Permit a ��� �� ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00256
DATE ISSUED: 6/29/2007
T. 1 - G . A 1 D,. 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S136DD-04100
SITE ADDRESS: 11850 SW 67TH AVE 200 ZONING: MUE
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT: 007 JURISDICTION: TIG
PROJECT: AMERICAN FAMILY INSURANCE
Project Description: Fire alarm low voltage.
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: X OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: :
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
LEISER, ANNE TRUSTEE CAPITOL ELECTRIC CO INC
6009 SW PENDLETON CT 11401 NE MARX ST
PORTLAND, OR 97221 PORTLAND, OR 97220 -1041
Phone: Contact #: PRI 503- 255 -9488
FAX 503- 257 -7121
FEES Reg #: ELE 26 -496C
LIC 48748
Description Date Amount SUP 2865S
[ELPRMT] ELR Permit 6/29/2007 $75.00
[TAX] 8% State Surcha 6/29/2007 $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: Permittee Signature: 11 _ (./S (/d,
i
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:
Cali 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.
06/27/2007 09:11 5032551966 CAPITOL ELECTRIC PAGE 04
ElectYicdl Permit Apniicati N D T'O1 ill k lr L Sl O N i
Received /
City of Tigard DatcB ,� �%i[s ' perm N // -=Q�
7 I UJ r L/ 260/-0403010
13125 SW Hall Blvd., Tigard, OR 97223U 2 Plan Revi. Other Permit: i
` O Phone: 503.639.4171 Fax: 503.598.1900 OF _ Datc/ny:
CITY t^ bate Rcady/t3y: kris; ‘. rage2 for
TIG� \i :f)` Inspection Line: 503.639.4175 VI I �a I I � Pt R D Supplemental Information
intamet: www.tigard•or.gov BUILDING Notified/Method:
PLAN REVIEW _
Please check eI1 that apply (submit 3 acts of plane w/itcnta checked below);
o Service or feeler 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards.
exceeds 10.000 amps at 150 volts or In Floating bultd'mga.
CATEGORY OF CONSTRUCTION exceeds
to Rmund, or cicceeds 14.000 0 Commercial -use Agricultural
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for ntl otherinstallatlons, u l a. of 75 KVA or
Master builder ❑ Other.: CI Fire pump.
0 ❑ Multi family ❑ ❑ Emergency system. larger separately derived system.
JOB SITE INFORMATIO AND LOCATION ❑ Addition of new motor Load of ❑ "A ". "Et". "1.2 ", " I.3 ",
I00HP or more. occupancy.
Job no.: 270610 1 Job site address: 11850 SW 67 Ave ❑ Si or more residential units. ❑ Recreational vehicle parks.
El 1{00.17h-alre facitidex. CI Supply voltage for more than
City /State /ZIP: Tigard, OR 97223 ❑ Hazardous locations, 1500 volts nominal.
❑ service or feeder 600 amps or mote,
Suite/bldg./apt. no.: 200 i Project name: American Family insuraece FEE SCHEDULE
Cross street /directions to job site: Dared t1°n I Qn. 1 see. 1 Tot41 1 •
_- New residential single- or multi - family dwelling unit.
Includes attached garage.
l 94- It. or Ices 145.15
Subdivision; I Lot no 4
-
Ea. adds 500 sq. 11. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 15.00 2
DESCRIPTION OF WORK with above a . tt.
Limited energy, multi - family 75 00 2
Install Fire Alarm Circuit residential (with above sq. 0.)
