Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
i�� DEVELOPMENT SERVICES PERMIT #: ELR2005 -00101
E�� II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/28/2005
PARCEL: 2S 102AA -04100
SITE ADDRESS: 12230 SW MAIN ST ZONING: CBD
SUBDIVISION: MORINS ADDITION LOT: JURISDICTION: TIG
Project Description: Limited energy for thermostat wiring for (6) HVAC units.
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: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 6
Owner: Contractor:
INTEGRITY INVESTMENTS INC ANCTIL HEATING & COOLING
2229 NE BURNSIDE SUITE 86 4320 N WILLIAMS AVE
GRESHAM, OR 97030 PORTLAND, OR 97217
Phone: Phone: 503 281 - 0752
Reg #: ELE 618LHR
LIC 8897
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 4/28/2005 $450.00
[TAX] 8% State Surchar€ 4/28/2005 $36.00
Total $486.00
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 folio -- = adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through .AR 952 -06 -s 3 o You may obtain copies of these rules or direct questions to OUN at 503 246 -6699.
Issued : y: 0 i 1 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.
FROM : ANCT IL Heating & Cool ing PHONE NO. : 503 2825722 Apr. 28 2005 02: 14PM P1
A 1 --- -..t
Electrical Permit Aip1ication Foiz orriec, USE ova
City of Tigard RE ED Received
DairJH ; 4 / oq: 45 pv.itNo.f4, , „ , - eolo
13125 SW Flail Blvd,, Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.5 5 98.19r Other Permit:
Inspection Line: 503.639.4175 i 2 8 200 a 113166.1111.11MI Ready/By: RI Sec Page 2 for
imernet: www.ci.tig CITY Of TIGARD
ard.or.us Notifted/method: M Supplemental Information
• . . • •
. . . ...
1. . •• .'..z • . . •• ' ERIEEIllib • OIS 1 3 1 . ' • .; . • " • .:.:"...: .:.• ""'• ......:.* .::) 7: ';' :' .
Q New construction 1iddition/ahereitiontreplacement Please check all that apply:
Demolition 0 Other:
CIService over 225 amps, comm OHazardous location
El
. .. , . .. . . . .... .,.. . . . .... ElService over 320 amps - rating 013uildog over 10,000 sq. ft.,
OF. CONS ':;':: :.•,..''.:, "::.•!: .::,;.04 : . 7. of I and 2 dwellings 4 or more new residential
0 1 - and 2 dwelling CE. •mmercial/industrial 0 Accessory building ['System over 600 volts nominal units in one structure
0 multi-famil 0 Master builder 0 O ElBuilding Mei three stories OFeeders, 400 amps or more
y ther:
, ., . , ljOccupant load over 99 persons 1:11vIanufacrured structunts or
: j.. :.: •. ..i' .. : : •? ::•. ;: .• .' :'. :-.; . 4QiPtTkT:44 1 gPOtOg.T.IA 1 #40.....0'441 . 9g.TME.;f,g4.. : 4:;.M. ElEgresS/lighting plan RV park
OHealth facility 00ther: .,
Job no.: Job site address: 1 aaso sw rifil,.) sT. Submit 2 sets of plans with any of the above.
City/State/ZIP: - r t am°. os- 112 Z3 The above are not applicable to temporary construction service.
•:::14
Suite/bldg./apt. no.: Project name: cia c
Desetiolioa I Qty. I Fee. I Total ( -7.--.
Cross street/directions to job site: New residential single- or multi-family dwelling unit.
Includes attached garage.
1,000 sq. ft_ or less I 145.15 I I 4
,..
Subdivision: 1 Lot no.: Fa. addl 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
0.1.W .41 M....::....,0,A10......V.:m w.- 4* 144rr Each manulktured or modular
dwelling, service and/or feeder 90,90 _ 2
Services or feeders installation, alteration, and/or relocation
10
200 amps or less 0. 2
F; 401 am
201 amps to 400 amps 2
am ps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/Stale/ZIP: Temporary services or feeders Installation, alteration, and/Or
Phone: ( ) I Fax: ( ) relocation
200 amps or less 66.85 ' 1.
