Permit CITY OF T I GA R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT #: ELR2003 - 00357
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/24/03
SITE ADDRESS: 09430 SW CORAL ST 150 PARCEL: 1S126DC -04400
SUBDIVISION: LEHMANN ACRE TRACT ZONING: C -P
BLOCK: LOT: 007 JURISDICTION: TIG
Project Description: Limited energy for HVAC controls.
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:
RENAISSANCE DEVELOPMENT ROTH HEATING & COOLING
1672 SW WILLAMETTE FALLS DR. 6990 S ANDERSON RD
CANBY, OR 97013
Phone: 503 -557 -8000 Phone: 503 -557 -8000
Reg #: L1(113 -26614
ELE 3- 314CRE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 11/24/03 $75.00 Elect'I Final
[ELPLCK] ELR Pln Rev 11/24/03 $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 a orth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules o r c uesti ns to OUNC at (503)
246 -6699.
Issued by Permittee Signatur
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
Received: 11/19/03 12:06PM; 5035981960 -> ROTH HEATING; Page 3
11/19/200311:43 FAX "5035 CITY OF TIGARD 1 1003 ,
r E
• e • FOR OFF1C 1 "hf Cl<<`L' st .'
Electrical Permit Application Received ��/� Electrical
iltjv ti ' LUUJ Date/By: if - / V ' A JJ2 PermitNo: . d V ''357' i •
Cit of Tigard PlanningAp.royal Sign
CITY OF TIGAR ► Date/By: • Permit No.: '� I
13'125 SW Hall Blvd. BUILDING DIVI 0 Plan Revie Other r� tape
Tigard, Oregon 97223 Date/By: Permit No.
~ ' Phone 503- 639 -4171 Fax: 503 -59S -1960 Post- Review Land Use • f
�R � • i� t`' DateB Case No.: _- --
' ; ;, . In te r net: www.ci.rigard.or.us a 4.. �I I Contact BI See Page 2 for
;,./ ;= f • 24 -1iour Inspection Request: 503 - 639 -4175 '�"" Name/Method: ' Supplemental knfosmatTca
' r-
�'.�. . : :
, .:.,•: �:a<; :':��, :,' .,,.' p .� ,...
•. .W _ PQ�Y�� -. •..
• �TYP � :'WORK ,,,;��,: � �. . . ... .PIAIV
C New construction Demolition t= 0 az ar Service over 225 amps- ❑ Health -care facility
commercial ❑ Hdous location
ddltlon/alteration/replacement ` Other: ❑ Service over 320 amps- rating of ❑ Building over 10.000 sonar; feet,' . .
• ' ' ` ?`' CATEGORY:OF C ONSTRUCTCON ? ''�'': F�' . . I & 2 family dwellings four or more residential units in •
1 & 2- Family dwelling Commercial/Industrial ❑ System over 600 volts nominal one structure .
❑ Building over three stories ❑ Feeders, 400 amps or more
Accessory•Building 0 Multi- Family ❑ Occupant load over 99 persons • ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other.
. i Submit sets of plans with any of the above: ,
OB;S YNFORMAI iind`LOCATION :1; .
The above are not applicable to temporary construction service.
Job site address: -7 3 -4 � ;; . , .• 2:.,t; . , .: -
Suite #: I CV 99 I Bldg./Apt.#: Number of inspections per permit a'ioweci -
Project Name: i v !l.IY' I 0.1 04 t t• 17, - L)7 " .1- • Description ' Qty Pee (ea.) 1 T�ena
New residential- single or multi- family per
Cross street/Directions to job site: dwelling unit. Includes attached garage. •
Service included:
1000 sq. R. or less 145.15 4
Each additional 500 sq. ft or portion thereof 33.40 • • I I
J Lot #�: Limited energy. residential 75.00 — f 2 .
Subdivision: Limited nergy, non residential 75.00 J 2
Tax map /parcel #: Each manufactured home or modular dwelling `
1 , . . • . ,.; ., •; service and/or feeder 90.90 •2
::;:;.:;..._..;;:i ". ''.::�'DESC' ONOE "; '' "''''
lit Services or feeders - Installation,
C1.2) V . 7 / g w alteration or relocation:
' • - • g - 200 amps or less 80 -30 : ' 1..21 ,r. �� • ' - 201 amps to 400 amps 106.85 4 _ ?
,-r w 401 amps to 600 amps 160.60 .
y r 601 amps to 1000 amp 240 _.
PROPERTY:OWNIER :' ; : ;.; ; TENAIV'JC'i ":`:'';= ::'; . . .: . I-; U
Vii- •• Over 1000 amR3 or volts . 454 -65
;: „�. ' . - Name: A/o t-v 1 c F' S v et.-7 s, Reconnect only 66.85 . . 2 '
Address: '.sic, ,'. Le>, Cow ,_ci/ e it 4 00 Temporary services or feeders - Installation, • • , , , .
City/State /Zip: 2 IAi v i. 6. e' q 9 2-oW alteration, 00 mps l
or relocation:
200 amps or less 66.85. • I •
201 amps to 400 amps 100.30 2
Phone: X25 - 3t7 Fax: �, „ nom 133.75
2 .
PL"IGANT S t "' c`:: ?:: CO V'PACT' PERSON" "'•::. > ° B ranch circuits - new, alteration, or
Name: . ? ie.. 1/VVR v"r 1 1 I extension per panel: .
Address: VO ,t-lo
O A. Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 6.65 -- F
City /State /Zi p' ` (1 . e_ 9 2 0 1 3 B. Fee for branch' circuits without purchase of
`� 1- �,� service or feeder fee, first branch circuit 46.85 • t 2
Phone: Z(p(�s [' ZLj I Fax: '� Each additional branch circuit 6.65 2
M isc,(Service or feeder not included): • •
E-mail: ., . 2
• :.�. Each p ump or ri - • 53.40
i CON:1CR[CT4R:= -. .... = .. Each P si or outl gation li htin circle •
- 53.40 _ i_2
Job No:
Business Name: 7Z0-144 , ,, e 0- to . , , Page/ . 2 alteration, or extension
Address: F �aoc j24 S" C - C Each additional ins eetion over the allowable in an of the above: .
- City /State /Zip: �G 1 ,-.,1, v bra ` - 7U� Per inspection per hour (min. I hour) 62.50
_ • Phone: Zio (o - /2. / Fax: 4 -gL/ 7 Investigation fee: - ,
L #: .. Ca-C °i, of
•
CCB Lic: #: 00 3/ 4'. Supervising el edNcailP- .eriiitt`Fees 'ix. ". i.,..::;
I :Y
p $ ectncian / Subtotal $ -1 i '° s gnature required: -11- ria_4. tie Plan Review (25 /o of Permit Fee) $ - 7 - 1
`" Print Name: fly ° bG� a- 1avi,se, \ Lic. #: 7e71 1.-a? State Surcharge (8% of Permit Fee) $
1 TOTAL PERMIT FEE 'S
' Authorize / /�� /+ 7 - , / � / / / ry 5 Notice: This permit application expires if n permit is not obtained within
Signatur • y / 55 /" ..--c�L. Date: � I 180 days after it has been accepted as complete.
-
� t ' `
•Fee methodology set by Tri- County Building Industry Service Board. •
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i:\Dsts\Permit Forms \ElcPermitAPP.doe 01/03 •
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