Permit 4 CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00435
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/26/2007
PARCEL: 2 S 102A B -0480 0
SITE ADDRESS: 12454 SW MAIN ST ZONING: CBD
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: COMMAND CENTER STAFFING
Project Description: Low voltage: Voice /Data (See ELC2007 - 00756 issued in error.)
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
CAPISTRANO, NICOLAS N + CHRISTIN CROWN VOLTAGE
6646 SW 35TH AVE DANIEL TUCKER
PORTLAND, OR 97221 12607 NE 199TH ST
BATTLE GROUND, WA 98604
Phone: Contact #: PR1 360 -666 -0995
FAX 360 -666 -4673
Reg #: ELE 37 -984C
FEES LIC 153934
Description Date Amount SUP 4116S
[ELPRMT] ELR Permit 11/26/2007 $75.00
[TAX] 8% State Surcha 11/26/2007 $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
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 or 1.800.332.2344.
Issued By: Permittee Signature: G
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.
Nov 23 07 03:31p CROWN VOLTAGE, INC. 1 360 666 4673 p . 1
. . .
Electrical Perm!, is., E z e tENEI. . FOR OFFICE USE ONLY . .
City of Tigard ..
oarfrt Li 1249/01 N3 PUMA Niai?
13125 SW glad lllvd., Tigard, OR 97223
.•;_att Resaval
Plan Review
Phone: 503.639.4171 Floc 503.598.110V 0 --- ' '''
) P lt Dawa-K----- Warr Perim:
Inspection Line: 503.639.4175 w- -. ,_ Daze Readyilty: iii M Sr rage 7 zur
lotcroct www,ci.tigarclocas • Jj I IU 111 Nairiedibtahod: Supplemental Information
....--
..... . . • . , PLAN REVIEW
?,_ dit IIL,
‘131VISI OR
0 New CartArtlai0a1 1 . 4 4 . .,•%.':;••• • , • - --- . matron/replacement Plcas0 thetk 011 that apply:
1:1 Demoliti °Service over 225 amps. conan'l 0 Harmilous location
on 0 Other:
0Scrricc ova 320 amps - rating 0 Buiklag ova 10,000 sq. IL.
CA MORI OF CONlifIttiCTION all- and 2-family dwellings 4 or more new residential
0 I and 2 dwelling 'ailiindintrial 0 Accessory building °System over 600 volts nominal units in one structure
- OBuilding over threes/mks 0 Feeders, 400 amps or more
0 Multi-family 0 Master builder D Other_
Document load over 99 persons OManulactured structures or
.1013 sITh INFORMATION AND LOCATION OEPTCSIAlgblIng Plan RV park
" ClOther.
Job no.: j Rob site address: i 4 tu 0 $ 5 - 014calth facility
Submit 7 sas of plans wilh any of lhe above.
City/State/ZIP: --r--- G 0 — The above are not applicable to temporary construction cc.
sC'
Suite/bldg./opt no.: Project name: .... el:K. RF.DITLE
- rlimb 9'7. ilet- 1 Tcal 1 '.
Cross street/directions to job site: New residential single- or multi-family dwelling unit
— bielades attacked garage.
1.000 sq. R. or less 145.15 4
• Subdivision: Lot no.: Ea. add') 500 sq. IL or portion 33.40 I
-
— Limited energy. residential 75.00 2
l'ax map/parcel no.:
Limited energy, non-residential 75.00 2
..•
DESCRIPTION OF WORK Each mann ramrod or modular
•-..,
,.._,
9 relocaton .
dwelling, writ= andfor loader 90,90 2
I • --- 4. i.t—dr_. Ig,
- Sevviees or feeders instant's:on, alteration,. and/or i
_ ... •
'At:, . It • • r1.1 / / 1 . 4. 200 amps or Ica 110.30 2
0 PR ERTY OWNF.R gi T 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
—
Name: 601 ampsto 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 1 454.65 2
----- Reconnect only 66.85 2
City/State/7.1P: Temporary services cer feederninstailarinn, alteration, andlnr
Phone:( ) 1 Fax: ( ) relocation ,
200 amps or less 66.85 A
--
Owner instalgition: This installation is being made oil property that Iowawnch 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 __ amps :33.75 2
— —
Owner signature: _ Date: linineb eiradts - new, alteration, ur este:osier. per panel
. —
—.-
0 APPLICANT 1 C3 (.'ONFA(T with
A. Foe for iianch circuits wt
service or foxier fee, each
6.65 2
BUS inc: branch circuit
13. Fee lix Munch circuits
Contact name: without service or feeder fee,
. 46.85 2
, each hunch circuit ress:
--- _ Each add, branch circuit 1
-------
Add -
City/State/ZIP: Miseelliocom (service or (ceder not Mel rated)
circle irrigation 53.40 2
Phone.: ( ) — I Fax: : ( ) Pump or _- . --L-
Sign or whim lighting ..._ 53,40
_ _..—
E-mail: Signal circuit(s) or limited:
CONTRACTOR energy panel, altaatien, or
,., . extension. Describe: / Page 2 2.
Business mune: (.:,-co ts.) k..1 • I la 0__. T.• e_ — —
, 911 __. , Each additional inspection over allorn.I., ia nay of the aho e
Addr=: . ‘ ?... (p 7 ii-C.: (17 -t.. • _
Per inspection t fi2.50
CilPS611e/ZIP' Investigation per hour (1 hr rnin) ' 6250
, .
°lurk (.3(00 )(J) (14) --0 ins Fax: (340 )6xdos 6,
plant per hour 7335
Induslti
n
ccn 1..i., 1 6'3 cfm Electrical Lic.: :, .9 1 Suprv. Lic.: /11143 S n uprv. Electrician sigpature, required:
Plan review (25% of pa
.- .-
Print name: Da\ A_ -k c 11
Authorised signature:
i s
/
' .....-' _.A
)45)/w/sill:IDIOM al
....
ELECTRICAL PERNIFF Eris-
— —
--
i iit Et IC --
11 --
State surcharge (8% of permit (cc) ---
....'
TOTAL PERMIT FEE g 0,0 ,
This permit ampticidion expires will permit ii ind oblaine4 within 1110
days arta it has Inn *mined as cassock -
Print name: r ca. %A t,. — 1 Date: Il VF ____
) • Fee mabodoloty sa by TTi-Catenty [leading !Music Service Brunt
.v • '''. ''' ** Number of inwediosz PO Daunt allowed.
'..
CITY OF TIGARD
BUILDING DIVISION
A , • PERMIT #: ELR2007 -00435
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/26/2007
Phone: (503) 639 -4171 q l
Inspection Requests (24 Hrs.): (503) 639 -4175 :�' °'- _
INSPECTION WORKSHEET FOR DATE: 11/27/2007 TIME: 7 :01AM PAGE: 47
SITE ADDRESS: 12454 SW MAIN ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: COMMAND CENTER STAFFING
DESCRIPTION: Low voltage: Voice/Data (See ELC2007 -00756 issued in error.)
OWNER: CAPISTRANO, NICOL.AS N + CHRISTIN, PHONE #:
CONTRACTOR: CROWN VOLTAGE PHONE #: 36C)-666-0995
Inspection Request Scheduled For: Date: 11/27/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 060279-01 360. 666.0995 Y
Corrections /Comments /Instructions: -______ _.- 2
N .
� PA . ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: &-' 1'6 Date: \112. Phone #: (503) 718- 2_441O