Permit CITY TI GARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 -00064
III 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/21/2005
PARCEL: 2S110AB -00200
SITE ADDRESS: 14405 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: CANTERBURY SQUARE LOT: 1 -3 JURISDICTION: TIG
Project Description: Data wiring add -on.
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:
KOLVE, G C CUSTOM TELCOM
14389 SW PACIFIC HWY 4785 TEXTRUM CT. SE
TIGARD, OR 97224 SALEM, OR 97302
Phone: Phone: 503 - 580 - 7500
Reg #: ELE 24- 397CLE
LIC 127754
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 3/21/2005 $75.00
[TAX] 8% State Surchari 3/21/2005 $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 95 01 -0100. You ay obtain copies of these rules or direct que ' , s to OUNC at 503 - 246 -6699.
Issued By: 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 ApgEgf 1 V ED FOR OFFICE USE ONLY
City of Tigard MAR 21 2005 Apto Received _./ /
Date/B t / EP f Permit No..,,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review -)
Phone: 503.639.4171 Fax: 503.598.1960 4 144,111V Date/B : Other Permit:
Inspection Line: 503.639.4175 CITY OF TIG ' ,,11 '-- Date Ready/By: Juris: El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: 7 6 Supplemental Information
Ft Ul
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0 New construction Addition/alteration/replacement Please check all that apply:
D
0Service over 225 amps, comm'l OHazardous location
Demolition 0 Other:
['Service over 320 amps - rating 0Buildng over 10,000 sq. ft.,
k„,,,„. .,: -.- y;?...,ts,r31`, t - 4,..
'''' ' - ''''' ''''' '' C1G'450 bli C-'' iii4g' k6Cii0" .." ' -.. ''''''')4' ' '''
"4..• ,.- '""•• ,-,:.;, - ".-'°, ' ,.. '''' 3.. AT .. -, _ 2: - - , M....- , ,P,T:h. , --,.-,;, 4 p-r v.,........ i,4 , of 1- and 2-family dwellings 4 or more new residential
0 1- and 2-family dwelling ;El 0 Accessory building 0System over 600 volts nominal units in one structure
0Building over three stories OFeeders, 400 amps or more
0 Multi-family 0 Master builder - 0 Other: ['
Occupant load over 99 persons 0Manufactured structures or
- - ,'-::,.. •', - l';`,;rt.'1- -4,1:1:::::fr:.='::-.-, '' 0M eu 4. LO CAT I ON .% .....1 ;- . '----- ,T- - 31' ,,-'
''°:-, i'. - ' :.'" -''' ' ^ ,', -■‘!- ' ■ JC Nt 0164w gii. -7•.; .:1-- r" -,...-•:,,':-, I:Egress/lighting plan RV park .
Job no.: Job site address: /4 5- 5.4..) - / ) AC. 1441,1 0Health-care facility ElOther:
Submit 2 sets of plans with any of the above.
City/State/ZIP: - 7 . 7 e -a' 0,e 97 , 7 ,2 L The above are not applicable to temporary construction service.
•:',.', , ..f - ?,'i..i . ; Z'I .■:f:'';:.,':,; , V 7 /TX * ,1f.4Tj.t4 : ,Ta*AF 1 .W: 7 ;':'7 : ,.. '7 . '..
Suite/bldg./apt. no.: Project name: ( 7„ 9 „A e , 0
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 z.,4 1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 • 1
Limited energy, residential , 2
Tax map/parcel no.: .
Limited energy, non-residential / 75.00 7,5
i;vd- 4i s ; ;-;:e. . f; 2
"
: . ,..--,: :::... '-..•:-. --; . !'-... ,4 i1--' 7 I .` -, f' . ■ '." ^,. '''' . r -; . ,.' '.. •:' - 4`." .
