2 sets of .lans with any of the above.
City /State /ZIP: T�•7 � Q 9- The above Qn 7 JOa� „" are not - pp licable to temporary construction service.
Suite /bldg. /apt. no.: Project name: �• . FEE *. SCHEDULE`` ` -.
r / , •Sei m , Description I Qty. I 'Fee. I Total
Cross street /directions to job site: New residential si gle- or multi - family dwelling unit.
Includes attached ,: , rage.
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, re dential 75.00 2 -
DESCRIPTION OF..:WOR1K r at r tz�,,
Limited energy, no - residential 75.00 2
!Y : _ } =S Each manufactured or modular
ka Q/? ei 4 , /_+ / dwelling, service a d /or feeder 90.90 2
!F-C ( Services or feeder" installation, alteration, and/or relocatio
• 200 amps or less 80.30 2
❑ PROPERTY OWNER ' ; 201 amps to 400 a ps 1 06.85 2
❑ TENANT :.;�;.;:M-�;.:
Name:
401 amps to 600 an ps 160.60 2
601 amps to 1,000 . mps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State /ZIP: Reconnect only 66.85 2
Temporary servic or feeders Installation, alteration, and /or
Phone: ( ) ( Fax: ( ) relocation
• 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 a •s 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449,670, and 701.
401 amps to 600 am.s 133.75 2
Owner signature: Date: Branch circuits — n w, alteration, or extension, per panel
❑ APPLICANT 1 ❑" CONTACT P,ER�,Oh7
,. A. Fee for branch ci uits with
.
service or feeder ee, each
Business name: branch circuit 6.65 2
Contact name: B. Fee for branch ci airs
without service 0 feeder fee,
46.85 2
Address: first branch circui
Each add'1 branch ci uit 6.65 2
City /State /ZIP: Miscellaneous (sery ce or feeder not Included)
Phone: ( ) Fax:: ( )
• • Pump or irrigation ci le 53.40 2
E -mail:
Sign or outline lighti g 53.40 2
Signal circuit(s) or li ited-
CONTRACTOR energy panel, alterati.n, or
Business name: /�' extension. Describe: Page 2 2
Address: L 5 , _ t 1 S yL /)� Each additional ins ection over allowable in any of the above
9 •
T G[J l . `�°� ' Per inspection 62.50
City /State /ZIP: c pd/" y.- /Q„ Qu x: /Q 3) 97,74/ Investigation per hou (1 hr min) 62.50
Phone: (5 3) a -� / , /_ 77/ Fax: . 77 Industrial p lant per h. ur 73.75
PW CO ELE a RICAL PERMIT FEES*
CCB Lic.: Ga4 r93 Electrical Lic.: = 24 - 5 - , Suprv. Lic.: w53,5
Subtotal _ 5 OD
Suprv. Electrician signature, required: / ,f • ' • ' Plan r: view (25% of permit fee
/
Print name: �--C1' i. Date: State su harge (8% of permit fee) • 00
�, t „AMIN • e , TOTAL PERMIT FEE +
B.A
Authorized signature:: / // / ` This permit appllcati, expires if a permit is not obtained within 180
Print name: Date: days afte It has been accepted as complete
. - .e4 _,,.," _ ' /� Fee methodology se , y Tri- County Building Industry Service Board
Number o f inspe pe r permit a ll o wed .
.UwIding\Permits \ELC- Perm,iApp "doe 12/03 440.4615T(10/02/COM /WEB
CITY OF TIGARD _`'. >7-
BUILDING DIVISION PERMIT #: Z0°C- /a 00
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: •
Phone: (503) 639-4171 rr1�I�1
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: / 2.3 Z 3 ' LO CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
•
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Schedu : • For: Date: 3 j - Pour Time: /71
• • - Inspection Des ipti • • Confirm # Contact # Message
l�r
• rrections /Comm - nts nstructions: i
esee-■
•
•
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector:: I Nog O La Date: 31 I 0 6 Phone #: (503) 718- 2 /446