Permit A 11
CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
A DEVE H Hall r S O ER 9 SERVICES 1 639 -4171 DATE ISSUED: ELR2004-00322
SITE ADDRESS: 13125 SW HALL BLVD PARCEL: 2S102DA -00401
SUBDIVISION: ZONING: CBD
BLOCK: LOT: JURISDICTION: TIG
Project Description: Limited energy for access control.
Job No. S4215
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:
INSTRUMENTATION: OTHER: ACCESS CON 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: 639 - 9988
Reg #: MET 00002446
LIC 64341
ELE 26- 497CLE
FEES SUP Itgeiti@d Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 10/19/2004 $75.00 Elect I Final
[TAX] 8% State Surcharl 10/19/2004 $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
throw. - •AR 9 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
Iss ed by .•ALA A _ 5 / Permittee Signatures
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
9 t rr 1 s x' a
Eueet k a Permit A' 1 t OVED ,,,.'•a ' FOR OFFICE U ONLY f t �,a
�V Received
il /` ��0
l'✓ Of Tigard Dale /B y: �� � %' �T }AWL.' Permit No.:�+L� 3
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.41 7 l Fax: 503.5 _ 0 OCT O 2004 4 > Other Permit: e
n ' „',ie` i '4 Date /By:
'..
Inspection Line: 503.639.4175 ",- � ° ,e7 ' ; . Date Ready/By: Ju� � ! 0 See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: / la! . . Supplemental Information
- fir.. ::,.� ;�r� „e� >�r ± � ;t .:��� .��` ;�, �� x a �r>
r:; ,.. °,.. red'` - ` _
o. � °�r,::..,.�. .,_..__.: �.r.,- .:,�.�4�c- x�:...:. >,., <.... �T� �' `�•OIRh• � .. .w?, =� k” �: _.:v. �� °�.r >- .�F:'r
❑ New construction ' 4 Addition /alteration/replacement Please check all that apply:
❑ Demolition ❑Other:
Service over 225 amps, comm'l EHazardous location
.., , °.: ..r- ,. ar °r. - ,
4 ,, �-�a ; „� ;3 , , g , J(yjN �� T Akx -�” ,` EService over 3�0 amps rating B o ver 10 000 sq. ft.
v. ;li. :"1,9516 ®1 .$0- ITiC N "",a +:,i: -q;" " '-
I (.��� > °��: I - .:� r ..,£.�:z.��i s ,... �_ ,,. ", ��.':? H " "�- of 1 -and 2- family dwellin 4 or more new r esidential
❑ "> and 2 family dwelling `rl Commercial /industrial 111 Accessory building ❑System o ver 600 volts nominal units in one structure
/ ❑Buildi ov three stories ❑Feeders, 400 amps or more
❑ Murti- fancily ❑ Master builder ❑ Other: ❑Occup load over 99 persons ❑
Manufactured structures or
. >,,, RV ark
?' „ JOB S[TE I*OR1IIA�fTO 1,0 LOCATIO N-, ,, _. ❑E ess /li P
�t�ca�.:,, �� > :; > '• ... ..< . _,.:::.. ., .��...: _:::,:_.0 � , �. f.. ter_. -.- <r; . , , ... ._.... �' S g plan
❑Health -care facility RV
Job no.: s4 Job site addre 1.7.1,-1.5 5 S4 I-) �`�
VI d Submit sets of plans with any of the above.
Ci ty /State /ZIP: d (�'� ss: The above are not applicable to temporary construction service.
Suite /bldg, /apt. no.: Project name: 3Yd Pexmr+' ' °° N . ";":<^ ,. EE :SCE EpU .i .:,: =< ? ° ";1: -: "'
� h Description 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 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
' A ' s��' iDESCRIP IOIV-.OF V.VORh; , , ` �>� 'r�':",-:z.�t.. a
v -__ _ ��r- ti:,,� -_ -... ,�,_.> .., ._..> u a. �" ��: �� .- _�,�»;a��. °...,,��:.: " ;._ ;. l Each manufactured orniodular
��/� VD)�e_ a� -gyp\
dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
.- -., s :•, " �,"s'�,s`R ,,. , �.a.,.,.. < i , 201 amps to 400 amps 106.85 2
_ ,:- <>w',. �_� I'ItOPERTI `OtiVN ®� T .,, ,,,L_ : A
�.� . ,.' �,���, -_ .. � s . M � •-<, 9.6�,�. � '. e''t. z ,'� � � . ` =� � , � �.�.�� - 401 amps to 600 amps 160.60 2
Name: ' d 601 amps to 1,000 amps 240.60 2
Address: � 1 V� I B\v J. Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
C try /State /ZI � ; �„ . d 0 (� q 1� Z 3 Temporary services or feeders installation, alteration, and /or
/ 1 — 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, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits- new, alteration, or extension, per panel
= "Y' l: Y''`'"� ? A. Fee for branch circuits with
AYPLICAN'T�:.�n. «: ice ®' " C'O , .z. . C �.,.
4-t .W - ==eN _ °� r�:.,,�m<r� - �. °._�s - v.._v�_�4��'� .. ._.e . ,���,__._x._ �.,s �.. service or feeder fee. each
<, 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: withoirt service or feeder fee, 46.85 2
each branch circuit
Address:
_ Each add'I branch circuit 6.63 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax: : ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2 ^
E -mail: Signal circuit(s) or limited -
jx i'°'Y 1:. ;- ` %f"�"°': @' energy panel, alteration, or
Rte= =Y�',_ COt T �CTOR': �.�,- �,.�.r. ;
I, :� �.� „..__� A , , _ .. extension. Describ
e: I Page 2 '6 OD 2
Business name. (---& ,snL
Address ') 'SW }� R I Each additional inspection over allowable in any of the above
� l )� Per inspection 62.50
City /State /ZIP: o d_\. � b IC 7 Investigation per hour (1 hr min) 6250
Phone: (',.,b3 ) t _ ca Fax: (5(3 1 ' "7 to -d 1 ?�5 % Industrial plant per hour - - = 7375 a <0 sELCGFRIC i. PERIVIOtFEES *tit ' +: e
CCB Lic.: lA? 1 Electrical Lic.: a Cruz Suprv. Lic.: `I 7 LE rlc Subtotal ,
Suprv. Electrician signature, required: i,' %:-' Plan review (25% of permit fee)
s l N. �) State surcharge (8% of permit fee) to ,00
Print name: l � pr~�� Date:
' ' « TOTAL PERMIT FEE 't s ;Oj)
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 Trr- County Building Industry Service Board
** Number of inspections per permit allowed.
1:\ Building \Permits \ELC- PermitApp. doe 12/03 440- 46I5T( I O /02 /CONYWEB
. CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2004 -00322
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/19/2004
Phone: (503) 639 -4171 . AM 1��i�Ij
Inspection Requests (24 Hrs.): (503) 639 -4175 „, •
. INSPECTION WORKSHEET FOR DATE: 4/6/2005 TIME: 7:10AM PAGE: 4
SITE ADDRESS: 13125 SW HALL BLVD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: CITY OF TIGARD PERMIT CENTER
DESCRIPTION: Limited energy for access control.
Job No. S4215
OWNER: TIGARD, CITY OF, PHONE #:
CONTRACTOR: SELECTRON INC PHONE #: 639 -9983
Inspection Request Scheduled For: Date: 4/6/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 003873-01 503- 670 -5216 N
Corrections /Comments /Instructions:
Awl
immummireiv
r PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: v Phone #: (503) 718 -