Permit RESTRICTED E
CITY OF TI GARD ERG
le\° RESTRICTED ENERGY
� A , DEVELOPMENT SERVICES PERMIT #: ELR2004 -00372
�� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/8/2004
SITE ADDRESS: 12755 SW 69TH AVE 201 PARCEL: 2S101AD -02900
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 031 JURISDICTION: TIG
Project Description: Additonal security.
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: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
ROTH, J T JR + THERESA A + SONITROL (AKA SOUND SECURITY)
ZOUCHA, MICHAEL S 8220 N. INTERSTATE AVE.
12600 SW 72ND AVE #200 PORTLAND, OR 97217
TIGARD, OR 97223
Phone: Phone: 503 223 - 5822
Reg #: LIC 53535
ELE 26- 370CLE
SUP 1812LEA
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 12/8/2004 $75.00 Elect'I Final
[TAX] 8% State Surcharl 12/8/2004 $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 ti Permittee Signature_ ` 0
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
'-�.– a — o4
III rical Permit Ap �� . . FOR OFFICE USE ONLY
City of Tigard �� Received Date/By: ` VC,
Permit No.: L L I , (,- j j 7�
13125 SW Hall Blvd., Tiga�d,F7tlt" 97223 ri 0 Plan Review G
Phone: 503.639.4171 Fax: 50® 9 _Al. 1 • y. i 1 ! ;f 1 1 1 11\ Date/By: Other Permit:
I nspection Line: 503.639.4175 I Date Ready/By: Juris: ® See Page 2 for
Internet: www.ci.tigard.or.us eNA° Notified/Method: / (1 Supplemental Information
lk
�, .. .1- -.: -� ` r�1 - 'orix -. ;t t - -P Alv'.itEVLEW
❑ New construction 6- "ddition/alteration/replacement Please check all that apply:
['Service over 225 amps, comm'l ['Hazardous location
❑ Demolition ❑Other:
❑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
❑ I and 2 family dwelling X Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑Building over three stories ['Feeders, 400 amps or more
❑ Multi - family ❑ Master builder ❑ Other:
❑Occupant load over 99 persons ['Manufactured structures or
..:'' ' '.JOB SITE INFORMATION SANDLOCATION;' ' =" • - RV
-'. ` ; .
. • ' � �'_ *s • •_.:.,':• ❑E g ress li plan park
P
Job no.:SjJ1 - ).l Job site address: , a ' V 5 t9 ❑Health -care facility ['Other:
Submit 2 sets of plans with any of the above.
City/State /ZIP: cp
no.: M cY 9 .1 a )-3 The above are not applicable to temporary construction service.
(� Project Project name: �/ fie l - :i'.i. .F- EE *- _SCHEDULE;.;; •
Suite/bldg. /a p O 1' ll.�� 1 �.�/ ' l� ' (
��-+�- C ri ption I Qty. I Fee. 7 Total I .•
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'l 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
- _ .. : OF WORK • '''...::.-: i. "•• •-• Each manufactured or modular
/1 (� (\ dwelling, service and /or feeder 90.90 2
G (1 (9A-k- ( ll J Q 0, Services or feeders installation, alteration, and/or relocation
VVV ,, • 200 amps or less 80.30 2
PROPER;O
TY WNER' ❑_TEN?usiT, , r.
- 201 amps to 400 amps 106.85 2
... -- - . _ .. 401 amps to 600 amps 160.60 2
Name: —Cr' a/\ �t \ _of y( _ -- "V 1 , 0 \'h\ 601 amps to 1,000 amps 240.60 2
Address: i T ( . . U c j `i r "4 S izs 'zoo Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: T\C 1IU.(_l 1 ('Z et - 1 ' Temporary services or feeders installation, alteration, and/or
relocation
Phone: (5 3) ( ,3 - ac, .3C , 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 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
❑. APPLICANT '.. - PLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each
Business name: branch circuit 6.65 2
. B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
each branch circuit
Address: Each add'l 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
extension. Describe: 1 Page 2 2
Business name: w.� SKA S(- (_y -.., -1
� ! �� Each additional inspection over allowable in any of the above
Address: O ,D V ice ��1 c. i - C 4,. u•< per inspection 62.50
City /State /ZIP: Cwyk_ V . - d I G r 9 1 a ` 1 Investigation per hour (1 hr nun) 62.50
Da - —cc a:4 Fax: ( (3) C�', 3 _ _- 3 Industrial plant per hour 73.75
Phone: (
*� ��/� . ELECTRICAL PERD4IT FEES
CCB Lic.::5 175 3 5 Electrical Lic.:a (0 _ 316. Suprv. Lic.: IOLf 5L t Subtotal 99 o�
s
Suprv. Electrician signature, required . ,ir p,(,4 Plan review (25% of permit fee)
''_ / State surcharge (8% of permit fee) (0 , ()C'! Print name: Date �� —
3 - � �� c �� TOTAL PERMIT FEE — 81 ■ Cam.
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: I Date: • Fee methodology set by Tri- County Building Industry Service Board
" Number of inspections per permit allowed.
i:\ Building \PermitslELC- PermitApp.doc 12/03 440- 8615T(10 /02'CONt/WEB
Electrical Permit Application - City of Tigard - 4,
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
�RESIDENTIAL
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:
x`COLVWItiiCIAII: `YORE ICtl, T
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: 1
*No licenses are required. Licenses are required
for all other installations
is\ Building \Permits\ELC- PermttApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2004 -00372
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/8/2004
Phone: (503) 639 -4171 �i, ru;m��
Inspection Requests (24 Hrs.): (503) 639 -4175 °` I
INSPECTION WORKSHEET FOR DATE: 4/7/2005 TIME: 7:14AM PAGE: 86
SITE ADDRESS: 12755 SW 69TH AVE 201 CLASS OF WORK:
SUBDIVISION: WEST PORTLAND HEIGHTS LOT #: 031 TYPE OF USE:
PROJECT NAME: MATRIX
DESCRIPTION: Additonal security.
OWNER: ROTH, J T JR + THERESA A +, PHONE #:
CONTRACTOR: SONITROL (AKA SOUND SECURITY) PHONE #: 503- 2235822
Inspection Request Scheduled For: Date: 4/7/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 003952 -01 503223 -6822 Y
Corrections /Comments/ Instructions:
V
C
1
14 7
..g PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ..1,., f t-'-^- Date: r- 7 Phone #: (503) 718-
1