Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' ° COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00333
TIGARD DATE ISSUED: 3/12/2008
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1 S136DC -04400
SITE ADDRESS: 11945 SW 70TH AVE ZONING: C -
SUBDIVISION: DARTMOUTH SQUARE LOT: 030 JURISDICTION: TIG
PROJECT: DARTMOUTH SQUARE
Project Description: Low voltage for HVAC.
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: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
POLLOCK, DONALD E AMERICAN HEATING
1834 SW 58TH #202 1339 SW GIDEON ST
PORTLAND, OR 97221 PORTLAND, OR 97202
Phone: Contact #: PRI 503- 239 -4600
FAX 503- 239 -7038
FEES Reg #: ELE 26- 993CRE
LIC 33135
Description Date Amount SUP 2640LEB
[ELPRMT] ELR Permit 3/12/2008 $75.00
[TAX] 8% State Surchaq 3/12/2008 $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 fog - • R 952- 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503.246.669' or1.800.'32.
Issued By. 1 ' / Permittee Signature: Mu, C Lyit,
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.
Ele Permit Ap II � , i i 1,1' :iVE® F OR OFFICE USE ONLY
City Tigard SEP of Ti 0 6 2007 Date /B : d p �� arm" PemutNo.: ✓ k
13125 SW Hall Blvd., Tigard, OR 97223 P lan Review
Phone: 503.639.4171 Fax: 503.598.196(�,pITY TI • . _ Received
' •g 0 '"'' -, ,a
� Date/B Other Permit:
Inspection Line: 503.639.4175 tn y� 11,-
. Date Ready/By: ® See Page 2 for
Internet: www.ci.tigard.or.us I3I�I�JII DIVI� . -. Notified/Method: IIMI Supplemental Information
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' ew construction Please check all that apply:
❑ Addition/alteration/replacement
❑Service over 225 amps, comm'l ['Hazardous location
❑ Demolition ❑ Other ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
� , t„ ice- a ` _ ftc� F +c u t� y s o° 0.6ii- Y o =y , , . `� ` ; 3 � of 1- and 2- family dwellings 4 or more new residential
Sb.: _.. ✓ .. = .. -.__ -7- 1'y �..V
❑System over 600 volts nominal units in one structure
❑ 1- and 2- family dwelling ommerciaUindustrial 0 Accessory building ['Building over three stories ❑Feeders, 400 amps or more
❑ Multi family ❑ Master builder ❑ Other: ❑Occupant load over 99 persons ❑Manufactured structures or
�tn�rr �� s fJ RV park
g;� kFi r tt' `t IA
l 4-4 (tt)�; �'�� a� f o figs. t:;:"a" N +I li
I r ,rj ti ngplan
d,_`��- L. 4L �. � ;d.:J:�.�1uuW,_��_ .....,._� .__.�.. ....: �_.. �: E: : .:...,__._ cc �c . ,..._ �., :.: - _ _.,,._.,3..: ❑Egress/1igh
.r.- El Other:
+ h ❑Health -care facility
Job no.: Job site address: ' 3 5 514 70 A Submit 2 sets of plans with any of the above.
City/State/ZIP: T A ,-C1 Q/ 9 72 2 3 The above are not applicable to temporary construction service.
