Permit v_
CITY OF T I GA R D
COMMUNITY DEVELOPMENT ELECTRICAL RESTRICTED ENERGY PERMIT
e PERMIT #: ELR2008 - 00096
'r I G A R D 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/21/2008
PARCEL: 2S 112 DC -00500
SITE ADDRESS: 15895 SW 72ND AVE BLDG B 220 ZONING: I -
SUBDIVISION: OREGON BUSINESS PARK III LOT: 040 JURISDICTION: TIG
PROJECT: HAIR CLUB FOR MEN
Project Description: Installing (1) low voltage data system.
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: 1
Owner: Contractor:
PACIFIC REALTY ASSOCIATES STEELHEAD TECHNOLOGIES INC
15350 SW SEQUOIA PKWY #300 -WMI 11600 SE HAWTHORNE ST
PORTLAND, OR 97224 PORTLAND, OR 97216
Phone: Contact #: PRI 503- 255 -0364
FAX 503- 255 -3947
FEES Reg #: ELE 26- 1205CLE
LIC 181413
Description Date Amount SUP 3251LEA
[ELPRMT] ELR Permit 4/21/2008 $75.00
[TAX] 12% State Surch 4/21/2008 $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 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: ' G � S 7 2 -t./
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.
• :Elcetrical Permit Application FOR OFFICE USE ONLY Received
City of Tigard r ' "' Date /B : Aro , iii Permi No.: E G� D- v ,�. a . 62
--IN, 13125 SW Hall Blvd., Tigard, OR " ' r t� Plan Review
Phone: 503.639.4171 Fax: 503.5'( • , , 'ice tag, c03 Date/By: Other Permit:
1.1G A It a Inspection Line: 503.639.4175 p 2 1. Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
,�
TYPE OF WOIVlI ‘1.. ! lll :Sk.tol� PLAN REVIEW
rm `i44 ce Please check all that apply (submit 2 sets of plans w /items checked below):
New construction ❑ Addition/alter S eri
❑ Service or feeder 400 amps or more ❑ Building over three stories.
,❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY 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..0 ❑ 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. A
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: I Job site address: /3 g ?� S� 7-Z' ' 100HP or more. occupancy.
?a.," ❑ Six or more residential units. ❑Recreational vehicle parks.
City/State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
l / � . . h 9 / ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: / I Project namei' r YyL ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1 •
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
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
V /‘ e J)�- residential (with above sq. 11.)
�/ 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
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I 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, er 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: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 7--- 2
Signal circuit(s) or limited-
Business name: $y e e //7 e ' / � (e c /. _.f- NG energy panel, alteration, or
Address: / a ` S� �/��; extension. Describe: / Page 2 2
City/State /ZIP: �42/ f/rf�e, 69-,(2 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (5-03)7/ QY 7 I Fax: (5v S
?�) - 7 _ 0 3IF Investigation per hour (I hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: 3757/4-44- Industrial plant per hour 73.75
yy E LECTRICAL PERMIT FEES
Suprv. Elects t an si ture, A/ _ /� w� (02 ELECTRICAL
ii.
Print namee L, -� :ate:
Plan review (25 % of permit fee):
T� a4)4/,e, y State surcharge (12% of permit fee): 7
Authorized signatu -: ✓ / ., �``' TOTAL PERMIT FEE: E 7,
Print name: Date: T permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
/� l/� r� • Number of inspections allowed per permit.
I: \ BuildinglPermits�ELC- PermitApp.doc O5�• •� 4404615T(I1/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
. 1
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 $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other •
•
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \Building\Permits'ELC- PermitApp.doc 03/23/06
CITY OF TIGARD .,
BUILDING DIVISION PERMIT #: CL. ?_408.
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Li , at, 0
Phone: (503) 639 -4171 rtj�l
Inspection Requests (24 Hrs.): (503) 639 -4175 `'__..
INSPECTION WORKSHEET FOR DATE: 14 . 38. Q$ TIME: PAGE:
SITE ADDRESS: I5896 61.0 12, CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: N(4ie4 Clval •
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: 5 T eELD PHONE #:
Inspection Request Scheduled For: Date: 4.'50.0% Pour Time:
Code # Inspection Description Confirm # Contact # Message
R13•131 'AO 1-45 v.) Y61 ict€.
Corrections /Comments /Instructions: U
PASS 0 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
����
Inspector: �J Date: Crt Phone #: (503) 718- Ai ■
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR200a.00096
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/21/2008
Phone: (503) 639 -4171 7 fd 4
Inspection Requests (24 Hrs.): (503) 639 -4175 �:_..
INSPECTION WORKSHEET FOR DATE: 5/27/2008 TIME: 7:01AM PAGE: 35
SITE ADDRESS: 15895 SW 72ND AVE BLDG B 220 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK 111 LOT #: 040 TYPE OF USE:
PROJECT NAME: HAIR CLUB FOR MEN
DESCRIPTION: Installing (1) low voltage data system.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: STEELHEAD TECHNOLOGIES INC PHONE #: 503 - 255-0364
Inspection Request Scheduled For: Date: 5/27/2008 Pour Time:
Code # Inspection Description Confi # Contact # Message
135 Low voltage 070344 -01 503 -761 -2510 Y
C t q F; J INN L.
Corrections /Comments nstructions:
9+
I \\
1 (�
W �.
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G-Th ��\\ Z1 Phone #:' (503) 718 -V (1 Iv �� � D ate: