Permit j
C ITY OF T G ARD ELECTRICAL RESTRICTED ENERGY PERMIT
PERMIT #: ELR2005 -00140
1111 DEVELOPMENT SERVICES DATE ISSUED: 6/2/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S102AA - 04100
SITE ADDRESS: 12230 SW MAIN ST ZONING: CBD
SUBDIVISION: MORINS ADDITION LOT: JURISDICTION: TIG
Project Description: Irrigation control.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT: X
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
INTEGRITY INVESTMENTS INC
2229 NE BURNSIDE SUITE 86
GRESHAM, OR 97030
Phone: Phone:
Reg #:
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit . 6/2/2005 $75.00
[TAX] 8% State Surcha 6/2/2005 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of O' - •ecialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This per • • is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oreg aw requires s • ' follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 thr ugh OAR 952 -00 100. You may obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: 1 :3 Permittee Signature: t M
OWNER INSTALLATIO ONLY
The installation is being made on property I own which is not intended for sale, lease, or re .
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.
.r •
Electrical Permit Application FOR OFFICE USE ONLY
City Of Tigard Received /
Date/13y: (� Z �� Y / Permit No.: :L ` �JFo /7i) C/ a
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ��` [
Phone: 503.639.4171 Fax: 503.598.1960 /.7r ,.; v� \ Date/By: Other Permit:
'hw�.�Ill
Inspection Line: 503.639.4175 y. c• Date Ready/By: � ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: j ! C Supplemental Information
'x sr r; .f�r; - ".•&, _ _ ti._ tg. -ib �:,,, -- -.. �]3� ?St c�; 1 4-.;G,. Y %' ir 4 . . ' y -t: •u ; . i a'. ,x + •q. 3bq ^_ • ••
t }� - ° 4 ' . _ .'- c � I':P1 ,OF 0 . :: t. i s - - z 1'0,1 • -a, . ,i ,, •#T ;,6 ' ,^ r : L'� ; 4 rj;; �y ..�, :
C' -' T k F!;, c-' �, �:..:. ��. �' S"-=` '�_..�.�u�= ` "^�...�.�.: „�• -•. ., �.- 1-.- �.: � �., -,5 ; t.' 'y+ _�'F`L :� `,'” � �h t. �c ,:bav�'ti� d� .-
lew construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑ Other: ['Service over 225 amps, comm'l Hazardous location
o F , _ - . , z . _ S t ; t , - OService over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
d r ': °' ".- ^ ` , - .., �Tt - of STI.,>*JG,I'IOL;1' �?.' - �;�i-: , qt., �
. of 1- and 2- family dwellings 4 or more new residential
- �,4.� <, v. ''�. . .; _.•�.-: 6.i:
.- -a °'Rri: �:• -zc � _ -- -'er -�..�� .:xr• �- �.:,�._,- �... ,. t��._ +..'^iF '_-�^ �c�`s`L -
❑ 1 - and 2 family dwelling 4aCommercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi family ❑Master builder ❑Other: ❑Building over three stories ['Feeders, 400 amps or more
_ _ , t F . . r ; , (a`T_;,, k ❑Occupant load over 99 persons ❑Manufactured structures or
`q"-i : ; : :r O
J - B_ �SIi7 , ,gad° ON:' ,r° , .4,' ^ - -: E ess/li htin plan RV. ark
1 ; , R IAt'•><, e�N7a LOti IUN., ,, • # .,,. _1: P
Job no.: Job site address: 122 � J Su) M A (f, ❑Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City/State /ZIP: The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: f' :t} ;,i;- FEDTrE;y; a «•,1 . .
Description I Qty. I Fee. I Total I
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
Tax map/parcel no.: Limited energy, residential 75.00 2
' ',, x Limited energy, non - residential 75.00 • 2
� .i - .. ., ' f . !- - -,- DE5CRIl TION O W , ,. „ . - . . , i � r- ., _ - Each manufactured or modular
- dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
_
+Y ,, • :a.'; " ;.r: . r , 4r - •ry 201 amps to 400 amps 106.85 2
❑'..PROP -
R•TY �- OWNER _ . , - . , , :, “. _. - - -- ` % " - - -- NA .j'IT _7 =1 ?- :: F v.
' ' " 401 amps 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/State /ZIP: Temporary services or feeders installation, alteration, and/or
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
,. : i N�a cor,a4er ` A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address:
Each add'I branch circuit 6.65 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-
,,,,:,e- , ' : v
'`• t ` •-,' _ , : -,-, i.' ,;; -� 0 ,ir. q; •l a;F ,t energy Panel, alteration, or
- ^,r ,N__ -s��. . ..'Al ..'!' .7,�r: - �- i- ; - °ti, .1� "T�i: ,S<. ;'J: `�. -. - _ �.;...... a. �3,; .��J�:.
Business name : � OS t , ` extension. Describe: Page 2 2
1� IIA .. C V �
Address: 2) $ 5 S
1 (���� O� (/ Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: L ut, k Vrk—r1 N. C -70 (O Investigation per hour (1 hr min) 62.50
Phone: ; J( ' ` O ` . . Fax: ( ) . Industrial plant per hour - 73.75
: ;,:' ; �t .'' T, `EE T?(C PERMIT _BES
'E*'w< i, �uu� , t ,._Ler
' >, . , pfd L ' r _,�3 �a,: ,:..HC .. .._
CCB Lic.: _ - ctrical Lic.: Suprv. Lic.: Subtotal
•
Suprv. Elec t: c an signa ■ e, a ` iced: Plan review (25% of permit fee)
Print name: 1 (1) f (mi vvt t� Ih,;AA,/pk I Date: to - 2,— d State surcharge (8% of permit fee)
f ` TOTAL PERMIT FEE
Authorized S i ! . attire• Nov 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 Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ BuildingVermiis \ELC- PertnitApp.dL 12/03 440- 4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
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:
•
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio 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
is\ Bui lding'Pemub\ELC- PermitApp.doe 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005 -00140
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/2/2005
Phone: (503) 639 -4171 t
Inspection Requests (24 Hrs.): (503) 639 -4175 ' .. yi
INSPECTION WORKSHEET FOR DATE: 6/3/2005 TIME: 7:09AM PAGE: 27
SITE ADDRESS: 12230 SW MAIN ST CLASS OF WORK:
SUBDIVISION: MORINS ADDITION LOT #: TYPE OF USE:
PROJECT NAME: CROWN CARPET
DESCRIPTION: Sri ation_control.
OWNER: INTEGRITY INVESTMENTS INC, PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 6/3/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
136 Low voltage - 008365-01 971 -404 -4601 Y
Corrections/Comments/Instructions:
•
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
/❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Ni"- c. - � Inspector: Date Phone #: (503) 718 -