Services or feeders installation, alteratinn, and /or relocation
200 amps or less 1 L 80.30 2
TENANT 201 a to 400 amps 106.85 2
0 PROPERTY OWNER -
401 amps to 600 amps I fi().60 2
Name; American Family Insurance
----- 601 amps to 1,000 amps 240.60 2
Address: Over 1.000 amps or volts 454.65 2
. - Temporary services or feeders installation, alter thin, and /or
City /Statc/7.TP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 I
201 amps to 400 amps 100.30 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 133.75 2
intended For sale, !case, rent. or exchange, according to ORS 447, 449, 670, and. 701.. Branch circuits- new alteration, or extension, Per panel
Owner signature: Date: A. Fee for branch circuits with
I above service o eee,
® APPLICANT fdr fee
CONTACT PERSON 6.05 2
each branch circuit
Business name: Capitol Electric Co., Inc. B. Fcc for branch circuits
without service or feeder fee. 46.85 2
Contact name: Dan Wilson first branch circuit
Each add'1 branch circuit 6.65 2
Address; 11401 NE Marx Street Miscellaneous (service or feeder not included)
City/State/ZIP: Portland, OR 97220 _ Each manufactured or modular 90.90 2
dwelling. service and /or feeder
Phone: (503) 255 -9488 I Fax: : (503) 255 -1966 Reconnect only 66.85 2
E -mail: dan@ccpdx.com
Pump or irrigation Circle 53.40 2
-
CONTRACTOR sign or outline lighting 53.40 2
Signal circuit(s) or limited-
Business name: Capitol Electric Co., Inc. energy panel, alteration. or 1 15.00
extens D escribe: Page 2 2
Address: 11401 . NE Marx Street - Fire Alarm
City /State /ZIP: Portland, OR 97220 _ Each additional inspection over allowable in nay of the above
Per inspection 62.50 _
Phone: (503) 255 -9488 I Fax: (503) 255"1966 Investigation per hour (1 hr main) — 62.50
CCB tic.: 48748 1 Electrical Lie.: 26-496C I Sup ELECTRICAL Lie.: 31 -g industrial plant per hour �iCA 73.7 L _ PERMIT FEES
Sum. Electrician signature, required: 'f _ _ _ subtotal: 75.00
i� Plan review (2S% of permit fec):
Print name: Darrell McNeel. Date: 6 7/07 S(Nre surcharge (8% of permit fee): 6.00
Authorized signature; TOTAL. PERMIT FEE: 81.00
_
This permit a pplteatioo expert tf a permit IF not obtalnnn within 180
Print name: Darnell McNeel. D ate: 6 27/07 days after It nag been accepted as complete.
Number of inspections allowed per permit.
maw \rv as\ELC- por,nn App.doe 052 3/Oh 440 4616T(1 7/05/COM/WFa
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007 -00256
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/29/2007
Phone: (503) 639 -4171 A-- . ,�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/11/2007 TIME: 7:01AM PAGE: 3(;
SITE ADDRESS: 11850 SW 67TH AVE 200 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE:
PROJECT NAME: AMERICAN FAMILY INSURANCE
DESCRIPTION: Fire alarm low voltage.
OWNER: LEISER, ANNE TRUSTEE, PHONE #:.
CONTRACTOR: CAPITOL ELECTRIC CO INC PHONE #: 503.255.9480
Inspection Request Scheduled For: Date: 7/11/2007 Pour Time:
Code # Inspection Description Confirm# Contact # Message
135 Low voltage 051804 -03 971 -222 -8040 Y
Corrections /Comments /Instructions:
•
,PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Illi spector: v `+ t• 64 Lt - Date: 11 I I (Y) Phone #: (503) 718- if/S)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007- 002%
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/29/2007
Phone: (503) 639 -4171 I�L�
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 8/24/2007 TIME: 7:OOAM PAGE: 63
SITE ADDRESS: 11850 SW 67TH AVE 200 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE:
PROJECT NAME: AMERICAN FAMILY INSURANCE
DESCRIPTION: Fire alarm low voltage.
OWNER: LEISER, ANNE TRUSTEE, PHONE #:
CONTRACTOR: CAPITOL ELECTRIC CO INC PHONE #: 503-255-9488
Inspection Request Scheduled For: Date: 8/24/2007 Pour Time:
Code # Inspection Description • • • # Contact # Message
199 Electrical final 054586.02 971 - 506^3495 N
Corrections /Comments /Instructions:
f L, =0o16) p,pp 4,, &j
1, 1
ewit -bli 1 t .� _i �. .
•
/
A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: • @V Date: c a- 2y • (19 Phone #: (503) 718- 2L' •