Permit Fp,
CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 -00151
DATE ISSUED: 6/10/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S102DA -00401
SITE ADDRESS: 13125 SW HALL BLVD ZONING: CBD
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Card reader at rear door.
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: i • HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: CARD READ X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
TIGARD, CITY OF SELECTRON INC
13125 SW HALL 7225 SW BONITA RD
TIGARD, OR 97223 TIGARD, OR 97224
Phone: Phone: 503- 639 -9988
Reg #: LIC 64341
ELE 26- 497CLE
FEES SUP 974LEA
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 6/10/2005 $75.00
[TAX] 8% State Surcha 6/10/2005 $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 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: ,� f..0 Permittee Signature: � 0 1 ,Q
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.
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a p� Plan Review I llat By:
v Hall Blvd., Tigard. O R 9 722 3 j j N
Phone. 503639417i Fax 503.59S.1960 2005 / 1 11., ' � 'ate Ready /By: t See Page 2 for
' � •
Inspection Line. 503.639 4175 CITY OF Ti Ali*. a Dare /By I Other Permit:
Juris
Internet: ',vwzv.ci. or. us BUILDING Notified /Method: �'( Supplemental Information
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1 ❑ New consti.t.tction • Addition/alteration/replacement Please check ail that apply . - > - - -- a
I Demolition Other: C ce over 225 ou
m a o ,
❑Sery r amps co Haza s location
v ti , I Servt ^e over amps tali ❑Build over 50,000 sq. ft.
1•I4 <: :,,. : ° I ;Y pF ; a , -t : ` of 1- and 2-family I #�_`�� >��d.3'� J �.z...., ; -�; r ;, ; : i , � 1 E GO E � M, , �',.�< .� _ .. < , . - � � e�� : ,x�-- " ., ,%,,,,,,,v,,,!:„-4,„,,,,..,,, . ...❑Syste dwellings 4 or more new residential
1 - and 2 family d 4 Commercial /industrial ❑ -accessor y building m over 600 volts nominal units to one structure
L] Multi-family // ❑ Master builder ❑Other: ['Building over three stories ['Feeders, 400 amps or more
W - :M -°r:,>,-- .7 : ; = : �a ,.'''.', -, ,- l ... -•: ;�,t °v, <.� r . ::. ;, _ x:ka- ,�. ; ; .,e.: c persons ❑Oc upant load over 99 e ❑NIanufactu edstructure or
1 '' ` , "z .- - � K JOB -SI11L 1 7IOi� � - -:4TIO " ❑ ET.ess /lig htintr plan RV park
<' - t .,. : - -- .- < r £3�.PD.,��...a'.£ :w S s, - >- _- ._ -a. e&<L�`vr.H : +Z� n, - .,. 3d+ . .a �Y b P
L, 1 ❑ Health -care facility ❑Other
Job no.: 5L Lr Job site address. hj) �5 51 }...4a0 IJI V Submit 2 sets of plans with any of the above
1 City /State /ZIP: r, Q � 1 41-7-2.:2-- The above are not applicable to temporary construction service.
Vi
Suite/bldg./apt. Projec nam /� a` l` il " Ir ;`E' :t1 CH3RDUO `i ' ,;,;
5 Description 1 Qty. Fee. 1 Total 1
Cross street /directions to job site: New residential single- or multi-family dwelling unit.
Includes attached garage.
1 1,000 sq. ft. or less I 145.15 4
1 Subdivision: Lot no.: Ea. add'l 500 sq. it. or portion 33.40 _ I 1
I
Fax map /parcel no.. _ Limited energy, residential 70.00 V 2
_ " _ e Limned energy, non - residential 75.00
1�r�. '`�tt DLS = tOC,��`ORi�° I
a :fit- '3t,,,Ir ra ���` �,�_ ; : ; ;ai : >t<= , „ ,• � �. : ' Each manu factured or modular
1 dwelling, service and/or feeder 90.90 1 2 !
I 1)vJ VO\ e ca,cd rC r add a-1 `}41e. Services or feeders installation, alteration, and /or relocation I
I 1'FXVry t+ Ce -� re-3� CA vt 200 amps or less 80.30 I 1 2
, . ? :, 201 am s to 400 am s - 106.45
1 r 1 :::, - ; 1 11 1: . < .:''' ' ' E1 ' r "'' 1V : \ER ; ; „a,:.:' ❑ :TT;v''INT,= r' ' ' '' r
I- � r 401 amps to 600 arnps I 160.60 2
Name: 601 amps to 1,000 amps I 240.60 I 1 2
i Address: Over 1,000 amps or volts 454.65 -
- Reconnect only 66.85 I 2
Cit /State /ZIP: Temporary services or feeders installation, alteration, and /or
1 - relocation
Phone: ( ) Fax: ( )
200 amps or less I 66.45 1
' Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps I 100.30 I 2
I intended for sale, lease rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 I2 _
1 ` Owner signature: _ Date: Branch circuits - new, alteration, or extension, per panel
" ` 3. '" i 1 'vx � > "�'aq 1 A Fee for branch circuits with
- service or feeder fee, each . 6.65 •
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 1 46.85
Address: each branch circuit
Each add'l branch circuit 6.65 I I 2
1
City/State/ZIP: Miscellaneous (service or feeder not included)
- Pump or irrigation circle 53.40 I 2
Phone ( ) Fax: : ( )
I Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited- .
t (1!1'l> :1Z �G I OK -« . : `: energy pan ,r
` ene el alteration, o
' '- ' ..' `` -' ' ` �'�""�" extension. Describe: Page 2 2 .
1 Business name: �, _
4 \\ , v I
.-, • fi r i , e � ,
I Address: "171 T �. �) I ,,, i ✓ Each additional inspection over allowable in any of the above
Per inspection I 62.50
City /State /ZIP: 1 -'�„, ; .) 1 - , l0 T c r ,� -
Investigation per hour (1 hr an) 62.50
...� , �--� I - > - , I Industrial plant per hour 73.75
Phone: l g- )fa �� _ ��I � t .0 Fax: i_ r : ; - ( , - yi �`j , 9 ..
1 C CB E tc.: i� c5, i Electrical Lic.: �� _ ? t �° Suprv. Lie.: Vii ! 1 Subtotal j ,l =�
S uprv. Electrici sig nature ; required: �= ✓ Plan review (25 /0 of permit fee)
r _
me: Date: �/9 State surcharge (8% of permit fee) I �; ? J
Print na
•
I ;'v �. ' I TOTAL PER1 1IT F'EE 1 A i , v -
I Authorized signature: This permit application expires if a permit is not obtained within 180
i
I days after it has been accepted as complete
1 Print name: Date: 1 - Fee methodology set by Tri -County Building industry Setvwe Board
- Number of inspections per permit allowed.
rAEuiioir4' P! C- Ptrrnir-iun doe 1 1 - 0- a615Ti10 /0'l(O01 /WEB
CITY OF TIGARD �p
BUILDING DIVISION PERMIT #: ELR2005 00151
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/10/2005
Phone: (503) 639 -4171
An �� I p i �f� l + l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/13/2006 TIME: 7:08AM PAGE: 75
SITE ADDRESS: 13126 SW HALL BLVD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PERMIT CENTER
DESCRIPTION: Card reader at rear door.
OWNER: TIGARD, CITY OF, PHONE #:
CONTRACTOR: SELECTRON INC PHONE #: 503- 639-9988
Inspection Request Scheduled For: Date: • 6/13/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 009037 -01 603. 619.9277 Y
Corrections/Comments/Instructions:
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. .
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: g o- — Date: C 11 v Phone #: (503) 718-
.