Permit .FY II CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
• COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00037
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/9/2007
PARCEL: 2S 102DA - 00401
SITE ADDRESS: 13125 SW HALL BLVD ZONING: CBD
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Installation of low voltage for audio /stereo and data. Work is to take place in Town Hall.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: X 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: 2
Owner: Contractor:
TIGARD, CITY OF OWNER
13125 SW HALL
TIGARD, OR 97223
Phone: 503- 639 -4171 Contact #:
FEES Reg #:
Description Date Amount
[ELPRMT] ELR Permit 2/9/2007 $150.00
[TAX] 8% State Surcharl 2/9/2007 $12.00 REQUIRED ITEMS AND REPORTS
Total $162.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable
laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work
is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center.
Those rule - - et forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503.24•...699 or 1.80$ 33 .
—
Issue. By: ' SO � I Permittee Signat tl� / , �% / L aI •
F 44
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 . L » '' N FOR OFFICE USCIO\LI a - . ,,, ,'
Received
City of Tigard Date/By. . 9 D 7 , 1 Permit No.: Eijac,t407 -6603 7
- " 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
11114 ..2' a •? Phone: 503.639.4171 Fax: 503.598.1960 DateBy Other Permit:
T I GA ^ RD`: Inspection Line: 503.639.4175 Date Ready/By: See Page 2 for
e, t u Internet: www.tigard or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
El New construction ddition/alteration /replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
• ❑ Demolition Other: where the available fault current ❑ Marinas and boatyards.
... .. • . CATEGORY. OF CONSTRUCTION - ' . exceeds 10,000 amps at 150 volts or ❑ floating buildings.
El 1- and 2-family dwelling less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
y g ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INF AND LOTION ❑ Emergency system. larger separately derived system.
. . . ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: ) 3/ 25 Su.) /7114 L e (v Six � S HP or more. c r eanon.
0 or more residential units. ❑ R eceational vehicle parks.
City/State /ZIP: I l �'�7 e / D £/_ „ l '7 ❑ Health -care facilities. ❑ 600 nominal more than
l r�CJ 77 '�'�'� ❑Hazardous locations.
Suite/bldg. /apt. no.: Project name: .7".Z, ( /-/A ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: Az46..e �-- g g4 f44,11 Description I Qty. I Fee. I Total
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: Limited energy, residential 75.00 2
. - . : "DESCRIPTION 'OF, ,WORK . ' - -`'.. :: . - -' :'. ` (with above sq. ft.)
Limited energy, multi - family
p..)5/ 7}-f— (,/¢r/ 45 tO /n} 1/ 13 ( residential (with above sq. ft) 75.00 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
PROPERTY: OWNER . '' '.• • . ''` : 0 . TENANT :'::,..:.--•,;::=:: 201 amps to 400 amps 106.85 2 •
401 amps to 600 amps 160.60 2
Name: C ( or 77 ��2) 601 amps to 1,000 amps 240.60 2
Address: / 3 / L .5 w #7446.L ,OL6;/7 Over 1,000 amps or volts 454.65 2
City /State/ZIP: - 6 / 2 /9 7.2..a4, Temporary services or feeders installation, alteration, and /or
`7 relocation
. Phone: (5 7 l 8 - 2.57_8, 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, lea - y`, +r exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature / - �►i ` Branch circuits — new, alteration, or extension, per panel
gn `.. f - � s Date: ' 8 "O 7 A. Fee for branch circuits with
®- APPLIGANT' - - -
CONTACT;;PERSONn` *..` t'
above service or feeder fee,
each branch circuit 6.65 2
Business name: / � B. Fee for branch circuits •
C yr e � -rop without sc cir cuit or feeder fee
Contact name: '' �� nn ��1�J� / � first branch h circuit 46.85 2
CTZ� " �
Address: ?? 5 c,, g,.../2,-,f7,--,4„, G Each add'l branch circuit 6.65 2
� Miscellaneous (service or feeder not included)
City/State /ZIP: '77 PAD /6"-el9 7 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (5e-3) ,O 7 -g 2/ 0 Fax: : ( ) Reconnect only 66.85 2
E-mail: C/ L, 6 776 -"2.12 — en 2. ( ) cJ _ Pump or irrigation circle 53.40 2
:CONTRACTOR ' ' ` ' . , . Sign or outline lighting 53.40 2
Business name:
Signal circuit(s) or limited -
6 �� energy panel, alteration, or
Address:
YY extension. D c e: _ Page 2 �o 2
City /State /ZIP: Each additional inspection over allowable in any of the above
P Per inspection 62.50
Phone: ( ) Fax:
( ) Investigation per hour (1 hr min) 62.50
CCB Lie.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES / -
Suprv. Electrician signature, required: Subtotal: / `"J O -
Print name: . Date:
review % p fee): PD
•
Authorized signature:
' State Plan surcharge (25 (8% of of permit ermit fee):
4 , iY viT TOTAL PERMIT FEE
Print name: Date: This permit application expires if a permit is not obtar a within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(11/05/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*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL. WORK ONLY: . .. .
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
ig ---e
udio and Stereo Systems
Boiler Controls
❑ Clock Systems
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
•
I:\ Bui lding\Peimits\ELC- PenniUApp.doc 03/23/06
i
CITY OF TIGARD
BUILDING DIVISION ,, ' .,
PERMIT #: ELR2007- 00037
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/9 /2007
Phone: (503) 639 -4171 ���iiglbi ;
Inspection Requests (24 Hrs.): (503) 639 -4175 ' 'I1.
INSPECTION WORKSHEET FOR DATE: 4/19/2007 TIME: 7:01AM PAGE: 64
SITE ADDRESS: 13125 SW HALL BLVD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: CITY OF TIGARD .
DESCRIPTION: Installation of low voltage for audio /stereo and data. Work is to take place in Town Hall.
OWNER: TIGARD, CITY OF, PHONE #: 503 - 639.4171
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 4/19/2007 Pour Time:
Code # nspec .. • D escription Confirm # Contact # Message
199 Electrical final 046725.01 503 - 716-2528 Y
Corrections /Commen • '. s: �t-05 :51.'
K/I a
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I U=' L ' . , -\ - 5 (AV')
X PASS ❑ PARTIAL APPROVAL i n NO ACCESS
❑ FAIL n CALL FOR INSPECTION NI ADDITIONAL FEES ASSESSED
Inspector: 1 N ( *(... Date: u () Phone #: (503) 718- 1•44)0