Permit CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
'" I DEVELOPMENT SERVICES PERMIT #: ELR2005 -00113
� 'il 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 5l13I2005
PARCEL: 1 S 135BA -03302
SITE ADDRESS: 10520 SW CASCADE AVE ZONING: I -P
SUBDIVISION: OFFICE DEPOT LOT: JURISDICTION: TIG
Project Description: Low voltage 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:
KP VENTURE LLC HVAC INC
2519 NW MARSDEN PL 5188 SE INTERNATIONAL WAY
PORTLAND, OR 97229 MILWAUKIE, OR 97222
Phone: Phone: 503 462 - 4822
Reg #: LIC 50897
ELE 26 -571 CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 5/13/2005 $75.00
[TAX] 8% State Surcharl 5/13/2005 $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
throw • •AR 952-641-01 u may obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699.
Iss • d By: ) Permittee Signature:,(.Sitau �, t"Aavi
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.
POPS ool
,ctrical Permit Application FOR' 0FFI.CE`USE.ONLY ' ; 1r��
Ie ,,
Received ..— Electrical n� ^�
` ' ® Date/By: /3 Q j Permit No.: Z1. � 5 A'/ /3
City of Tigard ��, V Planning App oval Sign
13125 SW Hall Blvd. Date /By: Permit No.:
Plan Review Other
Tigard, Oregon 97223 i 20 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 5 98 -1 §6 Post- Review Land Use
i
Internet: www.ci.tigard.or.us �1 Date /By: Case No.:
g �'' I �
24 -hour Inspection Request: 513, Y ( �� 3 Dk i �! �="° l Co
1 El See Page 2 for
e Name/Method: (C.,0" Supplemental Information.
r .. _?_ , x" *,, : . YTYPE�,OF WORK i" ,: �_ X, �:: ',4 ;g eN Y. AN =REVIEW``P , l
r] New construction n ❑ . `~�. � " °`` ,( ease ' "clieck�;all €tfiati.'appl�. *r`_ . ' °���8
Y)�.'
Demolit ❑ Service over 225 amps- ❑ Health -care facility
l�'A�dditio lteratio e lacement commercial ❑ Hazardous location
y r p ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
v: '. CATEGORYjOF.CONST N'_Kr "- : ; : :: -' 1 & 2 family dwellings Y g four or more residential units in
❑ 1 & 2- Family dwelling 0 sommercielndustrial ❑ System over 600 volts nominal one structure
❑ Building over three stones
EI
Accessory Building ❑ Multi- Family ❑Feeders, 400 amps or more
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
' '''' n' "" JOB ;SITE INFORIVIATIONfrand:IJUCATION !: `. '. `_•--' Submit sets of plans with any of the above.
Job site address; The above are not applicable to temporary construction service.
Suite #: Bldg. /Apt. #: .�;.:.... '•�i� ." ., „FE SCIIEDUL <xv�� �W.x s�a�
� � Number of inspections per permit allowed
Project Name: l-Jf't- -- -(”— Description Qty Fee (ea.) Total
Cross street/Directions to job site: New residential - single or multi - family per it
dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Subdivision: Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
% l' . DESCRIPTION
''' :OF VORK-5 :- ` °_ . 1 service and/or feeder
x �;, :' .�: "',g,�h,f, 90.90 2
1.01- v p D w f' r , i Services or feed in
l
l� ''� u•� 4�tvn /IQ/ alteration or relocation: ,
200 amps or less 80.30 2
- 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
li PROPERTyr t y: 6 01 am
OWNER, < i., = '`���,•. ��$s't`: = �� amps to 1000 amps 240.60 2
Name: (�-c- u,� b �� Over Reconnect amps or volts 454.65 2
"' Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
City /State /Zip: alteration, or relocation:
200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
[� APRI "` ;` 401 to 600 amps
ICANT; ;�' , .G,.:,= ;',, IS CONTAC;T;PERSONt =; ; ,:' ".� ,: p 133.75 2
Name: Th.) yckC Branch circuits - new, alteration, or
extension per panel:
Address: A. Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
Phone: service or feeder fee, first branch circuit 46.85 2
Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
7� Each
i ', � . >. r' .� 'I.CONTRACT,,012.14 " :: :: :• .i,. pump irr 53.40 2
Job Each sign or or outline igation lighting circle
5340 2
Job NO: ab ( Signal circuit(s) or a limited energy panel, /
Business Name: W AC. e� alteration, or extension / Page 2 2
Address: ' Description:
City /State /Zip: (Wa , (LIfL a 6, °17aa„ , Each additional inspection over the allowable in any of the above:
t Per inspection per hour (min. 1 hour) 62.50
Phone: 503 -- ti(oa 4 $aa- Fax: 503- (pet • (o555 Investigation fee:
CCB Lie. #: SO�g7 Lic. #:�� -5 7 CL>✓ Other:
Supervising electrician " > :`- '.tElectr x ..r:':p t'-!ii:',, =
ieal:PerinitrFees. s �`�
signature required: ' - rn . (A il —o Subtotal $
Plan Review (25% of Permit Fee) $
Print Name: 7 wl (,c1),,i Lic. #: (0D _ State Surcharge (8% of Permit Fee) $
Authorized _ r TOTAL PERMIT FEE $
Notice: This permit application expires if a permit is not obtained within
Signature: 0 r . a (iyt Date: Si/Z/0_5 180 days after it has been accepted as complete.
` *Fee methodology set by Tri- County Building Industry Service Board.
' Le�1 -- rte- �otrN vi-vs ate-,
(Please print name)
is \Dsts \Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
n Audio and Stereo Systems
n Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System
n Vacuum Systems
n Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
0 Boiler Controls
IT Clock Systems
F - 7 Data Telecommunication Installation
n Fire Alarm Installation
HVAC
O Instrumentation
n Intercom and Paging Systems
• Landscape Irrigation Control
n Medical
O Nurse Calls
• Outdoor Landscape Lighting
n Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
is \Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005-00113
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/13/2005
Phone: (503) 639 -4171 i
Inspection Requests (24 Hrs.): (503) 639 -4175 J
INSPECTION WORKSHEET FOR DATE: 6/10/2005 TIME: 7:05AM PAGE: 47
SITE ADDRESS: 10520 SW CASCADE AVE CLASS OF WORK:
SUBDIVISION: OFFICE DEPOT LOT #: TYPE OF USE:
PROJECT NAME: OFFICE DEPOT
DESCRIPTION: Low voltage for HVAC wiring.
OWNER: KP VENTURE LLC, PHONE #:
CONTRACTOR: HVAC INC PHONE #: 503 - 462 -4822
Inspection Request Scheduled For: Date: 6/10/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage . 008075 -02 503. 462 -4822 N
orrections /Comments / Instructions:
C
)
4 * - j
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: AP P I U-- Date: b 0 - Phone #: (503) 718 -