Permit CITY C)F TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
r��lll DEVELOPMENT SERVICES PERMIT #: ELR2004 -00348
----' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/19/2005
SITE ADDRESS: 07157 SW BEVELAND RD PARCEL: 2S101AB -02100
SUBDIVISION: BEVELAND ZONING: MUE
BLOCK: LOT: 003 JURISDICTION: TIG
Project Description: Limited energy for HVAC.
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
7165 SW FIR LOOP SUITE 100 1339 SW GIDEON ST
PO BOX 230698 PORTLAND, OR 97202
TIGARD, OR 97223
Phone: 503 -598 -3440 Phone: 239 -4600
Reg #: LIC 33135
ELE 26- 993CRE
SUP 2640LEP
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 11/8/2004 $75.00 Elect'I Final
[TAX] 8% State Surchari 11/8/2004 $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 questions to OUNC at (503) 246 -6699.
X/*)
Issued by Ca) Permittee Signature 1(
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 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Permit Appl FOR OFFICE USE ONLY.
City cf "Tigard O 2OO Date/B y: �6w Permit No.: f ` 1 J 1// _ I " ' jj
13125 SW Hall Blvd., Tigard, OR 97223 N hone: 503.639.4171 Fax: 503.598.1960 1� A . Plan Review
i , Permit:
Line: 503.639.4175 Ci I
Y OF TIGAR �� I Date/B
Other Per
' , e`/ Date Read /B y:
e, .4...w } 0 See Page 2 for
Internet: www.ci.tigard.or.us �t 1'��'�Cjj `S'' Notified/Method: Supplemental Information
•
r , ,x ,wit U :~ E n -D bs,.' ' al 5' s� svr «, _,, -- :.a,.. R .. .
E . t x � Y PE "O -- 'r a � ` . _ ` . — � - AN REA .-t s ' 4 - ,lb -i
In ew construction ❑ Addition/alteration/replacement Please check all that apply:
111 Demolition ❑ Other: ['Service over 225 amps, comm'l DHazardous location
�. ['Service over 320 amps - rating ❑Bulking over 10,000 sq. ft.,
i_ 4�3�R
ri fir_ _ ' G TEGU - ,Q) C ' Nw: .. =54 of t- and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑Building over three stories ['Feeders, 400 amps or more
Multi-family
❑ ❑ Master builder ❑ Other:
❑Occu ant load over 99 persons ❑Manufactured structures or
x l 'IRJOB Sf FORMAT o D MTiliON _ - P P
"> . .,. ., .. , , - te a .. 154.-. z ; -, ❑Egress /lighting RV park
y ,� N4 {J
B 4 — 0 Health facility ['Other:
Job no.: Job site address. ��a Submit 2 sets of plans with any of the above.
City/State /ZI1 {'` ht GI 7 T above are not applicable temporary service.
� ) of Icable to tern orar construction servi
Suite/bldg./apt. no.. P ro t Project name: ` �/��/ f� / j ramo ' ~;may {£ EEE *t"SC"oot A t , - z
==1J6- a./ i'W (✓7 f ttil.i' B Description s. _ ,.a.,...sa,"2., ,. ..._ ' i. `� ,. o �
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'l 500 sq. ft. or portion 33.40 l
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
T e , , - 4III1 SCRIPTiO Tfo O j t 4. , + Each manufactured or modular
Ail i V.) �� • 01 140, dwelling, service feeder 90.90 2
Servervices es or feeders rs ins nstaallation, alteration, and/or relocation
200 amps or less 80.30 2
,� n _SAW 1 i a 201 amps to 400 amps 106.85 2
, , � , � ER T' , Po... .; ,4' � = � . [ E A l ' kr.WA
401 amps to 600 amps 160.60 2
Name: X l H L -- 0_,e1 E_1 -0l1k1 601 amps to 1,000 amps 240.60 2
Address: PD --- e16 oC 3 1 G !t3 Over 1,000 amps or volts 454.65 2
L Reconnect only 66.85 2
�
City/State /ZIP: / /2.4. / O 2 9. 7 2.13' / Temporary services or feeders installation, alteration, and /or
Phone: (523 59 $ — ,34 (C (S Fax: ( ) 2 00 am ion
200 amps or less 66.85 " l
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
APPS CST ' '�` R COATAe7 _ PER$OPI�x� ` 1 A. Fee for branch c ircuits with
"� "'a,� ".. w _` "` ";M:." R ' 1 service or feeder fee, each
Business name: branch circuit 6.65 2
B. Fee For branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'I branch circuit 6.65 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Phone: Pump or irrigation circle 53.40 2
( ) Fax: )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
- ON ,, asq �_ ,� �CQTItAl�T -012 ��- ".' >� -t �; � energy Panel, alteration, or
t � � v extension. Describe: ' Page 2 2
Business name: A1"i ', ?` r t1 or,
Address: itio: ( 57 --
( Each additional inspection over allowable in any of the above
Per inspection 62.50
CitylState /ZIP I Investigation per hour (1 hr min) 62.50
Phone: ( ) A010.4415;00 Fax: 67:Z:.) „r� Industrial plant per hour 73.75
ELECTI_t:C T . ,.:I. i g,._
CCB Lic. j Electrical) LLil!—cc ----,( ' - t ! Suprv. Li O ., Subtotal 9!',0O
Suprv. Electrician signature, required d -- t Plan review (25% of permit fee)
y State surcharge (8% of permit fee) 6. U C)
Print nalp114 _ Date: O G
1 ��” `' � � ' " • TOTAL PERMIT FEE Dl,
Authorized signature: TM. - This permit application expires if a permit is not obtained within 180
-�� ,=. - � � days after it has been accepted as complete
Print name: , .r, J ` , Date: f " *At = Fee methodology set by Tri- County Building Industry Service Board
►'.� _ � 1 _= Number of inspections per pemtit allowed.
i:\ Building \Permits\ELC- PermitApp.doc 12/03 440- 4615T( IO /02JCOM/WEB
i
CITY Q.F TIGARD
BUILDING DIVISION PERMIT #: ELR2004- 00348
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/19/2005
Phone: (503) 639 -4171 AA ml i
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 513/2005 TIME: 7:14AM PAGE: 100
SITE ADDRESS: 07157 SW BEVELAND RD CLASS OF WORK:
SUBDIVISION: BEVELAND LOT #: 003 TYPE OF USE:
PROJECT NAME: ANDRUS
DESCRIPTION: Limited energy for HVAC. .
OWNER: ZIMMLER DEVELOPMENT LLC. PHONE #: 503-5983440
CONTRACTOR: AMERICAN HEATING PHONE #: 239.4600
Inspection Request Scheduled For: Date: 5/3/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 005896 -01 503 - 2096696 N
4.
Corrections /Comments/ Instructions:
li .,' • NN( 6 1 -- r\-10 . ■.\_. t) fNci ob o-, IA ,
_,,,. • _
-- yst - a6 HWO (0 VKA - b - 0 N UP 4-1) et. P n--
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
1. FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: /)./ l 1 Date:S. 6 Phone #: (503) 718-