Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 -00057
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/16/2005
PARCEL: 2S 101 AB -02201
SITE ADDRESS: 07117 SW BEVELAND RD /6O ZONING: MUE
SUBDIVISION: BEVELAND LOT: 2 - JURISDICTION: TIG
Project Description: Limited energy for HVAC wiring.
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:
ZIMMLER DEVELOPMENT LLC AMERICAN HEATING
7115 SW BEVELAND ST 1339 SW GIDEON ST
TIGARD, OR 97223 PORTLAND, OR 97202
Phone: 503 -598 -3440 Phone: 239 -4600
Reg #: LIC 33135
ELE 26- 993CRE
FEES SUP 2640LEP
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 3/16/2005 $75.00
[TAX] 8% State Surcharl 3/16/2005 $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 w I 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you • follow ru - adopted by the Oregon Utility Notification Center. Those rules ar set fprth i •AR` 52- 001 -0010
thr• gh OAR 952 -011 . 180. ou may obtain copies of these rules or direct ques io s to U • . 5!r:- 246 -6699.
Issu: d By: / i � �� Permittee.Signature2Q
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 OFFICE USE ONLY -
C it of Tip�and Received ��
y b Date:
�1 I/ Pemut No.: /
13125 SW Hall Blvd., Tigard, OR 97223 Y ��
Plan Review ' '� �� � ��
Phone: 503.639.4171 Fax 503 - 598.1960 ��� �N4(iivi +' DateB : Other Permit:
Inspection Line: 503.639.4175 ^ i h`,. I Date Ready/By: El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: . Supplemental Information
a', ._`"; '.r "' z e �«W3 53 J>?' " r :s "e 8 . ,z 11 11 - 'z e . 'r
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-¢ '� ...'�,,.sr . ��,,,� F :,F ... -�,:� .. _�r,:� . �°v��;, &�.��sat'�;. ,�: � .a,��� ". - >„ - � :» - .�`� +,.� � �*.:� .,.�, re , max. od `e �''" K ... s, �. , � "�,..
❑ New construction Addition/alteration /replacement Please check all that apply:
❑Service over 225 amps, comm'l ID Hazardous location
El Demolition 111 Other:
5 .: _ ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
�; , ;, ��A EGO F1CONST ION * - of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling Commercial /industrial El Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi- family ❑ Master builder El Other: ❑Buildin over three stories ❑Feeders, 400 amps or more
: £' M o l t , , r M . pykm ,,,,} „tr;,# builder pvto �, - " _ +tK -twk st _ ❑Occupant load over 99 persons ❑Manufactured structures or
x i M JO B STI'E IN$ORMA �ON IE;PA ION ; -0 ❑ Egress/lighting plan RV park
',, ,za �� . _ .; n.-�r .�3>�r� ..� � ��, u_.. a �- ..�a�r�� r-rca., .� -. ro�..,�S��U.v
Job no.: Job site address: t ❑Health -care facility ❑Other:
'Z '
Submit 2 sets of plans with any of the above.
City /State /ZIP: "`T" °_4 The above are not applicable to temporary construction service.
3 7 x , . V ,. +
� � . FJ,E* � SCHEDU[ - -" '
Suite/bldg. /apt. no.: Project name• - -"
Description Qty. 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: I 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
_,,„,:„, DS CR " ' ' a "_ 4 Each manufactured or modular
a dwelling, service and /or feeder 90.90 2
f y - A! .rA \ Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
. a ' O itif iMilli "a# v* '"r $ 1 MT, 201 amps to 400 amps 106.85 2
'- .t .;,, ,; ,, ,.,« v ': . :. -h' , '- -. . - ail : .. 401 amps to 600 amps 160.60 2
Name: 7 _ „ , i 4.. 441. Med DLO ptLL it &) Y 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
'/ relocation
Phone: (43) 5 F 8 _50 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 1 33.75 2
Owner signature: • Date: Branch circuits - new, alteration, or extension, per panel
Q tIPPICANT O1VT�A ER A. Fee for branch circuits with .
. �, i 1w, -. 4 ; `” ..,_.,, .14, " . °` service or feeder fee, each
Business name: branch circuit 6.65 2
Contact name: B. Fee for branch circuits
without service or feeder fee,
Address:
each branch circuit 46.85 2
Each add'I branch circuit 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) I Fax: : ( )
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
V L & CONTRACTOR `t ` g t r - energy panel, alteration, or
��Pr YP extension. D Page 2 2
Business name: � '� t 0 � .
:,:1';‘. (Qi
Address: rs' "`,. � f Each additional inspection over allowable in any of the above
if /� Per inspection 62.50
City /State /ZIP: Investigation per hour (t hr min) 62.50
`°
Phone: (�`P� ° ° 4 '` � d F ax: O a� ` 48:31 ��� Industrial plant per hour 73.75
. °° V fL GTte'WOR I,I' ; j"I?EES -W W :'`
CCB Lie.: . Electrical Lie.: ,y� Suprv. Lie.: Subtotal
Suprv. Electrician signature, required: y� u a/„ c I. g
State surcharge (8% of permit fee) Plan review (25% of permit fee)
l ow, (,�
Print name: ' C1. . � '>/ !/
o J a Date: 3///„/ QS
1 / l 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\Perauts\ELC- PermitApp doc 12/03 440- 4615r(10/02/COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005 -00057
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/16/2005
Phone: (503) 639 -4171 ildh ip'NPi�lfl girl
Inspection Requests (24 Hrs.): (503) 639 -4175 ' -_..
INSPECTION WORKSHEET FOR DATE: 4/25/2005 TIME: 7: 10AM PAGE: 69
SITE ADDRESS: 07117 SW BEVELAND RD-# /6 v CLASS OF WORK:
SUBDIVISION: BEVELAND LOT #: 2 -3 TYPE OF USE:
PROJECT NAME: WING FOLEY
DESCRIPTION: Limited energy for HVAC wiring.
OWNER: ZIMMLER DEVELOPMENT LLC, PHONE #: 503 -598 -3440
CONTRACTOR: AMERICAN HEATING PHONE #: 239-4600
Inspection Request Scheduled For: Date: 4/25/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 005225-01 503-209 -0731 N
Corrections /Comments /I ructions:
t
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
. FAIL (l CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G`_ ,/�
f Date: y...2.---,5--- Phone #: (503) 718-
1 �
1
CITY OF TIGARD -
1
I BUILDING DIVISION PERMIT #: ELR2005 -00057
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/16/2005
Phone: (503) 639 -4171 ,° ��7�ulp���ii��l liT\
Inspection Requests (24 Hrs.): (503) 639 -4175 J .. `__,..
INSPECTION WORKSHEET FOR DATE: 4/7/2005 TIME: 7:14AM PAGE: 96
SITE ADDRESS: 07117 SW BEVELAND RD CLASS OF WORK:
SUBDIVISION: BEVELAND LOT #: 2 -3 TYPE OF USE:
PROJECT NAME: EWING FOLEY
DESCRIPTION: Limited energy for HVAC wiring.
OWNER: ZIMMLER DEVELOPMENT LLC, PHONE #: 503.598 -3440
CONTRACTOR: AMERICAN HEATING PHONE #: 239 -4600
Inspection Request Scheduled For: Date: 4/7/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 003941 -01 503-209-0731 N
Corrections /Comments /Instructions:
r
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: //LA Date: `2 ✓ C Phone #: (503) 718 -