Permit - 6 , a CITY O F T I G R® ELECTRICAL RESTRICTED ENERGY PERMIT
' : COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00283
,r DATE ISSUED: 7/12/2007
T[ "AR 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S136DD-04100
SITE ADDRESS: 11850 SW 67TH AVE 100 ZONING: MUE
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT: 007 JURISDICTION: TIG
PROJECT: AMERICAN FAMILY INSURANCE
Project Description: Access control & CCTV system.
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: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: CCTV X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC NW PROPERTIES SELECTRON INC
6600 SW 105TH SUITE 175 7225 SW BONITA RD
BEAVERTON, OR 97005 TIGARD, OR 97224
Phone: 503- 626 -3500 Contact #: PRI 503- 639 -9988
FAX 503- 684 -4357
FEES Reg #: ELE 26- 497CLE
LIC 64341
Description Date Amount SUP 3645LEA
[ELPRMT] ELR Permit 7/12/2007 $75.00
[TAX] 8% State Surcha 7/12/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: yeia �2i(.. Permittee Signature: (9)7 %. .
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit ?iri M E D FOR OFFICE USE ONLY .
L
City of Tigard Received 2007 Date/By: I L . 6 Permit No.;,+ , •__,, —00 _ ' 3
13125 SW Hall Blvd., Tigard, OR 97223,: Plan Revi
Phone: 503.639.4171 Fax: 503.59$/''n7 -j;f- 4 "� Other Permit:
.1960 - ' li'�' Daze/By.
Inspection Line: 503.639.4175 �.+t 1Y C1' I i GIVRU � Date Ready /By: See Page 2for
Internet: www.ci.tigard.or.us 3Ul[[)INIG DIV S QN Notified/Method: � ®
Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction Addition/alteration /replacement Please check all that apply:
❑ Demolition Other: ['Service over 225 amps, comm'l ['Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling y3 Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other: ID Building over three stories ['Feeders, 400 amps or more
['Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION L. - 6 k Job RV park
DHealth-care facility ❑Other:
Job no.: � Job site address: ' 12� Ave Submit 2 sets of plans with any of the above.
� 1 /State /ZIP: C,��� �� applicable to temporary Cit y The above are not a construction service.
P Y
Suite /bldg. /apt. no.: � Project name: Ai call 1/ I
1 FEE* SCHEDULE I .•
Description Qty. Fee. Total
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 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non- residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
Iasi' I I SS e t}yV - ' t% s(S` ., dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or Tess 80.30 2
O. 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 I I 133.75 I 12
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: .branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'l branch circuit 6.65 I 2
City / State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
C extension. Describe: 1 Page 2 `7,h 2
Business name: 1 ec - 112.h 1 ) h(_.
l )- a., �d Each additional inspection over allowable in any of the above
Address: —72,'Z5 SAj j2- �'
r ` Per inspection 62.50
City /State/ZIP: r 4,1 0 g-0., Investigation per hour (1 hr min) 62.50
Phone: �D3 )�'7 - OA % Fax: (5c)3) (oil _}..15s -7 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: L I Electrical Lic.: 3c Lr „41 Suprv. Lic.: Subtotal -75, O
Suprv. Electrician signature, required < c --� ` Plan review (25% of permit fee)
Print name: /� Date: State surcharge (8% of permit fee) t .00
C I e.hh at 1m '�°�� TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: i Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PennitApp.doc 12/03 440- 4615T(10 /02/COM/WEB
CITY OF TIGARD - --
BUILDING DIVISION PERMIT #: ELR2007- 00203
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 7/1212007
Phone: (503) 639 - 4171 it .,14
Inspection Requests (24 Hrs.): (503) 639 -4175 .
INSPECTION WORKSHEET FOR DATE: 8/27/2007 TIME: 7:OOAM PAGE: 12
SITE ADDRESS: 11850 SW 67TH AVE 100 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE:
PROJECT NAME: AMERICAN FAMILY INSURANCE
DESCRIPTION: Access control & CCTV system.
OWNER: PACIFIC NW PROPERTIES, PHONE #: 503 - 626.3500
CONTRACTOR: SELECTRON INC PHONE #: 503 - 639.9988
Inspection Request Scheduled For: Date: 8/27/2007 Pour Time:
Code # Inspection Description _Con • • Contact # Message
135 Low voltage 054676 -02 503 - 522 -8559 N
i ° i q F44 rl .
Corrections/Comments/Instructions:
s
, \
iV
,PASS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: GY . R ") Z LE' Date: *2 2-1 Phone #: (503) 718- -2-4410