Permit C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 -00370
�' FII DATE ISSUED: 10/24/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2 S 110 BA -00390
SITE ADDRESS: 14040 SW 117TH AVE ZONING: R -4.5
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: All encompassing low voltage.
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: ALL ENCOMP : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
JAMSHED, SINA OWNER
14040 SW 117TH AVE
TIGARD, OR 97223 -
Phone: 503 - 590 - 6792 Phone:
Reg #:
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 10/24/200` $75.00
[TAX] 8% State Surchart 10/24/200E. $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 • • 80 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you • follow rules :sop - by the Oregon Utility Notification Center. Those rules are .. - forth in OAR 952 - 001 -0010
though OAR 952-00 01,04 You may btain copies of these rules or direct quest. o OUN .t 503 46 -6699.
I ued By: 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 Permit Application . FoR o,r1 lcE, usE. ow-, ",:.
City of Tigserd Received Permit No.: j
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review '" .. Phone: 503.639.4171 Fax: 503.598.1960 G. it t l l . D . Other Permit:
Inspection Line: 503.639.4175 J.. 'Al Date Ready/By ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: rdn Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition/alteration /replacement Please check all that apply:
❑ Demolition ❑ Other: 0 Service over 225 amps, comm'I ❑Hza
ardous location
❑ 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
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building 0 System over 600 volts nominal units in one structure
❑ Multi- family ❑ Master builder ❑Other: ❑Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons 0 Manufactured structures or
JOB SITE INFORNL4TIION AND LOCATION ❑Egress/lighting plan RV park
Job no.: ,'Job sit addr
1/471/12 5 w ❑Health -care facility ❑Other:
_ T Submit 2 sets of plans with any of the above.
C �,t+y /State/ZIPj The above are not applicable to temporary construction service.
( t 0 ✓ 9 7Z 2 �
Suite/bldg. /apt. no.: (1 itrcjectrnameb FEE* SCHEDULE
Description I Qty. I Fee. I 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'I 500 sq. ft. or portion 33.40 1
CO mited „residential --- 75.00 76 2
Tax map /parcel no.:
Limited energy, non - residential 75.00. 2
IlESCiRIIPAlIOJNEOF*WORK_OL Each manufactured or modular
All' C - J dwelling, service and/or feeder 90.90 2
� $ r , *z' �a G+, 5 �z(� (..J\-t
le Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 . 2
0 PROPERT ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name' ,) 5 j n & f't 7 a r vt 4 eJ 601 amps to 1,000 amps 240.60 2
P,,-ddi s: / 3 3/ v 5 W € r .144K 17 r Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
GityStatIP: _ ; Q p Temporary services or feeders installation, alteration, and /or ewe(
Phone: ) Fax: ( )
relocation
�'9 0 - 6 7 92 200 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
rye :,•}gn0uxe: - Date: Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each
Business name: branch circuit 6.65 2
Contact name: B. Fee for branch circuits
without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'l branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax :: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
6.13 ; tf2TACyTi 14 energy panel, alteration, or
extension. Describe: Page 2 2
Business name: oeio A) E
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City / State/ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ) F ax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: Electrical Lic.: Suprv. Lic.: Subtotal CO
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date:
State surcharge (8% of permit fee) 69. 00
TOTAL PERMIT FEE 8/ . O U
Authorized signature: This ermit application expires if a
p pp p 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
Electrical Permit Application - City of Tigard
Page.2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
= RLSIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
JO Audio and Stereo Systems*
Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
rCOMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 91 8- 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
i:\ Building \Permits\ELC- PermitApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION '` PERMIT #: ELR2005 -00370
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/2412005
Phone: (503) 639 -4171 imodo
Inspection Requests (24 Hrs.): (503) 639 -4175 -IL
INSPECTION WORKSHEET FOR DATE: 10/25/2005 TIME: 7:10AM PAGE: 8
SITE ADDRESS: 14040 SW 117TH AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: JAMSHED
DESCRIPTION: All encompassing low voltage.
OWNER: JAMSHED, SINA, PHONE #: 503 - 590 -6792
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 10/25/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
136 Low voltage `- 019282-03 503 - 380 Y
Corrections /Comments /Instructions:
0
4` , ,
G w
Cc Ok
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12 ../i "I/ 11 14 A , A ; . -•-. i /
IIM
4 .
X l f PASS ❑ PARTIAL APPROVAL n CANCEL [1] NO ACCESS
I I FAIL M ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
( " Cpl (!
Inspector:
09 Date: hone #: (503) 718-