Permit Wi 4'
CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
II
' ° COMMUNITY DEVELOPMENT PERMIT #: ELR2006 -00311
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12122/2006
PARCEL: 25101 BB -01400
SITE ADDRESS: 12150 SW GARDEN PL BLD3 ZONING: C -G
SUBDIVISION: PARK 217 LOT: 002 JURISDICTION: TIG
Project Description: Low voltage. HVAC stats
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:
RREFF MANAGEMENT OREGON HEATING & AIR CONDITIONING
729 SW WASHINGTON # 630 PO BOX 397
PORTLAND, OR 97205 DUNDEE, OR 97115
Phone: 503- 295 -5555 Contact #: PRI 503 -538 -2953
FAX 503 -537 -2172
FEES Reg #: ELE CRE -15
LIC 172126
Description Date Amount
[TAX] 8% State Surcha 12/22/200€ $6.00
[ELPRMT] ELR Permit 12/22/200€ $75.00 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 or 1.800.332.2344.
Issued By: Permittee Signature: A CAA L 6/1.-
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. .
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Approved plans are required on the job site at the time of each inspection.
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De`,22 06 11: MS Rentals, Inc. 503 - 537 -2172 p.1
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tE1ectrical Permit 'A e, z; nca ,io> OFFICE USE O NLY
Cl of Tigard LL ,' ' F :ti Received 2 I O b 3 ' / `_ 2
t i , / -' r f ; li 1 D I /.�� / . Permit No : ,i • ♦ l7 ��C! y l 1
13125 SW Hall Blvd., Tigard, OR 97223 `- e Plan Renew //
Phone: 503 639.4171 Fax: 503.598.I960 ' ^a'y r' Y' Date/By Other Permit-
Inspection Line' 503.639.4175 DEC :'� 1 ' Date Review
By: Ie f H SeePage2 for
Internet www.ci.tigard.or.us (r 22 �00 Noofied/Method Supplemental Information
+)�/ U L AX!1 REVIEW: °:
❑ New construction .s7; ,-; il + -7 Ott _ Fera t� nt Please check all that apply:
El Demolition T � � 0 Service over 225 amps, comm'l OHazardous location
■ Ither: cT
OService over 320 amps - rating ❑Butldng over 10,000 sq. ft.,
CATEGORY OF GONSTRUCITON of 1 -and 2- family dwellings 4 or more new residential
❑ 1 - and 2 family dwelling EXCotrunercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one stricture
['Building over three stories ❑Feeders, 400 amps or more
❑ Multi - family ❑Master builder ❑Other:
[(Occupant load over 99 persons ❑Manufactured structures or
- ' " JOB SITE INFORMATION AND LOCATION ' " ['Egress/lighting plan RV park
Job no.:Q64:- Job site address: /a),5 61 . 3c 1 (der) -� I ❑H r. ealth - care facility ❑Othe
J Submit 2 sets of plans with any of the above.
City/State /ZIP: ' SIC G ✓� The above are not applicable to temporary construction service
1 , " ' FEE' - 'SCHEAUTI:Z.... ;_ A Suite/bldg. /apt. no.: `-'' Project name: �� '
Des mption I 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 I 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 "' - - , . Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Set or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
' _ . El. PROPERTY, OWNER- _ .. -. • . : • I b T' NAN 201 amps to 400 amps 106.85 2
^ 401 amps to 600 amps 160.60 2
Name: V ( 1 r+ 601 amps to 1,000 amps 240.60 2
Address: l .. i so ��.I ' `1 I ( Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City / State/ZIP: ( j ( a ( I ()( C. - 7 - D.--13 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 to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 4-49, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
- ❑Y APPLICANT- • . ❑ CONTACT. PERSON • •• A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: rjO + c tt/fy branch circuit
Contact name: B. Fee for branch circuits
without service or feeder fee, 46.85 2
Address: p J 3 q 7 each branch circuit
/ Each addl branch circuit 6.65 2
City/State/ZIP: ` D I�� 6' c..1__ G 7 I I 5 Miscellaneous (service or feeder not included)
1 7 ----1-73_
Pump or Irrigation circle 53.40 2
Phone: (3) �C 3 -1)..-CI, a?c y � ! _J � Sign or outline lighting 53 40 2
E -mail: Signal circuit(s) or limited-
. .
• . , ' CONTRACTOR. • ' - , energy panel, alteration, or
extension. Describe: j Page 2 L 2
Business name: 0 , CC' CY1 ( W- r
Address: ,'�(3Jx , q - Each additional inspection over allowable in any of the above
vvv vti i, ` Per inspection 62.50
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City/ State/ZIP: ) � e-CG(.- �� J G C, 7 I ` Investigation per hour (1 hr elm) 62.50
Phone (G C:3 53:-" i �Cf� Fax: L5 � f'�. Industrial plant per hour 73.75
=�� .f. - 7,..,4 - 7, _ ELECTRICAL PERMIT FEES*
CCB Lie.: 1 7..1 Electrical Lie.: LJ-f g do Suprv. Lic.: CR&T-J± Subtotal "I
Suprv. Electri jar( signature, required: ^ - ' w r GfiGd - C Plan review (25% of permit fee)
�•• ,.
State surcharge (8% of permit fee) C' Print name: 61._ , .rte ;' _ ' Date: .. .. 1,
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CITY �~�����N�������� .. ' ' �
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BUILDING DIVISION PERMIT #: ELR2D06'UO3|1
13125SVV Hall 8hd.. Tigard, ORS7228 DATE ISSUED: 12y22/2006
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 A- *��.
INSPECTION WORKSHEET FOR DATE: 12y27y2006 TIME: 7:00AM PAGE: 12
SITE ADDRESS: 1216DSW GARDEN F,LBLD3 ' CLASS OF WORK:
SUBDIVISION: PARK 217 LOT #: 002 . TYPE OF USE:
PROJECT NAME: AAA OF OREGON '
DESCRIPTION: Low voltage, MVACmto10
OWNER: RRFFFh4AWAGEhAENT. PHONE #: 503.
CONTRACTOR: OREGON HEATING & AIR CONDITIONING PHONE It: 503'633.2953
Inspection Request Scheduled For: Date: 12/27/2OO6 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 04153301 503-349-8162 N
Corrections/Comments/Instructions:
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� PARTIAL APPROVAL �C� �
CANCEL NO ACCESS
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/ I FAIL CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
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Inspector: ^ ���J�� �~t�' Date: .�1 �/ L�� Phone #: (503) 718' ����*b
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