Permit CI TY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00390
•
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/15/2007
PARCEL: 10100
SITE ADDRESS: 10350 SW LINCOLN ST ZONING: R -4.5
SUBDIVISION: TOWN OF METZGER LOT: 005 JURISDICTION: TIG
PROJECT: METZGER ELEMENTARY PORTABLES
Project Description: Limited energy panel for fire alarm. Job No. 13746 -07
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: X OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
TIGARD TUALATIN SCHOOL DISTRICT T & L COMMUNICATIONS INC
6960 SW SANDBURG ST PO BOX 87387
TIGARD, OR 97223 VANCOUVER, WA 98687 -7387
Phone: Contact #: PRI 360- 737 -9725
FAX 360 - 737 -9648
FEES Reg #: ELE 37- 428CLE
LIC 67787
Description Date Amount
[ELPRMT] ELR Permit 10/15/2007 $75.00
[TAX] 8% State Surcha 10/15/2007 $6.00 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
issuanc it wor ' - uspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utili otification Cente . • e rules are set forth in OAR 952 - 001 -0010 through OAR 9 • I A100. You may obtain copies of these
rul s or direct questions • OUNC . t 503.246.6699 or 1.800.332.2344.
Is ed By: j � `i _�� Permittee Signature:
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 Applic r OFFICE 1)81'; ONLY
i \-1/1
City of Tigard l ' ' ' Date/B ed : /O �� iI Permit '"Q �
L amp ^�
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1 60. T
(> C I 15 2007 Date/By:
Other Permit:
T I G A H D Inspection Line: 503.639.4175 (� ) L Date Ready/By: f 63 See Page 2 for
Internet: www.tigard- or.gov • • ified/Method: ( Supplemental Information
I C (4 " 4 ( .
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TYPE („� � � � T„ T PLAN REVIEW
❑ New construction deli t aj 7 ' T ' ;eln ' V ISIO
1 `I Please check all that apply (submit 2 sets of plans w /i[ems checked below):
❑ Demolition Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
0 Demolition tther:
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
y dwelling ❑ Accessory building less to ground, a exceeds ons, ❑ Commercial -use agricultural
❑
1- and 2 -famil dwellin Commercial/industrial ry g amps for all other installations. buildings.
❑ Multi- family Master builder ❑ Other: ❑ Flue pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ 'A ", "E ", "l -2 ", "l -3 ",
Job no.: (J -Di I Job site address: 10 S� Li rco) fl S+ or more. occupancy.
❑ Six Six o or r more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: /y n (j --t ❑ Health-care facilities. ❑ Supply voltage for more than
�ny- 1 �l.Ln� ) I C) _l 1 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: ILL ei zo o � hi es ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
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'I 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
4A ` G ( `1/, 5 ' o7 y f W.2.5 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 I TENANT 201 amps to 400 amps 106.85 2
Name: Z / V for b to 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: \ O ? 5.-r, 5 L3 l A N (o 1 "- Over 1,000 amps or volts 454.65 2
City /StatelZIP: *eb r Temporary services or feeders installation, alteration, and/or
0 relocation
Phone: t3(0) --) 3 7775 Fax: 7 c 76 ye 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 599 amps 133.75 2
Branch circuits – new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: T C-o HA. vku � ( c,,, %.__j B. Fee for branch circuits
� 1 46.85 2 without service or feeder fee,
Contact name:
et,r k,.J first branch circuit _
Address: ) ( ( . , cc - 23 r-1 Each add'I branch circuit 6.65 2
� Miscellaneous (service or feeder not included)
City /State/ZIP: G /24 L (\ Each manufactured or modular 90.90 2
�! D) 1 3) 972 s- LA.) I ��) ) `! � t Reconnect t onl service and/or feeder
Phone: b Fax:: ( Y!p Reconnect only 66.85 2
E - mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
• /1�
/►/� Signal circuit(s) or limited -
Business name: T a L co t rn i n I 1 1 A�1enS energy panel, alteration, or
Address:) - BO-A_ 551 2)(g'( extension. Describe: ( Page 2 2
City /State/ZIP:vanl al vU Luc, t q Dl(/ l(! I Each additional inspection over allowable in any of the above
(2j ^) 13, i 2 C ) I Fax: (2 ( O --1-1 q t 048 Per inspection ti 62.50
Phone: : 7/1u 2.5 JY� ' 111 Investigation per hour (I hr min) 62.50
CCB Lic.: t 0 7-42(4 Electrical Lic.:3(p 4 < I Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 6 ti t ., ( A / Subtotal:
Print name: L y- (r / , I
1, Date: 1 0 _ 1 (�7 Plan review (25% of permit fee):
-` - t I ` State surcharge (8% of permit fee):
Authorized signature: TOTAL PERMIT FEE:
Print name: � Date: 1 r� This permit application expires if a permit is not obtained within 180
or
L / S- `� ! Co if V / days after It has been accepted as complete.
( • Number of inspections allowed per permit.
IABuildingWemws\ELC- PennitApp.doc 0523 440-4615T(rl /05/COM/WEB
CITY OF TIGARD
BUILDING DIVISION A .. PERMIT #: ELR2007 -00390
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1W1 &2007
Phone: (503) 639 -4171 '�
Inspection Requests (24 Hrs.): (503) 639 -4175 I L.
INSPECTION WORKSHEET FOR DATE: 10/2642007 TIME: 7:00AM PAGE: 57
SITE ADDRESS: 10350 SW LINCOLN ST CLASS OF WORK:
SUBDIVISION: TOWN OF METZGER LOT #: 005 TYPE OF USE:
PROJECT NAME: METZGER ELEMENTARY PORTABLES
DESCRIPTION: Limited energy panel for fire alarm. Job No. 13746-07
OWNER: PHONE #:
CONTRACTOR: T & L COMMUNICATIONS INC PHONE #: 360-737-9725
Inspection Request Scheduled For: Date: 10/26/2007 Pour Time:
Code # Inspection Description ' on ' # Contact # Message
199 Electrical final 058431 -01 360-737-9726 N
Corrections /Comments /Instructions:
c i tJ AL � 'a`r1b'Y• ' R 44.46441\ u N 4 1 US 4 fit.
iikt.lt ►E p t off i; ve (34 7 see tIL. i F-1 tkg-L-.
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❑ PASS XPARTIAL APPROVAL _ ❑ CANCEL _ ❑ NO ACCESS
❑ FAIL El CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �, NV) �..f Da te: 4 I qG1 Phone #: (503) 718- it.
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