Permit v CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00478
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/26/2007
PARCEL: 2S 102AC - 01101
SITE ADDRESS: 12562 SW MAIN ST 210 ZONING: CBD
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: SPEC SPACES
Project Description: Voice and data.
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:
WILKING INVESTMENTS V LLC A -REBS COMMUNICATIONS INC
16325 BOONES FERRY RD STE 200 5855 SW TARALYNN AVE
LAKE OSWEGO, OR 97035 BEAVERTON, OR 97005
Phone: Contact #: PRI 520 -0625
FAX 503- 641 -5216
FEES Reg #: ELE 34- 558CLE
LIC 86096
Description Date Amount
[ELPRMT] ELR Permit 12/26/2007 $75.00
[TAX] 8% State Surcha 12/26/2007 $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 P ermittee Signature: ILI ifs`:. =rt.:
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.
I
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Date/By: /��O 7 Z� Permit No 7 mp 13125 SW Hall Blvd., Tigar g, E IVED
Plan Review
I , 17 Phone: 503.639.4171 Fax: 503.598.1960 DDate/By: Other Permit:
TI G A R D Inspection Line: 503.639.4175 DEC 2472001 Date Ready/3y: luris: / 0 See Page 2 for
Internet: www.tigard- or.gov Notified/Method: /// Supplemental Information
TYPE pp U ' F' ' � 'f D i9ON PLAN REVIEW
❑ New construction �Additi o replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling KCommerciallindustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire 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 ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 2.56. 2_ Sc,.) t 't�- or more. occupancy.
I ! v1f�` Ai '' ❑ Six ix o or r moo re a residential units. ❑ R ecreation
al vehicle parks.
City /State /ZIP: (� ��jj �7 ❑ Health -care facilities. ❑ Supply voltage for more than
t pan C J7 L z 3 a I 0 Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no. Project name: S 7.1.) 1 5 0 Service or feeder 600 amps or more.
W[ry G _ was Zat S7 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
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
� Limited energy, multi - family 75.00 2
(J0 t c.. /�A
6 /PerrA CNE/ NC- residential (with above sq. ft.)
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: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 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 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
pp /�s each branch circuit
Business name: A _REs co-1 64 aN C_ B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
( —[( o_ C. first branch circuit
Address: 5855 sW lAt2A L/ur3 4 0-E
Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: at-co r OR 9 7 06 S Each manufactured or modular
90.90 2
dwelling, service and/or feeder
Phone: (9)5) C (.;ZS I Fax: : 663 ) G y1 52/ c, Reconnect only 66.85 2
E -mail: . Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
R — lgc M energy p ane l , a or t o n ,
Business name: or
— t M C ener panel, alteration, or
Address: G8 S5 & -TAR tv yitiN 4J extension. Describe: Page 2 2
Cit /ZIP: U N az g 704 Each additional inspection over allowable in any of the above
( Per inspection 62.50
Phone: 603) 520 X,2- 5 Fax: (563 ) 6v/ SZ 1 6 Investigation per hour (1 hr min) 62.50
CCB Lic.: 8614 Electrical Lic.: 4- CS 41 Suprv. Lic.: 2.y3a czt; Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: \.' - I _ og Subtotal:
Plan review (25% of permit fee):
Print name: ST D pi G Date: /2/z0-7
�GQ State surcharge (8% of permit fee):
Authorized signature: TOTAL PERMIT FEE: /
Print name: Date:
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I :\ Building \Permits\ELC- PermitApp.doc 05/23/06 440.4615T(11/05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
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:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
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
I:\ Building \Permits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: EI.R 2007.00478
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1 ?/26/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 _�'!+�
INSPECTION WORKSHEET FOR DATE: 2/19/2008 TIME: 7:01AM PAGE: 47
SITE ADDRESS: 12662 SW MAIN ST 210 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: SPEC SPACES
DESCRIPTION: Voice and data
OWNER: %MIXING INVESTMENTS V LLC, PHONE #:
CONTRACTOR: A -REBS COMMUNICATIONS INC PHONE #: 520.0625
Inspection Request Scheduled For: Date: 2/19/2008 Pour Time:
Code # Inspection Description onfirn Contact # Message
199 Electiical final 065132- 1 503. 347 -1184 N
Corrections/Comments/Instructions:
c \N,
s
NC ',
--\..
\i
A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
• ' IL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G NCQS Date: Z-lq,' lh Phone #: (503) 7181-14
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007 -00478
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 17/23/2007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 12/27/2007 TIME: 7:00AM PAGE: 66
SITE ADDRESS: 12662 SW MAIN ST 210 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: SPEC SPACES
DESCRIPTION: Voice and data.
OWNER: WILKINC INVESTMENTS V LLC, PHONE #:
CONTRACTOR: A -REBS COMMUNICATIONS INC PHONE #: 5062.5
Inspection Request Scheduled For: Date: 12/27/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 062162 -01 503. 520 -0625 N
Corrections /Comments/ Instructions:
\ ►Z 'ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �• �`��V Date: 120 Phone #: (503) 718- ViT30