Permit v CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00311
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/4/2008
PARCEL: 2S 101 AA - 08100
SITE ADDRESS: 12480 SW 68TH AVE ZONING: MUE
SUBDIVISION: WEST PORTLAND HEIGHTS LOT: 028 JURISDICTION: TIG
PROJECT: HAYDEN CONSULTING ENGINEERS
Project Description: Low voltage for data.
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:
Owner: Contractor:
KELSCOR LLC ADVANTAGE AUDIOVISUAL
12716 SW 116TH 400 SW 141 AVE.
TIGARD, OR 97223 BEAVERTON, OR 97006
Phone: Contact #: PRI 503- 670 -9238
FEES Reg #: ELE 34- 639CLE
LIC 116050
Description Date Amount
[ELPRMT] ELR Permit 11/4/2008 $75.00
[TAX] 12% State Surch 11/4/2008 $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 la , work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance •r if work is s •ended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility otification Center. , e r e- -re set forth in OAR 952 -001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules ' direct questions t• • • .246.6699 or 1.800.332.2344.
_ ._ Issue. By: I �L <���il. 4 : 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.
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Date/By: Permit No.: i,.....p_spps... (/v3(1
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
TIC, n it D Inspection Line: 503.639.4175 Date Ready /By: Juris: 0 See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
100HP or more. occupancy.
Job no.: Job site address:
Z t(8b 5 c.) 6 8'. ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: A .% t c� ❑Health-care facilities. 0 Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: (4Ayb ,,y ka.,tik • ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty I Fee. I Tom I •
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'I 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.)
� 11 / Limited energy, multi - family 75.00 2
1 e tcoC2 t o- .di p ,ti t d residential (with above sq. ft.) _
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
,PROPERTY OWNER 1 ❑ TENANT 201 amps to 400 amps 106.85 2
Name: t k(� fo 1j �{QGaT -Z.� a K i(,C 4 Q 401 amps to 600 amps 160.60 2
l 601 amps to •1,000 amps 240.60 2
Address: 1 Z y PA 5 w a 9 -w / a 7/ isw 1 1 !0 Over 1,000 amps or volts 454.65 2
City/State /ZIP: ‘Af►•0 ` O!._. �r-t�A� 002 972_9- 3 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 1 ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: ^V V RIuT E Ali o lag 150 At.. B. Fee for branch circuits
Contact name: -� without service or feeder fee, 46.85 2
J 1 Yw ' R / L4 . tom- first branch circuit
Address: y Do 5t.- I y ( k tl Each add, branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: "?„.c tip aoI), 06.-_ k 100 L Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( 3 ) 48 /. 3 4 3 7 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: Signal circuit(s) or limited- y
v ' h aso Eck 1S .1 1 extension. Describe: lrtion, or I page 2 / oO 2
Address: 400 St..1 I'-( At-o
City/State /ZIP: '3 sikura/L f bo , pit— c 10 b 6 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( 5 b 3 ) 4 $I _ 3 q 3 7 Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: / 1 ` p y Electrical Lic.:- 63 ?C( Suprv. Lic.: _-' Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: �J - Subtotal: 75 . 00
Print name: j r � •( LANO „� Date: !/ p Plan review(25 %of permit fee): AS--
State surcharge (12% of permit fee): 9•00
Authorized signature: n TOTAL PERMIT FEE: S y, 0d
` 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 inspections allowed per permit.
1:\Building\Pennits\ELC- PermitApp.doc 05/23/06 4404615T(I1 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
_RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system •
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR 1008 -00311
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/4/20011
Phone: (503) 639 - 4171,x° ,fl �I '�
Inspection Requests (24 Hrs.): (503) 639 -4175 -
INSPECTION WORKSHEET FOR DATE: 11/7/2008 TIME: 7:02AM PAGE: 4
SITE ADDRESS: 12480 SW 68TH AVE CLASS OF WORK:
SUBDIVISION: WEST PORTLAND HEIGHTS LOT #: 028 TYPE OF USE:
PROJECT NAME: HAYDEN CONSULTING ENGINEERS
DESCRIPTION: Low voltage for data.
OWNER: KELSCOR LLC, PHONE #:
CONTRACTOR: ADVANTAGE AUDIOVISUAL PHONE #: 503- 67Q9238
Inspection Request Scheduled For: Date: 11/7/2008 Pour Time:
Code # Inspection Description C firm # Contact # Message
199 Electrical final 077834-01 / 503- 481 -3933 N
Corrections /Comments /Instructions:
/
U
(t PAS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G\ 08 LE Date: k k I 1 4 9) Phone #: (503) 718= IA_