Permit CIT OF TI GAR D ELECTRICAL RESTRICTED ENERGY PERMIT
i� DEVELOPMENT SERVICES PERMIT #: ELR2006 - 00086
� I DATE ISSUED: 4/18/2006
'�" 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S113AB-00600
SITE ADDRESS: 16195 SW 72ND AVE BLD.D ZONING: I -L
SUBDIVISION: PACTRUST BUSINESS CENTER LOT: JURISDICTION: TIG
Project Description: OPTION CARE : Protective Signal & Access.
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: ACCESS
TOTAL # OF SYSTEMS: 2
Owner: Contractor:
PACIFIC REALTY ASSOCIATES ENTRANCE CONTROLS INC
15350 SW SEQUOIA PKWY #300 -WMI 12606 NE 95TH STREET
PORTLAND, OR 97224 SUITE C -100
VANCOUVER, WA 98134
Phone: 503- 624 -6300 Contact #: PRI 360 - 256 -4416
FAX 360- 256 -4939
FEES Reg #: ELE 3847LEA
LIC 65581
Description Date Amount
[ELPRMT] ELR Permit 4/18/2006 $150.00
[TAX] 8% State Surcha 4/18/2006 $12.00 REQUIRED ITEMS AND REPORTS
Total $162.00
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. �r
Issued By: Permittee Signature: ,,�-+- 2�c �� ?`'
OWNER INSTALLATION O
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.
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Electrical Permit A ott ri
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'City of Tigard r` DDate/13 d C . — a, Permit No... ' — OIt■
13125 SW Hall Blvd., Tigard, OR 97223 ' . nn t, Plan Review
s " A Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 ' I �i+. Date/BY:
Inspection Line: 503.639.4175 � .•„� ' C:_:. Date Ready/By: tuns' hl Sce Page 2 for
I r ^
` �y S �� Notified /Method: Su lemental Information
Internet: www.ci.tigard.or.us �s ll � � � pp
, N i i ' - ' • PLAN REVIEW
❑ New construction .Q Addition /alteration /replacement Please check all that apply:
❑ Demolition ❑ Other: ❑Service over 225 amps, comm'l ['Hazardous location
❑Service over 320 amps - rating 013uildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION • . of 1- and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling (S Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi - family 0 Master builder 0 Other:
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park ike ❑Health -care facility ❑Other:
Job no.: Job site address: A/5 rS� �0( Submit 2 sets of plans with any of the above.
City /State /ZIP: 7 - 4 r2/ (-)e... The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: v t Project name: FEES SCHEDULE
a , Description I Qty. 1 Fee. I 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 '1 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non - residential 75.00
DESCRIPTION OF WORK Each manufactured or modular
j / dwelling, service and /or feeder 90.90 2
e. )dd'.
c ' - .Yy1L 7 5/S1'ri a Services or feeders installation, alteration, and/or relocation
o / 200 amps or less 80.30 2
IR PROPERTY OWNER I XTENANT 201 amps to 400 amps 106.85 2
�; �, � e f p 401 amps to 600 amps 160.60 2
CJ
Name: f �- 01,_ � 601 amps to 1,000 amps 240.60 2
Address: /6/9-- a_ Over 1,000 amps or volts 454.65 2
�/ Reconnect only 66.85 2
City /State /ZIP: V a CDNe Temporary services or feeders installation, alteration, and /or
Phone: ( ) Fax: ( ) relocation
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 1 pia CONTACT PERSON ; A. Fee for branch circuits with
service or feeder fee, each 6.65
Business name: .� branch circuit 2
� �ut� C /� o►n � o�`a,
Contact name: c ; cl - )(., B. Fee for without service circuits or feeder seice feder fee,
�` each branch circuit 46.85 2
Address: /4:96 D c /v 93-1( 5� S c.. /60--G Each add'I branch circuit 6.65 2
City /State /ZIP: a hGOc..,,,_ 6_, yf. Miscellaneous (service or feeder not included)
����yy Pump or irrigation circle 53.40 2
Phone: gr ,2.5-6 ` . 9 s // .6 Fax: ( ) O y S 6 — � 3F
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
^ L am' / extension. Describe: Page 2 2
Business name: . f r
Address: /1y 61 , s� 5 sr _ /4s Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: U K ��,€.-e.-- 9P- Investigation per hour (I hr min) 62.50
)i ^ L . Industrial plant per hour 73.75
Phone: , �
Gy /e ( 36o
Fax: S � ! ELECTRICAL PERMIT FEES*
CCB Lic.:, C.L/..5-��i/ t Electrical Lic :Z-s(L5 Suprv. Lic. /7/rL Subtotal � , Or
Suprv. Electrician signature, required: � ' /510 Plan review (25% of permit fee)
Print name: I r Date:.!/ ie c, State surcharge (S% permit fee) /2, `~ TO L PERMIT FEE (nlp 2 Q
Authorized si nature: ���
g � J` � This permit application ex pires TA if a permit is not obtained w ithin " 180
/ / days after it has been accepted as complete
Print name: O f/ Date: yam-/ - (� " Fee methodology set by Tri- County Building Industry Service Board
`" Number of inspections per permit allowed.
is \Iiuilding \Permits \Ii1.C- PcrmilApp.doc 1 440.461ST( /02 /COM /Wtai
CITY OF TIGARD = -
BUILDING DIVISION PERMIT #: ELR2006.Q00
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4111 /200u
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/20/2006 TIME: 7:04AM PAGE: 57
SITE ADDRESS: 16195 SW 72ND AVE I3LD.D CLASS OF WORK:
SUBDIVISION: t'ACTRUST BUSINESS CENTER LOT #: TYPE OF USE:
PROJECT NAME: OPTION CARE
DESCRIPTION: OPTION CARE : Protective Signal & Access:.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 603- 624 -6300
CONTRACTOR: ENTRANCE CONTROLS INC PHONE #: 360 - 266 -4416
Inspection Request Scheduled For: Date: 4/20/2006 Pour Time:
Code # • • k.tion Description Confirm # Contact # Message
35 i- volte•e 020370.01 603-793.4569 Y
Jq 1 FiCJ# .
Corrections /Comments /Instru 'ons -
o� \)
c
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C N 6 Date: y WIND Phone #: (503) 718- IV V .