Permit CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00471
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/19/2007
• PARCEL: 2S 102AD -01900
SITE ADDRESS: 08935 SW BURNHAM ST ZONING: CBD
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: TVF &R
Project Description: Low voltage wiring 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:
TUALATIN VALLEY FIRE + RESCUE ANCTIL HEATING & COOLING
20665 BLANTON ST 4320 N WILLIAMS AVE
ALOHA, OR 97007 PORTLAND, OR 97217
Phone: Contact #: PRI 503- 281 -0752
FAX 503- 282 -5722
FEES Reg #: ELE 618LHR
LIC 8897
Description Date Amount
[TAX] 8% State Surcha 12/19/2007 $6.00
[ELPRMT] ELR Permit 12/19/2007 $75.00 REQUIRED ITEMS AND REPORTS
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 ques s to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: / 4 � Permittee Signature ! r
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.
N Electrical Permit Appl c : EIVED FOR OFFICE USE ()N.I.,V
City of Tigard ..1 200A Received
Date/B : , / O zi • Permit N o
e e, 7 VI op 0
13125 SW Hall Blvd., Tigard, OR 97223 DEC 1 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 (ATV OF fIGAr'.:_tliti ...... Date/B : Other Permit:
Inspection Line: 503.639.4175
B EM or 4 •;;A; 7"... Date Ready/By: Juris: 4 r•' -. IZI See Page 2 for
Internet: www.ci.tigard.or.us V . i_ w • , Notified/Method: - / Supplemental Information
.r '' '- 'fi ' M s 4 ;';" :"; -1 q : 4:1[ : : ` '; ' Q' '' ' ' '-i : :: ' ,!:' . . -: ? . '" Z' .'._?'ti r :010W,*-0 ' ./01 ' ' ' .: - -.-: -, • -,.. . _,
0 New construction 10 Addition/alteration/replacement Please check all that apply:
['Service over 225 amps, conun'l [Hazardous location
0 Demolition 0 Other:
0 Service over 320 amps - rating EIBuildng over 10,000 sq. ft.,
.4* ,
:-:;- ? 4 .;•'.:-.;. l[TS
"•''''':'':- `-•" .: --,- - '-- '" , :.
:t.x,z;,1:6 r .... . -- .... of 1- and 2-family dwellings 4 or more new residential
11 1- and 2-family dwelling E Commercial/industrial [2 Accessory building ['S over 600 volts nominal units in one structure
DBuilding over three stories OFeeders, 400 amps or more
0 Multi-family 0 Master builder Ell Other:
['Occupant load over 99 persons OManufactured structures or
:lop3s1wipTrognIATjoN, -LOCATION DEg,ress/lighting plan RV park
. .. ... . ..
['Health-care facility ['Other:
Job no.: a. ei is Job site address: fle3, s 6,132.,d1.44,0z-: Submit 2 sets of plans with any of the above.
City/State/ZIP: 1 4 /A-0_42 I c (-?7,1D The above are not applicable to temporary construction service.
Suite/bldg./apt. no.: Project name: .-N/ l D j 71 -7
_ Description ' ''''- ..... 2 .. 1. .PEt c 4001 5 ,4C r-::',. . 7.- ;... ' , ', : ' :.; :- :,.: - Z,
Qty. Fee. 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
Limited energy, residential 75.00 2
Tax map/parcel no.:
Limited energy, non-residential 75.00 2
Each manufactured or modular
dwelling, service and/or feeder 90.90 2
rk 14-- b123 (ltri-Dy - 10-44,}zoteic4r-- i4 i fa- • Services or feeders installation, alteration, andlor relocation
200 amps or less 80.30 2
4I",..... AiWNE' " ":R" ...•.• - :". - -1
, ..,..-.,:.:;: .,',..,,,.. , •& ..-:'. 4 "'...:.- 'I. .0 •TENA.Nt • .. . 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: cry1.7.7 i t 601 amps to 1,000 amps 240.60 2
Address: Le Co Thaittild kt.1_ Over 1,000 amps or volts • 454.65 2
Reconnect only 66.85 2
City/State/ZIP: 7),14 ,4 el 7/1/6 Temporary services or feeders installation, alteration, and/or
i ""--. I relocation
'Phone: ( ibi ) 94,c _ 91 I Fax: (1-- 3) 479 fq5,11.6--- 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
.. . „,. ...,.—
PPLIC 'IcNT.‘ •,,, - • . .: : :: • 0 CONTACT' PERSON:. • • A Fee for branch circuits with
service or feeder fee, each
6.65 2
Business name: 411/4.10Avi tRiO'rid( 2( t.otn-id branch circuit
B. Fee for branch circuits
Contact name: 041.- A4 vrw, without service or feeder fee,
46.85 2
first branch circuit
Address: i4.3 t d .um. „,,,,,, d , A
Each add'l branch circuit 6.65 2
City/State/ZIP: 196 0 , 2 91,2 Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: (9 -i ) A - Fax: : (1 ) .
Sign or outline lighting 53.40 2
E-mail: PAI 4 A44441114 war . qwt, Signal circuit(s) or limited-
it§W5CF.ATZVZ.r'k':rtri,' ',..,'":: - -, - - ' :...- -. ' energy panel, alteration, or
- - " •• - extension. Describe: - Page 2 2
Business name: 1A)Jt/"--bil
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: ( ) Fax ( ) Industrial plant per hour 73.75
' '" ' - ALEPTWAVAP,E
it..
CCB Lic.: F Electric
7 -,774,--1,:;4:i..7-7 .g . : t /FL t ... -:,::. -a Subtotal
::„..... ,--i- -- - .•- :- , .
Plan review (25% of permit fee)
State surcharge (8% of permit fee)
rintffiane , t 1..0 Date:
TOTAL PERMIT FEE -- I -* -
Authorized signature: (b ,,,,,,z This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: .011, po-i Date: la - 1(1_ 7 * Fee methodology set by Tri-County Building Industry Service Board
1 ,
** Number of inspections per permit allowed.
i:\Bnilding\PertnitsELC-PermitApp.doc 12J03 440-4615T(10/02/COM/WEB