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2� 1 Y.; �.rtlP yam t �' � : �.:F ra A 1
Suite/bldg./apt. no.: Project name: AI f yh�U'� �1 SQ Jane D«e.lpnon Qty. p«- 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'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
r 1 : ' ,� ' ,r y �j �� ) ri irei- " tS,d" '' + - 4 , s tit i i Each manufactured or modular
Fs. §
__��• .. s., , - , t , .. { .L � .��. -c - "� - -
/Q VI/ V O / / ' ' - e - -
5 / r ABINIMIll dwelling, service and/or feeder 90.90 2 Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
�• + • � Sf, a c+ti cgrlr it r `rr'i{ r z `i r, , ` r' ' , . T 201 amps to 400 amps 106.85 2
fj d R 1. ^ 7 �� g a ' a' r �.•.:- lf. ',3:4.1.:..It. :i s.. 1:t , . '?...a.- .�..3.�. s_3`. ,. 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
relocatio n
Phone: ( ) Fax: ( ) 200 amps or less 1 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
t :M1 r'� f4 +' _`15 6 ti l��Mt , , „i,r} �, t 1 r; c rJ 1��,` 1 r41 iii � 1 kqn c xiT A . . ... ... _.. 5
_ ri ?' r Fee for branch circuits with
n o n er pa
; ,L , E_'.a, t � -2. r . - _.s:w u _t_ f,I .. - ir . :. _ 1 - service or feeder fee, each
6.6 2
branch circuit
�� B. Fee for branch circuits
Contact name: A. eel G C/ h t? without service or feeder fee, 46.85 2
each branch circuit
Address: r33i 3E ■ tip • S]/ S"( . Each add'l branch circuit 6.65 2
City/State/ZIP: - Do y'4 °A d 0 12_ Cr) D 0 . Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: •) 0 �'/� 3 I - . UO Fax: : )a�- - e 7
Si or outline lighting 8 g
53.40 2
E-mail Signal circuit(s) or limited-
+ f 1 t ' 1 �, , ? i .f .4 t y � (tio F _u?.2 -e ff �L`�l_: r sL ir_... &9'�.A5� 1,-i.L :_ 1..4 4A,"ty. .energy panel, alteration, or 4
,,,,,2,,, ,., 1 ;fr /Y „._ ,al « «r , t Pa 2 ` 2
_4' �,..._ � - extension. Describe:
Each additional inspection over allowable in any of the above
Address: J 3 G j 1 �3� Per inspection 62.50
City/State/ZIP: P . d 0 e_ I'1 a0? Investigation per hour (1 hr min) 62.50
Industrial plant per hour 73.75
Phone: ( ) FaX: :Y 1 •- f plant h Gf -��r F *� 2� ° ��z' {{ K e ., lu�f
3 ,( Cee Sup - y -
•
CCB Lic.: Electrical Lic.: � Su Lic.: �� 0 '� Subtotal
Suprv. Electrician signature, required: 7-. 1� ` / 7 � ; Plan review (25% of permit fee)
State surcharge (8% of permit fee) U t�
Print name: Date: u
v 0 TOTAL PERMIT FEE
V �
Authorized signature: �„ - 1 / ,,� ` '\ This permit application expires if a permit Is not obtained ithin 180
days after it has been accepted as complete
., d Date: 9' Q . • • Fee methodology set by Trf- County Building Industry Service Board
Number of inspections per permit allowed.
i.\ Building \Pamita\ELC- PernitApP.doc 12/03 440-4615T(10 /02/COM/wEB •
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information • r'= �,
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 -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
IABuilding\PermitslELC-PermitApp.doc 03/23/06
Ii
CITY OF TIGARD -�
BUILDING DIVISION PERMIT #: ELR2007- 00333
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/12)2008
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 K__—
INSPECTION WORKSHEET FOR DATE: 7/17/2008 TIME: 7:00AM PAGE: 49
SITE ADDRESS: 11945 SW 70TH AVE CLASS OF WORK:
SUBDIVISION: DARTMOUTH SQUARE LOT #: 030 TYPE OF USE:
PROJECT NAME: DARTMOUTH SQUARE
DESCRIPTION: Low voltage for HVAC.
OWNER: POLLOCK, DONALD E, PHONE #:
CONTRACTOR: AMERICAN HEATING PHONE #: 503 -239 -4600
Inspection Request Scheduled For: Date: 7/17/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 072783 -01 503.793 -4001 \ Y
Corrections /Comments/ Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Cr • \ UG Date: r o Phone #: (503) 718 -it
4
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007 -00333
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/12/2008
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 914 /2008 TIME: 7:02AM PAGE: 20
SITE ADDRESS: 11945 SW 70TH AVE CLASS OF WORK:
SUBDIVISION: DARTMOUTH SQUARE LOT #: 030 TYPE OF USE:
PROJECT NAME: DARTMOUTH SQUARE
DESCRIPTION: Low voltage for HVAC.
OWNER: POLLOCK, DONALD E, PHONE #:
CONTRACTOR: AMERICAN HEATING 0 vcr PHONE #: 503-239-4600
Inspection Request Scheduled For: Date: 9/4/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 07506(1.01 503-793-4001 Y
Corrections/Comments/Instructions:
\\
PA S ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G ,`� � L Date: 911 Phone #: (503) 718- PILI6