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Permit • 11 a CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00065 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/7/2007 PARCEL: 2 S 103 D D -01201 SITE ADDRESS: 13920 SW PACIFIC HWY ZONING: C -G SUBDIVISION: GOODWILL INDUSTRIES CENTER LOT: JURISDICTION: TIG PROJECT: GOODWILL INDUSTRIES Project Description: Low voltage for wiring & thermostats. 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: GOODWILL INDUSTRIES HVAC INC 1943 SE 6TH AVE 5188 SE INTERNATIONAL WAY PORTLAND, OR 97221 MILWAUKIE, OR 97222 Phone: 503- 238 -6190 Contact #: PRI 503- 462 -4822 FEES Reg #: ELE 26- 571CLE LIC 50897 Description Date Amount [ELPRMT] ELR Permit 3/7/2007 $75.00 [TAX] 8% State Surcha 3/7/2007 $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:Ze Permittee Signature: - (vQ, g htuisOdy .. 1 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. L,.. • • Electrical Permit Application 1.01z (Irrlc l; t six ()NI.) 'City 125 SW Hall Blvd, � '� Tigard, O D DateB . W)i / =! V.-4 *J0,1". - Date/0 . Other Pemtit: Inspection Line: 503.639.4175 Phone: 503.639.4171 Fax: 50 - , I Date Ready/B r 3 �+ ® See Page 2 for O 7 2007 �,;�. � '__� Internet: www.ci.tigard.or.us MAR Notified/Method: / / Supplemental Information 1 4UbT17° teration/ K j - .;- 14",;,;y- say: '.PLAN > 4Iew construction [ & replacement Please check all that apply: ❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ❑za Hardous location ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. R, _ :' -_-._ _ _ _ _CATEGORY .OF CONSTRUCTION - . of I- and 2 -family dwellings 4 or more new residential ❑ 1 - and 2 family dwelling Wommercial/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 ❑Occupant load over 99 persons ❑Manufactured structures or ' • • JOB INFORMATION AND LOCATION RV ❑Egress/li plan park Job no.: 3 Job site address: ❑Health -care facility ❑Other: Submit 2 sets of plans with any of the above. City / State/ZIP: Qilij (') (6 construction above are not applicable to temporary consction service. 1 , ! T � - -.;, _,- -. :- FEE! SCHEDULE ,; : i- . Suite/bldg. /apt. no.: Proje name: (] w`Ce , Tor.iv ies Description Q,3 I Fee 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 __- - - -1- - _ DESCRIPTION OF WORK - - Limited energy, non-residential 75.00 2 Each manufactured or modular /_ - V O / -, fl l4_ MOgL dwelling, service and/or feeder 90.90 2 (,�lf,U I Co� t/� �t".lJ act... Services or feeders installation, alteration, and/or relocation J 200 amps or less 80.30 2 - : - _. ❑ PROPERTY OWNER ❑ 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: ( ) F es: ( ) 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 • ❑ 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: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2 Sign or outline lighting 53.40 2 • E - mail: Signal circuit(s) or limited- s CONTRACTOR - energy panel, alteration or - extension. Describe: / Page 2 2 Business name: 1 _..rte___ Address: Si 8' SE / 4 (,(� Each additional inspection over allowable in any of the above Per inspection 62.50 City/State/ZIP: I - pp 1 ` ( c ud ( k. Q O Investigation per hour (1 hr min) 62.50 Phone ( ) 4 (0 1 _ Li C _ Fax: 3 ) kicea cos -S . �' .,, : ,r, s ELECTRICAL _PERMTT -FEES` :; : �i : : --w CCB Lic : 5o ? 7 Electrical Lica Suprv. Lic. :605' Subtotal q�i Suprv. Electrician signature, required: C CU F. Plan review (25% of permit fee) / Print name: AA es COb a0-- Date: 3. I `7 I p'7 State surcharge ( 8% of permit fee) G `� ��Z� TOTAL PERMIT FEE b Authorized signature: - J � 1J 1�� ' This permit application expires if a permit is not obtained within 180 "`1ff� days after it has been accepted as complete Print name: �( . ` ri ,, � s8 , Date: 3 / I ' 6 7 • Fee methodology set by I'd -Comity Building Industry Service Board / • • Number of inspections per permit allowed i :\BuiWiaglPumibtELC- PumitApp.doc 12103 440- 4615T(I0/02/COM/w® CITY OF TIGARD , BUILDING DIVISION PERMIT #: ELR2007 -00065 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/7/2007 Phone: (503) 639 -4171 /aku! ( Inspection Requests (24 Hrs.): (503) 639 -4175 `I �.. INSPECTION WORKSHEET FOR DATE: 6/7/2007 TIME: 7:00AM PAGE: 54 SITE ADDRESS: 13920 SW PACIFIC HWY CLASS OF WORK: SUBDIVISION: GOODWILL INDUSTRIES CENTER LOT #: TYPE OF USE: PROJECT NAME: GOODWILL INDUSTRIES DESCRIPTION: Low voltage for wiring & thermostats. OWNER: GOODWILL INDUSTRIES, PHONE #: 503 -238 -6190 CONTRACTOR: HVAC INC PHONE #: 503 - 462-4622 Inspection Request Scheduled For: Date: 6/7 /2007 Pour Time: Code # Inspection Description • • Contact # Message 199 Electrical final - 049764 -01 503 - 209.3586 N • W1ARY•4• Corrections /Comments /Instructions: • f PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ A CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 0 6 Date: ID' 1 ' 0 Phone #: (503) 718- 2 �4 CITY OF TIGARD • BUILDING DIVISION PERMIT #: ELR2007 -00065 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/7 /2007 Phone: (503) 639- 4171 , or 1 Wpgg4 ((( Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 4/24/2007 TIME: 7:01AM PAGE: 33 SITE ADDRESS: 13920 SW PACIFIC HWY CLASS OF WORK: SUBDIVISION: GOODWILL INDUSTRIES CENTER LOT #: TYPE OF USE: PROJECT NAME: GOODWILL INDUSTRIES DESCRIPTION: Low voltage for wiring & thermostats. OWNER: GOODWILL INDUSTRIES, PHONE #: 503-238.6190 CONTRACTOR: HVAC INC PHONE #: 503- 462 -4822 Inspection Request Scheduled For: Date: 4/24/2007 Pour Time: Code # Inspection Description - - - ' �i # Contact # Message 135 Low voltage 047036 -01 503-462-4822 — Y Corrections /Comments /Instructions: j \ E 4N 51Tt ,co31g3n FA PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: 4121 Phone #: (503) 718 - 2.��