Owner installation: This installation is being rode on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or cxchangc, according to ORS 447, 449, 670, and 701.
401 amps to 600 amps 133.75 2
. _
Owner signature: • - Date: Branch circuits - new, alteration, or enension, per panel
-
,i,i.,.....:....: :."':::: 11,41%:::
4
"'ilifi idiV:re.t.'iSit- A. Fee for branch circuits with
,.......%.$ .....:...:.;: •.:.;...., ..TAKKA: . S2 . : ..7 - ,, : , :ii ,..
"" service or feeder fee, each
2
Business name: A 10 C L HI T I p..) Cr. A ccza4 A G• branch circuit 6.65
B. Fee for branch circuits
Contact name: Mere-11- 1+04 Geg-Fp94) without service or feeder fcc,
- 46.85 2
each branch circuit
Address: 932-0 /•). v■J ) I-1.1 Arts AJ G. Each add'l branch circuit 6.65 - ... 2
City/State/ZIP: PO 1 Cg— 4 1/ 2- 1-7 Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: (S03 ) 2 i - 0-7s 2. I Fax: : ( 503 ) al 2- - S 7 7-2- Sign or outline lighting 53.40 2 .
.
E-mail: Signal circuit(s) or liroitcd-
qii,::?.i:i:::.:::::.;:.:-::(....A.;.9,110.4kOkOlt:f2 energy Panel alt
t:;ZWia . eration or
extension. Discribe: 6 Page 2 we 2
•
Business name: $t,'" A iSo■)6: 1n4 Egriosnyr Inflgle)6.
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City/StateJZIP: investigation per hour (1 hr. min) 62.50
.
Phone: ( ) Ilif0 1 Fax: ( ) ef ea I.H11-, 1 , Industrial plum per hour 73.75 ,. ..
; : : . : •i,.' :- .:'.:::;: : : .- "t;:''. ; ?.F 2 LEcTRICAtit . itlX.R1VER , : . :1'. 4.E•S''''.
CCB Lie.: ogcicil Electrical Lic.:_tgliateP-1" Suprv. Lie.: it /MO Subtotal 167) - °
•
Suprv. Electrician signature, required:)±1„... fi re064 , 0 4 4)., Plan review (25% of permit fee)
State surcharge (8% of permit fee) 6.1
Print name.
• a&I. 3P-.6G. 1-fFer./ArJOE2.- Date: c4/2
TOTAL PERMIT FEE q st.0 0
Authorized signature: _ (—) .112Is permit application aspires its permit is not obtained within ISO
days after it has been accepted as complete
, Print name: _c_ a izari , , jr_, I Date: 2 r /
/ • pee methodology set by ifi.COtakty Building rndrdaYSeTvice Board
" Number of inspectiotts per permit allowed.
i:\auadinsWermirsT-LC-Permilapp.doc 12/03 44046 I5T00102/COM/WEB
CITY OF TIGARD
I, BUILDING DIVISION PERMIT #: ELR2005 -00101
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/28/2005
Phone: (503) 639-4171
.��� ' `_ u , /, 1gp JI
Inspection Requests (24 Hrs.): (503) 639 -4175 _ 1.
INSPECTION WORKSHEET FOR DATE: 6/3 /2005 TIME: 7:09AM PAGE: 53
SITE ADDRESS: 12230 SW MAIN ST CLASS OF WORK:
1
SUBDIVISION: MORINS ADDITION LOT #: TYPE OF USE:
PROJECT NAME: CROWN CARPET
DESCRIPTION: Limited energy forAhermostafwiring for t6)_HVAC units.
OWNER: INTEGRITY INVESTMENTS INC, PHONE #:
CONTRACTOR: ANCTIL HEATING & COOLING PHONE #: 503 - 281 -0752
Inspection Request Scheduled For: Date:' 6/3/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 00034101 503 - 281 -0752 N
- -o
Corrections/Comments/Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / -- -� Date: L - Phone #: (503) 718 -