Yf 0 (;:,!.. -!.4. :Y-E.,!. .:-. 4.-..4.:: ,Yr. -. ! -,,.,.. '.:-.i ..., Each manufactured or modular
. - dwelling, service and/or feeder 90.90 2
Adz/A.47 .4/4,4. m.i-
),4,75 Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
... 1,.--, 1:1 zpiaitiiiii tat•iii i.: ',--,...,-=;••--, , .....1 4:::40,,iirsaiTti_..,-::,,,c4% 201 amps to 400 amps 106.85 2
... .. .„ .- ,:. •` -•', . --7 '- - ; " ' ' '' `-' -'' '''; "' : 4.-4 .)' 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: ( ) 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
.. ..,, ...- with
0s- :-.-,. .,, -..,, • , , , -:.,,.; .,,......t:ti c vi - vt , '...ii . circuits
p WANT' "t:.. , '[.---.t , • -- • ' -co TA T A Fee for branch circui
• 'r
service or feeder fee, each
6.65 2
Business name: 1 /34,,171 /77 an
- 77 e lco py-2 brch circuit
B. Fee for branch circuits
Contact name: ,.../...., .---
‘4_, ..77,A.s-e-.0- without service or feeder fee,
46.85 2
each branch circuit
Address: 9 715- --71" x74- e.r. sc. Each add'I branch circuit 6.65 2
City/State/ZIP: .. 54 z , 0 e. 97.30 2- Miscellaneous (service or feeder not included)
1
Pump or irrigation circle 53.40 2
Phone: 073) _57, r O--7,s Fax: : ( 39:9_ g. 3 3 2_, .
Sign or outline lighting 53.40 2
E-mail: -- Signal circuit(s) or limited-
,;,.; .
,K. 1. . :;,, .,. 2 , T.7; ...->,• .,-. _.,, .., -,.., • ;:, t :, ,, ,. t . ,- .. .1A.<4.i-v.,. - ,: ;',.T.I t v . : ‘...: i y,d:At . energy panel alteration or
, ,
,...,.. -,,....-., 4 :,--. :,.. - ':, r, • t -/--:.,■ ' ....._1,.... -.. - .. ' '..,--.. .. '‘ -,;■'',-.,.. ,• rii) '
extension. Describe: • Page 2 2
Business name: O 3 A pr) --7 ;,/e
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: . 0......"71_---- Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
L'
CCB Lic.:7 775V Electrical Lic.: ae /I 7 l- 397 Suprv. Lic.: Subtotal --) .5 -•
Suprv. Electrician signature, required: O g Plan review (25% of permit fee) (
State surcharge (8% of permit fee) ...--
Print narne,L An .. 2.77 4.5s-e_r- Date: .,;/-7..-//d....i
TOTAL PERMIT FEE %I , co
Authorized signature: 727 a...4 This permit application expires If a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri-County Building Industry Service Board
** Number of inspections per permit allowed.
i:\Buildineermits\ELC-PermitApp.doc 12/03 440-4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
SIDE IMP O TL ; ¢ `'°,CMF:
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:
V GOIt I R _ V O0iON7; : . , ; ,4,4 . ... 1
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
,ata Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: /
*No licenses are required. Licenses are required
for all other installations
is\ Building \Pe mits \ELC•PrnnitApp.doc 04/03
CITY.OPTIGARD - • . •
BUILDING DIVISION PERMIT #: ELR2005 -00064
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/21/2005
Phone: (503) 639 -4171 ��roadly$f il`
Inspection Requests (24 Hrs.): (503) 639 -4175 L.
INSPECTION WORKSHEET FOR DATE: 4/7/2005 TIME: 7:14AM PAGE: 100
SITE ADDRESS: 14405 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: CANTERBURY SQUARE LOT #: 1 -3 TYPE OF USE:
PROJECT NAME: CASHCO
DESCRIPTION: Data wiring add - on.
OWNER: KOLVE, G C, PHONE #:
CONTRACTOR: CUSTOM TELCOM PHONE #: 503-580-7500
Inspection Request Scheduled For: Date: 4/7/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 003930-01 503-580 -7500 N
Corrections /Comments /Instructions:
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,,,,
1
irq PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
/ _
Inspector: 44.74.-e71. r ''r Date: 7 Phone #: (503) 718 -