Permit fs
CI TY OF TIG A RD ELECTRICAL RESTRICTED ENERGY PERMIT
l DEVELOPMENT SERVICES PERMIT #: ELR2005 - 00137
� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6l1I2005
PARCEL: 2S113AC-00103
SITE ADDRESS: 07216 SW DURHAM RD 200p ZONING: I -P
SUBDIVISION: PACTRUST LOT: JURISDICTION: TIG
Project Description: Cabling.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC REALTY ASSOCIATES PROGRESSIVE TELEPHONE SYSTEMS
15350 SW SEQUOIA PKWY #300 -WMI 710 NE CLEVELAND # 120
PORTLAND, OR 97224 GRESHAM, OR 97030
Phone: Phone: 503- 665 -4900
Reg #: ELE 26- 1117CCLE
LIC 150175
FEES SUP 3290LEA
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 6/1/2005 $75.00
[TAX] 8% State Surcha 6/1/2005 $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 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
_ c
Issued By: s:(% Permittee Signature: �
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.
4 . • '
Electrical Permit Application ., ,,,. ,:,.. , , --:,..: Fog OFFICEVE.01:1(. . ' .,.. - :- . • l '' ..!.:
City of Tigard
A, , . .. .,,... _...,
Received
Date/B :
Plan Review I pr 1 - Permit No.:A -IL - _
i _ ,., 7
,
13125 SW Hall Blvd., Tigard, OR 97223 ,...-_, •
Phone: 503.639.4171 Fax: 503.598.1960 --- Intliiit Date/B : --- T Other Permit:
Inspection Line: 503.639.4175 ,.._,-V* • , 42.,, Date Ready/By: Mil E See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
ilagt, -:' Y'.:= , ;;r0e-fMtV4IfediVairle.XWMWM - MNFKriPataltntt ixtvil
timies,-...., 4...,,, y x. , 11;,sti''' ,,;;',",'.'.,'' , ;c" . '°,•-• --,-.-- -. '
0 New construction IR Addition/alteration/replacement Please check all that apply:
OService over 225 amps, comm'l EHazardous location
E Demolition Ell Other:
. EService over 320 amps - rating OBuildng over 10,000 sq. ft.,
'-'-'5- WW '1C 'P of 1- and 2-family dwellings 4 or more new residential
, ".e..., ..t,•.-e %. " ' „sa
El 1 and 2 dwelling iR Commercial/industrial I=1 Accessory building ['System over 600 volts nominal units in one structure
OBuilding over three stories OFeeders, 400 amps or more
0 Multi-family 0 Master builder El Other:
W-V WeirgreiWOWTIdisTAVIAlrerTVIST - DOccupa
' 0 Egress/
nt load over 99 persons ['Manufactured structures or
RV park
4a:t , _ 7 ,,, e ,, , ,, ,,, , 4 _, , ,, :4 „; , ,, .• „r• 7,- *1; - q , ; z,.. ; lighting plan
Job no.: Job site address: .72 ) 4, s „, Po /2.14A iNN 1d , Health facility DOther: _
Submit 2 sets of plans with any of the above.
City/State/ZIP: p (D /4 9 "1 "2-2--4- The above are not applicable to temporary construction service.
/ X.,,MCP-MitagEfOtr#007
Suite/bldg./apt. no.: 2_00 Project name: Lx, e n p i v z:r . A.). exa
Description I Qty. Fee. Total "*
Cross street/directions to job site: o 0 0. _ 4 , s -2 „.) 1...._ i -ejt. 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 I
Limited energy, residential 75.00 2
Tax map/parcel no.: r .
u Limited energy, non-residential 75.00 2
4 •FAIV - W'' l VeiTintifes fg
"MffroVititVoit ''Wiiwiam,tf.&i
,, =,. - ' - manufactured or modular
dwelling, service and/or feeder 90.90 2
4 f 9;81. -r. J L 0 t-o 1/c c. c_,.. Services or feeders installation, alteration, and/or relocation
e-A I.- 1 A-,S 200 amps or less 80.30 2
14 itit: -1:147fri 201 amps to 400 amps 106.85 2
IWillf.....x.....1%.-,..d. '•eir,.A.,,,....41,1,-...-.*•&:31;, 401 amps to 600 amps 160.60 2
Name: 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: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps 10 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps 10 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
',i,VWX-WliiltA . . ; ',7::: - ' A. Fee for branch circuits with
service or feeder fee, each
6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
46.85 2
each branch circuit •
Address: _
Each add'l 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 . Signal circuit(s) or limited- c.-
Nawnis..:17-,:." ,&,,,,,:avre energy panel, alteration, or 15
extension. Describe:LP ‘,.? 1 Page 2 4 4,..C ir - 2
Business name: P T 5 c V v LTA 4 t_
Each additional inspection over allowable in any of the above
Address: , -.1 I b ) 0 4 ... d L ex.y. LA A..2.0 51 1 2._.c: Per inspection 62.50
City/State/ZIP:C xm fv .. ) ) 0 . e . _ q 70 3 0 Investigation per hour (1 hr min) 62.50
Phone: (9)) 665 L/9,06 Fax: c52,9 t65 9g3 0 Industrial plant per hour 73.75 ,
M!..47-13MUMAMITIVRM.W....affr ?•`:'
CCB Lic.: 1 5 / 25 Electrical Lic.: 2 6,... ifi7 Lic.: 5 Z96 Lai Subtotal -64 4Q9-- -
Suprv. Electrician signature, required: ....e.„60. •
Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Print name: ,...
3 7 ,FCC__-k. / 0-$. Date: 5/ i ) c , 5 -
TOTAL PERMIT FEE
Authorized signature: At _te.e...„...„6:€,e4 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: srees 4 Date: 5/3// • Fee methodology set by Tri-County Building Industry Service Board
`• Number of inspections per permit allowed.
i: \BuildingWermits \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:
Wi � +� M d � ,� .. ;.mho,. Ni ii•
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
I1 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- PemutApp.doc 04/03
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005 -00137
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/1/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/14/2005 TIME: 7:10AM PAGE: 47
SITE ADDRESS: 07216 SW DURHAM RD 200p CLASS OF WORK:
SUBDIVISION: PACTRUST LOT #: TYPE OF USE:
PROJECT NAME: WELL PARTNER
DESCRIPTION: Cabling.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: PROGRESSIVE TELEPHONE SYSTEMS PHONE #: 503-665-4900 •
Inspection Request Scheduled For: Date: 6/14 /2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
1.35 Low voltage 009206 -01 603-665-4900 Y
Corrections /Comments /Instructions:
f Ah/tQl,
•
67 /(
___) /4;DASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
• Inspector: — Date: C fy Phone #: (503) 718-
1
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005 -00137
/13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/1/2005
Phone: (503) 639 -4171 ��rd�4V IpupGU���I'�
./ Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/7/2005 TIME: 7:17AM PAGE: 85
SITE ADDRESS: 07216 SW DURHAM RD 200P CLASS OF WORK:
SUBDIVISION: PACTRUST LOT #: TYPE OF USE:
PROJECT NAME: WELL PARTNER
DESCRIPTION: Cabling.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: PROGRESSIVE TELEPHONE SYSTEMS PHONE #: 503665 -4900
Inspection Request Scheduled For: Date: 6/7/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 008549 -01 503 - 665-4900 Y r"
Corrections /Comments/ Instructions:
C,
'g 1 yi
•
❑ PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 6 Date: ' t Phone #: (503) 718-