Permit zl
CITY F TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
, 0 4 ', DEVELOPMENT SERVICES PERMIT #: ELR2005 -00065
c 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/22/2005
PARCEL: 25101 DB -01000
SITE ADDRESS: 07080 SW FIR LP 100 ZONING: C -P
SUBDIVISION: 72ND BUSINESS CTR-VARNS PARK LOT: 012 JURISDICTION: TIG
Project Description: Installation of low voltage for data telecommunications.
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:
LDS FAMILY SERVICES DRISCOLL COMMUNICATIONS
7080 SW FIR LOOP P.O. BOX 33402
TIGARD, OR 97223 PORTLAND, OR 97292
Phone: 503- 620 -1 191 Phone: 503- 255 -4685
Reg #: ELE 26- 116CLE
L1C 119620
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 3/22/2005 $75.00
[TAX] 8% State Surchart 3/22/2005 $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 folio _ A dopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010
throug AR 952 -00 1 10. • may obtain copies of these rules or direct questions • 04 I C -s - 246 -66' •
Issue By: A, I ___,, i, P !, Permittee Signature: ., ��, .�
OWNER INSTALLATION ONL,
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.
oC1 k A''iwa xG, `"11,.4.t �..=/hr eR alb L4. t . tE �1 ,, p x' .f 4. „-* j
Electrical Permit Application ' '` < '` ' ;n , F9,49M USE ONLY , , , �p " :,R
City of Tigard /J D Permit No / 401 ��
13125 SW Hall Blvd , Tigard, OR 97223 ' Plan Review
Phone. 503.639.4171 Fax 503 598 1960 "N�I� Date /By. Other Permit: i
Inspection Line 503 639 4175 , 1 .EN� II' Date Ready/By 1 0 See Page 2 for
Internet www ci tigard or us Notified/Method (f co Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply'
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ❑Hazardous location
EService over 320 amps - rating ❑ Buildng over 10,000 sq ft ,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ❑ Commercial /industrial El Accessory building ❑S over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi -family ❑Master builder ❑Other
El Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Job no • Job site address: 7o,..0,_0 �41c 17 ❑Health -care facility CI Other
Submit 2 sets of plans with any of the above
City /State /ZIP: f � jr2Q 4e,a 7�?, The above are not applicable to temporary construction service
Suite/bldg. /apt. no.: `QQ Project name: k...,S FEE* SCHEDULE **
Description 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'l 500 sq ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75 00 2
Limited energy, non - residential 75 00 2
DESCRIPTION OF WORK Each manufactured or modular
_ " A , dwelling, service and /or feeder 90 90 2
/9®L�l/ _ ldN�!' / G�per4 ,v.��/p w /'e Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
III PROPERTY OWNER ,g1 TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160 60 2
Name: , ( z 9,5 fr j ylt/ 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 j) //' f p /� Fax: ( )
relocation
,
(O�''� < / 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 ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each
Business name: . 13/e4 ... - e ,(A ��,aN/ 517 -jci branch circuit 6 65 2
B. Fee for branch circuits
Contact name:
� p'" -- / /, ,. 54 'U4L without service or feeder fee,
✓ each branch circuit 46.85 2
Address p', , I ° ' . K � 4�®? Each add'I branch circuit 6.65 2
City/State /ZIP: ,d/L J2/wt/ti ��j i t/ 77 P07-----52;47,°Z Miscellaneous (service or feeder not included)
�9 a �j ."a<� Fax: : J�z� fS _ Gr,_.S
Pump or irrigation lighting 53 40 2
Phone.
� ) � Sign or outline lighting 53.40 2
E -mail: z ae4.5c ''LCci' T, feP/lvL; , Cd/1' Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
/
extension. Describe: Page 2 2
Business name: „ ae/3CO3.(4 C.n •emu t%i,.,r, „mss —7Di4-7—
Address „4: 562c)X Each additional inspection over allowable in any of the above
Per inspection 62 50
City /State /ZIP: �� ae�Vv,(J 9� '7 _ j e Cds Investigation per hour (1 hr min) 62.50
Phone �� 455 ' 6efv I
d— Industrial plant per hour 73.75
�
1)44 6 ELECTRICAL PERMIT FEES* Fax: (.x�'�J`') ,,.?__Cr- liL6`��S
CCB Lic : ` /X6dQ i 1 ctrica Lic.:WW0,(�� Suprv. Lic :nn// ��t/K.; � L y Subtotal 7 -
d'I! S✓
Suprv. Electrician signature, required ./.../....- / r 0 c Plan review (25% of permit fee)
Print name f ” '� State surcharge (8% of permit fee) 6, , O
Date: ^ d
v ` j �� ` ✓, � � ✓ E TOTAL PERMIT FEE '/
Authorized signature' This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name Date: * Fee methodology set by Tn-County Building Industry Service Board
** Number of inspections per permit allowed
1 \Buddmg\Permits\ELC- PemritApp doe 12/03 440- 4615T(i0 /02/COM/WEB
Electrical Permit Application - City of Tigard
";:Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
Audio and Stereo Systems*
I I Burglar Alarm
Garage Door Opener*
Heating, Ventilation and Air Conditioning •
System*
Vacuum Systems*
I I Other:
COMMERCIAL WORK ONLY:
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
ata Telecommunication Installation
Fire Alarm Installation
HVAC
Instrumentation
Intercom and Paging Systems
Landscape Irrigation Control*
Medical
I I Nurse Calls
I I Outdoor Landscape Lighting*
Protective Signaling
Other
Total number of commercial systems: I
*No licenses are required. Licenses are required
for all other installations
\Building \Penm[s\ELC- PenmtApp doe 04/03
CITY OF TIGARD - .
BUILDING DIVISION PERMIT #: ELR2005 -00066
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/22/2005
Phone: (503) 639 -4171 . °myj i,`,
Inspection Requests (24 Hrs.): (503) 639 -4175 ,n—
INSPECTION WORKSHEET FOR DATE: 4/11/2005 TIME: 7:10AM PAGE: 30
SITE ADDRESS: 07080 SW FIR LP 100 CLASS OF WORK:
SUBDIVISION: 72ND BUSINESS CTR -VARNS PARK LOT #: 012 TYPE OF USE:
PROJECT NAME: LDS CHURCH
DESCRIPTION: Installation of low voltage for data telecommunications.
OWNER: LDS FAMILY SERVICES, PHONE #: 503-620-1191
CONTRACTOR: DRISCOLL COMMUNICATIONS PHONE #: 503 - 255 -4685
Inspection Request Scheduled For: Date: 4/11/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 004213 -01 503- 516.2066 V
Corrections /Comments/ Instructions:
C w - tA
-� \\VN61 a \,'��
C C
P
•
i-16 PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL 1 1 CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �� %. / Jir Date: Z hi d Phone #: (503) 718-
/