Permit C ITY . O F TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° • COMMUNITY DEVELOPMENT PERMIT #: ELR2008 -00241
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/12/2008
PARCEL: 2S 102AC -00700
SITE ADDRESS: 12550 SW MAIN ST ZONING: CBD
SUBDIVISION: DOLAN BUILDING LOT: 001 JURISDICTION: TIG
PROJECT: A -BOY
Project Description: Installing low voltage wiring to new roof top unit.
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: : X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
DOLAN + CO LLC HVAC INC
BY FLORENCE T DOLAN 5188 SE INTERNATIONAL WAY
4025 SE BROOKLYN MILWAUKIE, OR 97222
PORTLAND, OR 97202
Phone: Contact #: PRI 503- 462 -4822
FAX 503- 462 -6555
FEES Reg #: ELE 26- 571CLE
LIC 50897
Description Date Amount SUP 605LEA
[ELPRMT] ELR Permit 8/12/2008 $75.00
[TAX] 12% State Surch 8/12/2008 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
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 questi • •. to OUNC at 503.24.:: - • or 1.800. • .2344.
Issued By: � � / / Permittee Signature: ,I144,D aC(4 .4 -e'Y\
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.
t s
.El Permit 1 �1t 1.-K sr. ()NIA
,Elect _ rm�. App ���
City of Tigard ` Received
1:1- e DaeB . A ►. .
Q
13125 SW Hall Blvd., Tigard, OR 97223 \ 1 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 '' • . ; , i p • Other Permit:
Inspection Line: 503.639.4175 `' ;�i,! Date Ready/By. ® See Page 2 for
Internet: www.ci.tigard.or.us f'•`� Notified/Method , Supplemental Information
le-gc'V = . - _ :- . TYPE OiNVOIIK > - _ • _ . -. PLAN REVIEW ..' ; .- c •
❑ New construction ® Addition/alteration/ � I Please check all that apply: .
❑ emolition LJ Other ['Service ['Hazardous over 225 amps, com'I Hazardous location
['Service over 320 amps — rating ❑ Buildng over 10,000 sq. R,
_ _ _' _ - CAT STRUCTION - of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling Commerc in ustrial ❑ 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
❑Occupant Toad over 99 persons ❑Manufactured structures or
' ' ' JOB SITE INFORMATION AND LOCATION RV park
❑Egress/lightingp1an P
Job no.: thp 1(o Job site address: la ii ) (11 am, ..s.4. ❑ Health -care facility ❑lei:
Submit 2 sets of plans with any of the above.
City/ State/ZIP: ^ e rr ) r o 1 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: 4- --- ) "' ¢roject ne: A_ ( &) V S >e_____ FEE• SCHEDULE .. _ .-
Description ` I Qtr. I Fee. I Tad 1
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. R or less 145.15 4
Subdivision: I Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
'� Limited energy, non - residential 75.00 2
- ' OF WORK - Each manufactured or modular
��,' ` dwelling, service and/or feeder 90.90 2
'Av'^' t /b' t)UV GI Services or feeders installation, alteration, and/or relocation
Y 4--. (J Ail 200 amps or less 80.30 2
- - . ` ❑ PROPERTY OWNER . 0 TENANT
201 amps to 400 amps 106.85 2
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: ( ) p er: ( ) -
200 amps or Tess 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
. -• ❑ APPLICANT I ❑ CONTACT PERSON 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, 46.85 2
Address: each branch circuit
Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) F es; ; ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
- . ,-. ' :. CONTRACTOR - _. ... .. _ - energy panel, alteration, or
extension. Describe: / Page 2 2
Business name: iV/OC
Address: Si Oc 5e / ,i - /AD Each additional inspection over allowable in any of the above
Per inspection 62.50
City/ State/ZIP: M ` la)L Yee Investigation per hour (I hr min) 62.50
r
Phone: i(5 402_ 4 g Fax: ) wea '(oSS 3 Industrial plant per hour 73.75
• r S E : . ' Y 2 : L : ° • V ELECTRICAL PERMIT: E E F S _ •_ v. °_ t* - " =
CCB Lic.: 5 I Electrical Lica / Suprv. Lic.: :05[.EA Subtotal - ,e,IJ
Suprv. Electrician signature, required: e_..' t- Plan review (25% of permit fee)
Print name: ( E b Q2 Date: State surcharge (8% of permit fee) GO
rr __^ ,^, � TOTAL PERMIT FEE cc/.
Authorized signature: 2
0 AAJ.b �Y W tJ ' � t t Ibis permit application expires if • permit is not obtained within 180
>� Y i.�i I Date: 0 r , days after it has been accepted as complete try
Print name: Service Board
lSJ /O� • Fee methodology set by Tri Building industry Se
• • Number of inspections per permit allowed
i:\ Building \PermitstELC- PamitApp.doc 12/03 410-4615T(I602JCOM/WFB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2008 -00241
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 81121200'3
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 9/16/2008 TIME: 7:01AM PAGE: 5
SITE ADDRESS: 12550 SW MAIN ST CLASS OF WORK:
SUBDIVISION: DOLAN BUILDING LOT #: 001 TYPE OF USE:
PROJECT NAME: A -BOY
DESCRIPTION: Installing low voltage wiring to new roof top unit.
OWNER: DOLAN + CO LLC, PHONE #:
CONTRACTOR: HVAC INC PHONE #: 503-462-4822
•
Inspection Request Scheduled For: Date: 9/16/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Me ssage
199 Electrical final `, 075519-01 ' 971.322 -6353 Y
Corrections /Comments /Instructions: \` S 1 U. bAI t
11:30
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I ATE. ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C Th N-V e _ Date: I f 'b 1 v I1 Phone #: (503) 718 -14