Permit A CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
l� DEVELOPMENT SERVICES PERMIT #: ELR2005 - 00267
y' r � l II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/8/2005
PARCEL: 1S135DD-03301
SITE ADDRESS: 11945 SW PACIFIC HWY 250 ZONING: C -G
SUBDIVISION: HOFFARBER TRACTS NO.1 LOT: 002 JURISDICTION: TIG
Project Description: Thermostat contols.
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: 1
Owner: Contractor:
TIGARD PROPERTIES INC AMERICAN HEATING
8320 NE HWY 99 1339 SW GIDEON ST
VANCOUVER, WA 98668 PORTLAND, OR 97202
Phone: 360 -574 -6255 Phone: 239 -4600
Reg #: LIC 33135
ELE 26- 993CRE
FEES SUP 2640LEp
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 9/8/2005 $75.00
[TAX] 8% State Surcha 9/8/2005 $6.00
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.
Issued By: , j� ��'_ 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.
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received tl ,..., .... )
Permit No.: I 3-- 1
Date/:
13125 SW Hall Blvd., Ti By gard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 A, A 1 k
- t Ve riAlli t-- Date/By: Other Pennit:
Inspection Line: 503.639.4175 A4" 1±. „1, Date Ready/By: . • brit: I IZ See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: 1 --/( 1 -- Supplemental Information
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,,r.,•,-.., „.•, •• ,..,.,., -, ...,:,%0. „Inf.. ,„ • t _:. nak-4. - ac.c .,..., ...r......./..--,...„........ % :, -,,, , !t , .. , .i.%:..z,..,-., -,, ,- -
ID New construction Addition/alteration/replacement Please check all that apply:
OService over 225 amps, comm'l I:Hazardous location
El Demolition 0 Other:
['Service over 320 amps - rating 0Buildng over 10,000 sq. ft,
i,-,--It . i-.'7 : '.7 , ::*. , :g.p4r,-1.:,...-; . ..'.. • ' ; - ..... .!.:11_, - . .,,A, :tattwAr. .Ei.. ., ,kiv, of 1- and 2-family dwellings 4 or more new residential
El 1- and 2-family dwelling )KConunercial/industrial 0 Accessory building 0System over 600 volts nominal units in one structure
['Building over three stories [Weeders, 400 amps or more
0 Multi 0 Master builder 0 Other:
DOccupant load over 99 persons 0Manufactured structures or
,,,,ii ' -. ain ;
o j= ■4.` , Ai...p.1,: . lt. „.. _ I:E plan RV park
Job no.: Job site address: / ci S , iL_ ' a at_ DHealth-care facility ['Other:
Submit 2 sets of plans with any of the above.
t
City/State/ZIP: i ' . 11 Q . ■ MIMI The above are not applicable to temporary construction service.
1 c "R:4;4, 5;.,t1
Suite/bldg./apt. no.: p Project name: To CLam , o t C..
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 leis 145.15 4
Subdivision: I_ Lot no.: Ea. addl 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 .._ 2
Tax map/parcel no.: Limited energy, non-residential
piw i pTvw.rW M
.4 ,-. ...7 . ' q 7
iF Limi
41. 75.00 2
gi Altii. - . . - 4 - ._4.r...1: - zst. ..-- . . -. --, - : ', - .. - . V.L...124 ..--ct. - ..,u Each ' - ; - .-., • c h manu f actured or modular
Illirlippll=1111111 dwelling, service and/or feeder 90.90 2
-4/10Allisx ...s 1 ififf ll • at IA .44 Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
2WW:r. .4- ic" ''',. 751.0 ..v..41924 201 amps to 400 amps 106.85 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: ( ) I 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
, ,,'...%W.* .7 . der '',F,I A. Fee for branch circui ts with
, ...,....e=t:. -,' • ..:.- , ili.■ '1.a... ',22 -....
E=:ijlffllilAMMIRUPSMIIIIMIII - service or feeder fee, each
branch circuit 6.65 • 2
B. Fee for branch circuits
Contact name: ( • (X_ e) - ‘f (LUX without service or feeder fee, 46.85 2
each branch circuit
Address: ) "3" Ok ) F, ( 1. c
Each addl branch circuit 6.65 2
City/State/ZIP: "4-(c ‘ 0 fa Miscellaneous (service or feeder not included)
Phone: FILZ ) -x3c(„c[G60 I Fax: : (2J /j3--103% Pump or irrigation circle
Sign or outline lighting 53.40
53.40 2
2
E Signal circuit(s) or limited
ItraeattipaginengittifedWr #1,44:4p.7.4*4.44 7:... a energy panel, alteration, or
extension. Describe: I Page 2 /. 2
k
Business name: (NA, 1 cat fl \ 0 ...c , _
Address: CILIX1° Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: _
Investigation per hour (1 hr min) 62.50
Phone: 6(53 _- ((Got I Fax: r-Y5 '• - 7 423 Industrial plant per hour 73.75
gItt
CCB Lic.: '3 v5(-5 I Electrical Lic.: I Suprv. Lic.:,?.6 40 2 2 Subtotal --75. CC
, 1
Suprv. Electrician signature, required: ■ Plan review (25% of permit fee)
Iinviltrilli 4
Print name: 7 S V Q Y • U...(1.61
4e Date. al 4-Eir4
0 . J State surcharge (8% of permit fee)
Authorized signature: IP )
- This permit ap plication TOTAL PERMIT FEE ,/ , p 0
expires if a permit is not obtained within 180
ElAlti_Pa a GV& VI Date: f A --,
...-0 U -.1 days after it has been accepted as complete
Print name: a ,-
• Fee methodology set by Tri-County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\Building\Permitsk .
ELC-PennitApp.doc 12/03 440-4615T(10/02JCOM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005 -00267
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 9J8/2005
Phone: (503) 639 -4171 u 1 1 1 l l�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 9/12/7005 TIME: 7 :04AM PAGE: 107
SITE ADDRESS: 11945 SW PACIFIC HWY 250 CLASS OF WORK:
SUBDIVISION: HOFFARBER TRACTS NO.1 LOT #: 002 TYPE OF USE:
PROJECT NAME: JO-ANN FABRICS
DESCRIPTION: Thermostat contols.
OWNER: TIGARD PROPERTIES INC, PHONE #: 360- 5746255
CONTRACTOR: AMERICAN HEATING PHONE #: 239 -4600
Inspection Request Scheduled For: Date: 9112/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 015332 -01 503- 239 -4600 N
Corrections /Comments/ Instructions:
i (y y7(26...,
1PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: _ Date"—, ,-....---/ Phone #: (503) 718-