Permit CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
I DEVELOPMENT SERVICES PERMIT #: ELR2006 -00099
DATE ISSUED: 5/5/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S101 DA -01200
SITE ADDRESS: 07165 SW FIR LP 204 ZONING: C -P
SUBDIVISION: 72ND BUSINESS CTR -VARNS PARK LOT: 014 JURISDICTION: TIG
Project Description: Data/Telecommunication.
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:
AMERICAN PROPERTY MANAGEMENT ALREADY TELEPHONE SYSTEMS
2510 NE MULTNOMAH 124 DEERBROOK DR
PORTLAND, OR 97232 OREGON CITY, OR 97045
Phone: 503- 284 -6133 Contact #: PRI 503- 443 -2178
FEES Reg #: ELE 34- 578CEP
LIC 132697
Description Date Amount
[ELPRMT] ELR Permit 5/5/2006 $75.00
[TAX] 8% State Surcha 5/5/2006 $6.00 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 questions to OUNC at 503 - 246 -6699.
Issued By: �� �2tl' Permittee Signature: g- '
� vg�
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.
Electrical Permit Application= N \F1 _.______- FOR _OI FIC USL;ON1 l' u_
11,1 Ci of Tigard ` 1 1 1 Date/B ' / L.,17 ,
J
Permtt No.: � iA
13125 SW Hall Blvd., Tigard, OR 97223
6 r.. Phone: 503.639.4171 Fax: 503.598.1960 / .6 2006 DatePlan /B Reiew
. v Other Permit
TIGARD G A R D Inspection Line: 503.639.4175 �� ' l Date Ready/By: INIM ® See Page 2 for
Internet: www.tigard - or.gov �cgg� Notified/Method: Supplemental Information
rg' . I tit 'i t 32W
�r - c s `oi��', .a
TYPE O1 � Oltl .-c -r? S.S1 a , , PLAN REVIEW " .
❑ New construction . p' Addition/al tionirepl`ac'ement Please check all that apply:
ra a t- " ❑Service over 225 amps, comm'l ['Hazardous location
['Demolition ❑ Other:
❑ Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
C OF CONSTRUCTION . of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building El System over 600 volts nominal units in one structure
❑ Multi-famil ['Building over three stories ['Feeders, 400 amps or more
y ❑ Master builder ❑ Other:
['Occupant load over 99 persons ['Manufactured structures or
JOB ; SITE INFORMATION AND LOCATION . .. . ❑ Egress/lighting plan RV park 7 / /��-' .. 0---- ,_ ❑Health -care facility ❑Other:
Job no.: Job site address: b
0'�"? Submit 2 sets of plans with any of the above.
City / State/ZIP: r' �-L 9 7 a 3 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: FEE* , •
Description I Qty. I Fee. I Total I " `*
Cross street/directions to job site: 5W 7 2. 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 1
Limited energy, residential 75.00 2 •
Tax map /parcel no.:
Limited energy, non - residential 75.00 . 2
DESCRIPTION OF WORK , manufactured or modular
�¢' J i C � �� dwelling, service and/or feeder 90.90 2
��ff Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
- 0, PROPERTY OWNER ' I ❑ TENANT` 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: t 2_ U / / 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
Phone: ( ) I F ax: ( ) relocation
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
❑'.APPLICANT. ❑ CO ACT PE'' ON. A. Fee for branch circuits with
f . , service or feeder fee, each 6.65 2
Business name: f / /• branch circuit
- I :.. _ . .i i �Li
Contact name: B. Fee for branch circuits
•
� / without service or feeder fee,
Address: � / � � > first branch circuit 46.85 2
7/0 b C % / E ( / � r�w �/v L Each add'l branch circuit 6.65 2
City /State/ZIP: 2/-„ W/� 75,(12 Miscellaneous (service or feeder not included)
,( 7 ' {' Pump or irrigation circle 53.40 2
�
Phone: (5y) / � c� 7 '-Z- / 7(> I Fax: (.5 0) 2g — g 2, / P g
Sign or outline lighting 53.40 2
E- mail: Signal circuit(s) or limited- '
CONTRACTOR- energy panel, alteration, or
extension. Describe: % Page 2 / 2
Business name: 5 Al ---
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: ( ) I Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL `PERMIT FEES*
CCB Lic. /32 6 I Electrical Lie j'7, cc 4 Suprv. Lic. :i2 3F45/4 Subtotal: 75
Suprv. Electrician signature, required: ` ,. , Plan review (25% of permit fee):
_ l
Print name /? 2 , /`' �/ Y Date: State surcharge (8% of permit fee): I I
V /�' / r�� ^�� TOTAL PERMIT FEE 2 / I
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: egi -, i h/ T ,( Jj Date: 3 - l -0 . • Fee methodology set by Tri- County Building Industry Service Board
V ` '• Number of inspections per permit allowed.
19Building\Pennits\ELC- PermitApp.doc 03/23/06 440-4615T(11/05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
F RESIDENTIAL WORK'gNLY: -`
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.
I ' COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
q 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
1:\ Building \Permits\ELC- PennitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: ELR200&•00099
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 502006
Phone: (503) 639-4171 FIN
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 5/16/2006 TIME: 7:02A1v1 PAGE: 40
SITE ADDRESS: 01165 SW FIR LP 204 CLASS OF WORK:
SUBDIVISION: 72ND BUSINESS CTR-VARNS PARK LOT #: 014 TYPE OF USE:
PROJECT NAME: WELKIN ENGINEERING
DESCRIPTION: Datafrelecommunication.
OWNER: AMERICAN PROPERTY MANAGEMENT, PHONE #: C0-204.6133
CONTRACTOR: ALREADY TELEPHONE SYSTEMS PHONE #: 503.443-2170
Inspection Request Scheduled For: Date: 5/1612006 Pour Time:
Inspection Description Confirm # Contact # Message
135 Low voltage 029953-01 603•442178
4c1C\ Fi t
• -
on - •mments/Instructions:
•
PASS { PARTIAL APPROVAL El CANCEL El NO ACCESS
n FAIL n CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: G . N68 LE: Date:C11 Phone #: (503) 718- 1—*