Permit � _ r
CITY OF TIGARD ELECTRICAL ENER -
RESTRICTED ENERGY
�� DEVELOPMENT SERVICES PERMIT #: ELR2004 -00183
4
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/28/2004
SITE ADDRESS: 08060 SW PFAFFLE ST 100 PARCEL: 1S136CD -00600
SUBDIVISION: SPRINT PCS WIRELESS MONOPOLE ZONING: C -P
BLOCK: LOT: JURISDICTION: TIG
Proiect Description: Low voltage for sensor.
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: SENSOR X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
CAMERON, KIRK (EEI SOLUTIONS) HVAC INC
5665 SW MEADOWS RD. 5188 SE INTERNATIONAL WAY
STE. 300 MILWAUKIE, OR 97222
LAKE OSWEGO, OR 97035
Phone: 503- 221 -1121 Phone: 503- 462 -4822
Reg #: LIC 50897
ELE 26-571CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 6/28/2004 $75.00 Elect'I Final
[TAX] 8% State Surchart 6/28/2004 $6.00
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 1-u-1--0.- P ermittee Signature m,,A I I i 4.
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 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Permit Applic , „ FOR OFFICE USE ONLY /
City Of Tigard L —' Date /B :. �' -( % f i i Permit No. 411 ' 2cV* - ki 4
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie
Phone: 503.639.4171 Fax: 503.598.1960 A ti ro , �� I� B Date : Other Permit:
Inspection Line: 503.639.4175 I, * Date Ready/By: Jurir ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPO b)!_VYbRIf t ; ` ‘;; PLAN REVIEW
❑ New construction g Addition/ Please check all that apply:
ID 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 1- and 2- family dwellings 4 or more new residential
❑ 1 - and 2 - family dwelling Idustrial ❑ Accessory building DSystem over 600 volts nominal units in one structure
❑ Multi family ❑ Master builde ❑ ['Building over three stories ['Feeders, 400 amps or more
Other:
['Occupant load over 99 persons DManufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
_ ��(� ❑Health - care facility ❑Other:
Job no.: Job site address:
10 o ��W r i-egl - Submit 2 sets of plans with any of the above.
City/State/ZIP:7 ,. 0/r (6b pi C P 21-3 The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg. /apt. no.: Projec name: � a .ftn.Ltr T 1 r Description 1 Qty. 1 Fee. 1 Total 1 .• •
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
Limited energy, residential 75.00 2
Tax map/parcel no.:
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
/ � dwelling, service and /or feeder 90.90 2
tsu
MAt 1' 5e-41 S 0 V 6 ax' Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ 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 1 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 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT 1 ❑ 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,
each branch circuit 46.85 2
Address: Each add'I branch circuit 6.65 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
144),4(1 T extension. Describe: Page 2 2
Business name: ..__1�f1 C'. _
/ Each additional inspection over allowable in any of the above
Address: 5 t k t l S 4-4 L A 4 ! ` Per inspection 62.50
City/State/ZIP: IV LIL)(2 lLJLIC-- Qrec --t cj72. .7_. Investigation per hour (1 hr min) 62.50
Phone: ( 3) q( _ E lectr F: (�3) c/�p2 —�SSS Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 5 i 7 Electrical Lic.R_5-7 /Cte Suprv. Lic.:a 2 2 i 9 Subtotal �4
Suprv. Electrician signature, required: Plan review (25% of permit fee)
'' AA II __ State surcharge (8% of permit fee) v b
Print name: -1(-731,14 Vl ) t 1 501 Date: (P r Z3/ t{ TOTAL PERMIT FEE
1 al
Authorized signature: oil This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: S I, , t R g Date: CO 113/O • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Building \Pernuts\ELC- PennitApp.doc 12103 440- 4615T(10 /02/COM/WEB
Electrical Permit Application - City of Tigard 4
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 system $75.00
(SEE OAR 918 - 260 -260)
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 \Pertnits\ELC-PcimitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Lines., (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 9-=a AM PM BUP
p
Location 6(cin Suite M 0 MEC
Contact Person .44 /l-r Ph ( ) � � Z PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access:
Ftg Drain ELR 4:206 y D0/9
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation , .
Drywall Nailing r_ ' - �e 'Rod • / Ft Al
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
42 PART FAIL
Please call for reinspection RE: Unable to inspect – no access
Fire Supply Line
ADA '� Q l(
Approach/Sidewalk Date 1 � ~ — Inspector / ` "�'^- / (51 I E4LIExt
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL