Permit r .z CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
�11+
DEVELOPMENT H O PMENq r S o ERV SERVICES 639 -4171 DATE ISSUED: 4 -00065
- 13125 ED: 3 16/04
SITE ADDRESS: 10685 SW GREENBURG RD PARCEL: 1S135BB-00700
SUBDIVISION: ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: Job No. 1747 -052 Protective Signaling
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: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
BEAVERTON HONDA SONITROL PACIFIC
10685 SW GREENBURG RD 8220 N. INTERSTATE AVE.
TIGARD, OR 97223 PORTLAND, OR 97217
Phone: Phone: 223 - 5822
Reg #: LIC 53535
ELE 26- 370CLE
FEES Required Inspections
Description Date Amount Ceiling Cover
[ELPRMT] ELR Permit 3/16/04 $75.00 Wall Cover
Elect'I Final
[TAX] 8% State Surchar€ 3/16/04 $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 throuc
Issued by Permittee Signature 41 d e
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
• J
i ` : ; FOR' OFFICE
Received ' USE = ONL
Falectl� eal Permit A T ��[/® (�
�� "�� Date/B : • Permit Nola _ Electrical / cc ee C�7 / Od o .
Planning A royal Sign
1 , g PP
City of Tigard p 5 :O`t Date/B : Permit No.:
13125 SW Hall Blvd. MQR . v Plan Review Other
Tigard, Oregon 97223 GA' D Date/B : Permit No.:
Phone: 503- 639 -4171 Fax: 503 - 598 -
1 ?�( �F �N Post - Review' Land Use
; ri � , l , , 1 T t Date/B : Case No.:
Internet: www.ci.rigard.or.us BJ n .' I� ^ Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 W Name/Method: Su lemental Information.
v. ., ne,,... ; di t z. _ �;S..,r,. s.s:; x. _ r lease clieck all tl at,a° =,� µ .. ..•. r.,,_
:
r- ,,��.�� > � �-�„ - TYP.,E:�OF; WORK;��:�; -...,r � z °�� rw� ��:``',� "` � . :�PI;AN,.REVIEW�(P _ , - PP Y)�� w ,....
❑ New construction ❑ Demolition » ❑ Service over 225 amps- El Health -care facility
commercial ❑ Hazardous location
IN Addition/alteration /replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
1 ' l `;`x . UC'ATEGORY OE}CONSTRUCTION.:' F z`'' ":: - ;'?')Fn r ;l 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling [Xi CommerciaUIndustrial El System over 600 volts nominal one structure
❑ Building over three stories El Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons El Manufactured structures or RV park
❑ Master Build
Builder ❑ Other: ID Egress/lighting plan CI Other:
- p ; JO &SITE X NF:ORIVIATIONan ,�, r i Submit • sets of plans with any of the above.
d> 'O,CATION . •:r >�: ^re The above are not applicable to temporary construction service
' :.;.:�; ., * t v• ,'
Job site address: VS fin. t 5 � C°iY.es�.+n a n ��"'�.�,,�`� » = :�`,��.�`, ,' ��: �- ��r�FEE=HEDULE;,tic Ye:.,_� =e,� .:r.e�.,�� -��`. : >...
Suite #: Bld . /Apt. #: Number of inspections per permit allowed
Project Name: t Cw'w�/
l _fin f a - (C Description Qty Fee (ea.) Total 1
a y .... sNew residential - single or multi - family per
U. XDV' �
Cross street/Directions to job site: . - dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 • 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: Lot #. Limited energy, non residential 75.00 2
Tax map /parcel #: .' Each manufactured home or modular dwelling
%
.. f a x service and/or feeder 90.90 2
,..' ggill::,`„ _: ny: b , (DESCRIPTION OFL,WU <;•' r . ,, -' .<- _'n ,
Services or feeders - installation,
alteration or relocation:
. 200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
P•ROPERTYOW_ N_ER ' r '° °''
r. _nom „�,i�;. •„�•��• °� � 601 amps to 1000 amps 240.60 2
- �= .�.;�� �` TENAIvT = °���;,,...-_.. = w p 454.65 2
=.. ,..,((���;, Over 1000 amps or volts
Name: -c\l.X��`-' Reconnect only 66.85 2
Address: 1O3 St ) C.Q.).SC(1.a. '1/44:.\ v C. Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: \ V(). 1 C)`r • c. r i oZ a 3 200 amps or less 66.85 1
� � , „ CgIY:TACT:PERSON' ,r : 201 amps to amps
amps
100.30
Phone: Fax: �_ 201 amps ps to 400 100.30 2
Z El LIC'ANTF';r »i' • ” >`: ' ®? '' Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of 6.65 2
Address: service or feeder fee, each branch circuit -
City/State/Zip: ty'State /Z1 . B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: Fax: Each additional branch circuit 6.65 2
Misc or feeder not included): 2
E-mail: e 53.40
Each pump or irrigation circle
r a a, , ' = r -. 53.40 2
CONTRACTOR s;<: '.
�s�',�m��;�sr _� Each sign or outline lighting � GO
P' t4 r 1 - - ( a Signal circuit(s) or a limited energy panel, 2
Job No: L n " alteration, or extension ' Page 2
Business Name: SC yl/� �k rO�c�� Description:
Address: S aaP ./..nr _ Each additional inspection over the allowable in any of the above:
City /State /Zip: p \'* tri`(t l 012__ 1L_- `tl ._, Per inspection per hour (min. 1 hour) 62.50
Phone: a a S " , a D. Fax: 6193- 41 4.
r l 9 Investigation fee: _
Lic. #: a _ 3 (_ Other: _
CCB Lic. #: 35 C o - 7 - µ i:
3 5 �'�:..���.�__ ����: ����r <��Electrical�Per:.mit�Feesx -� ..,. >�� :. r':��: -
Supervising electrician t On,
/ Subtotal $ 1 ' t 00
signature required: 'l r 1 Plan R eview (25% of Permit Fee) $
Print Name: S' c'77T tie 2 , 6"r Lic. #: 2 Z 4tV 6 State Surcharge (8% of Permit Fee) $ � + c (� G
( TOTAL PERMIT FEE $ t3 \ i 0
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it. has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
is \Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information •
4 ,
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
n Audio and Stereo Systems
n Burglar Alarm
n Garage Door Opener
n Heating, Ventilation and Air Conditioning System
H Vacuum Systems
n Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
El Boiler Controls
n Clock Systems
n Data Telecommunication Installation
Fire Alarm Installation
n HVAC
Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control
n Medical
n Nurse Calls
Outdoor Landscape Lighting
Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations '
i:\Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03