Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I I DEVELOPMENT SERVICES PERMIT #: ELR2005 -00277
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/14/2005
PARCEL: 2S 113 B0 -00600
SITE ADDRESS: 16580 SW 85TH AVE ZONING: I -P
SUBDIVISION: SEWER TREATMENT PLANT LOT: JURISDICTION: TIG
Project Description: Replace fire alarm system.
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: X OUTDOOR LANDSC LITE:
OTHER: • HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
CLEAN WATER SERVICES NORTHWEST FIRE SUPPRESSION, INC.
2550 SW HILLSBORO HWY 10220 SW ALLEN BLVD #F
HILLSBORO, OR 97123 -9379 BEAVERTON, OR 97005
Phone: 503- 681 -3600 Phone: 503- 644 -7720
Reg #: LIC 88629
ELE 34- 517CLE
FEES SUP 4273LEA
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 9/14/2005 $75.00
[TAX] 8% State Surchari 9/14/2005 $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 quest. s t UNC t 503699.
- Issued By: , 1 1`7 Permittee Signature:
I ;
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.
• Electrical Permi T k FOR OFFICE USE ONLY
City of Tigard 1 41005 DaDate/By: q y s .91 Permit No.: l� 7 j� 7
/
13125 SW Hall Blvd., Tigard, OR 9721 1 Plan Review �" +"'
Phone: 503.639.4171 Fax: 503.598.1 i ,'.,\.
Date/By: Other Permit
Inspection Line: 503.639.4175 �F TIGI , tig ".4 ., Date Ready/By: El Ju l See Page 2 for
Internet: www.ci.tigard.or.us CITY stnsiM Notified/Method: - Supplemental Information
II
TYPE OF WORK : ` PLAN REVIEW •
❑ New construction N Addition/alteration /replacement Please check all that apply:
El Demolition El Other: ❑Service over 225 amps, comm'l ['Hazardous location
_ ❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
E `�CATE CO s 'i 'CJC'I'ION of 1- and 2-family dwellings 4 or more new residential
❑ 1- and 2- family dwelling p Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi family El Master builder
OBuilding over three stories ❑Feeders, 400 amps or more
❑ Other: ❑Occupant load over 99 persons ❑Manufactured structures or
.! JOB SITE INFORMATION AND LOCATION a DEgress/lighting plan RV park
< r Ave., ❑Health -care facility DOther:
Job no.: Job site address:
j S8� J �� Submit 2 sets of plans with any of the above.
City/State /ZIP: T GA a-0 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: C t e I,J. )x-_ -� 'nJ FEE' SCH t
1 e..e' -S Description I Qty. I Fee. I Total
Cross street/directions to job site: ' ,4 .M 1` 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 ��l CO 2
? r „ ,, ,,, Each manufactured or modular
dwelling, service and /or feeder 90.90 2
re Ia A_C.e c k f....• ti \ 5L S 2 Services or feeders installation, alteration, and/or relocation
200 amps or less _ 80.30 2
t s a r s! 1 , y 201 amps to 400 amps 106.85 2
' i . ; � „ � , . � � ❑TENANT
a 4u4 401 amps to 600 amps
_ 160.60 2
Name: C t e c ,� I...) to r Se. rvt Lc_ S 601 amps to 1,000 amps 240.60 2
L tT
Address: KS N t Sfi A U �"”) U Over 1,000 amps or volts 454.65 2
f' n Reconnect only 66.85 2
Ci /ZIP: R 1 C.tr, S (� vtt;,, 0 ) U (L ` cj 7 (2 3 Temporary services or feeders installation, alteration, and /or
/ relocation
Phone: (SOO) �� b' - ( o 2.- ) I Fax: ( ) 200 amps or less 66.85 I
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° �• : ° ` I i A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: 1i1 /71 - -'t V•1 L 1C' 5 1 h 1-t- , I - e 3 S It , iv . branch circuit
_,.s..2)4,.. B. Fee for branch circuits
Contact name:
U „A ,Q without service or feeder fee, 46.85 2
I Address: t Q 2 0 , 4 11 each branch circuit
A �i n_�4 M• Each add'l branch circuit 6.65 2
City/State /ZIP: 1, ? - (- op, ?"/c)06 � Miscellaneous (service or feeder not included)
G�3 // Fax: .�� Pump or irrigation circle 53.40 2
Phone:
(J` ) b 94i_ 772c, (�` ) � Sign or outline lighting 53.40 2
F mail: ' / 1 ,, i C , Signal circuit(s) or limited -
rA CONTR ACTOR '1'..77-',, energy panel, alteration, or
extension. Describe: Page 2 2
i
Business name:
10 � hwe � - { — � i 2f _ ` > , � � c e ssl o ,-� �- ��,
Each additional inspection over allowable in any of the above
Address: t UZoD < L L AI1e's glo a
Per inspection 62.50
r
``
City /State/ZIP: l3 l A v r - - r0/`) 0.X.- 1 !)O S Investigation per hour (1 hr min) 62.50
Industrial plant per hour 73.75
Phone: (So 3 ) 6 fly- 772o Fax: (So3) (� t� y ' Fl2$° 9 _ .
F`EE,S
CCB Lie.: is q g 62 9 Electrical Lie.: 3%/- SI7Q4- Suprv. Lic.: 1 /7 73 L.4 Subtotal
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: go p. A R Q Date: 1 1)Y) QS State surcharge (8% of permit fee)
A )....4.3 TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: = Fee methodology set by Tri -County Building Industry Service Board,
_= Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PermitApp.doc 12/03 440- 4615T(10/02 /COM/WEB
k
C F TIGARD
B LDING DIVISION • PERMIT #: ELR2005 -00277
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/14/2005
Phone: (503) 639 -4171 ����
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/19/2005 TIME: 7:03AM PAGE: 77
SITE ADDRESS: 16580 SW 85TH AVE CLASS OF WORK:
SUBDIVISION: SEWER TREATMENT PLANT LOT #: TYPE OF USE:
PROJECT NAME: CLEAN WATER SERVICES
DESCRIPTION: Replace fire alarm system.
OWNER: CLEAN WATER SERVICES, PHONE #: 503- 681 -3600
CONTRACTOR: NORTHWEST FIRE SUPPRESSION, INC. PHONE #: 503- 644-7720
Inspection Request Scheduled For: Date: 10/19/2005 Pour Time:
Code # • _ - _ _ • Description Confirm # Contact # Message
135 Low voltage 018654 -01 503.644 -7720 Y
C • ections /Co ■ ents uctions: P‘y
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: C' 1• o t4 Date: bI O Phone #: (503) 718- I
V