Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
44 DEVELOPMENT SERVICES PERMIT #: ELR2004 -00019
..�� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/27/04
SITE ADDRESS: 06650 SW REDWOOD LN 160 PARCEL: 2SI12DA -01400
SUBDIVISION: PP1996 -048 ZONING: I -P
BLOCK: LOT: 002 JURISDICTION: TIG
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:
PACIFIC REALTY ASSOCIATES CABLEFORCE COMMUNICATIONS
15350 SW SEQUOIA PKWY #300 -WMI 2737 NE NELA ST
PORTLAND, OR 97224 PORTLAND, OR 97210
Phone: Phone: 503 778 - 7474
Reg #: LIC 151912
ELE 26 - 1161 CLE
FEES Required Inspections
Description Date Amount Ceiling Cover
[ELPRMT] ELR Permit 1/27/04 $75.00 Wall Cover
Elect'I Final
[TAX] 8% State Surchari 1/27/04 $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 for - in OAR 952 -001 -0010 throuc
l
Issued by r L-e-/v Permittee Signature i
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 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Ele Permit Application FOR OFFICE USE ONLY
R ece i ve d � Electrical
�
Date/By: /' a 7- 6 3 Ord Permit No.€6, 20'a y -vlb l9
City of Tigard Planning Approval Sign
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: , Permit No.: al (/ 'V6 '7
- err
rats
503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use r
% -,All, I 'f� Contact Contact y: ® See Page 2 for
^
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
p The above are not applicable to temporary construction service.
I
Job site address: La (05 S De ea.(I3 QOfk Qi # 1 bo FEE* SCHEDULE
Suite #: / bo Bldg. //A tt. #: _ Number of inspections per permit allowed
Project Name: fi Ls `G r cir Ol"l (.., Description Qty Fee (ea.) Total 1
Cross street/Directions to job site: New residential single or multi-family per
,Q dwelling unit. Includes attached garage.
b1,0 ca{V. ->r3 J y 0 O e t t he'-' Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
Services or feeders - installation,
N O(_L E Qrlri Oak Cad 1.00i alteration or relocation: • 200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY OWNER WANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: FtArly 1(2..E Electra LUJ Reconnect only 66.85 2
Address: Add 92. q 5 W V e-r i Temporary services or feeders - installation,
City /State /Zip: 7t5& 'C (' . q 1a-d`q 2 or relocation:
J 2000 0 a amm amps or less 66.85 1
Phone: 3— &3 -- 0 q5b Fax: 201 amps to 400 amps 100.30 2
401 to APPLICANT O Branch 'CONTACT PERSON
❑ Brch h amps 133.75 2
circuits - new, alteration, or
Name: C Cek t &Ala h extension per panel:
r `L A. Fee for branch circuits with purchase of
Address: 2 1-5 1J W (J ela 2 r - service or feeder fee, each branch circuit 6.65 2
'
City /State /Zip: u∎ y�,,t C - - 3-Z 1-0 B. Fee for branch circuits without purchase of
� r 3 ) o/ service feeder branch circuit 46.85 2
' - "t
Phone. 2 i I Fax: ( Each additional branch circuit 6.65 2
E -mail: (e . C4Aav�..z (1.6. a 4vJ,(! -ce • - Misc.(Service or feeder not included):
Each pump or irrigation circle 53.40 2
CONTRACTOR Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
_
B Name:Oasjega4 - 6 e61/ltt/vuca t•` alteration, or extension Paget 2
On:
Address: °). tvw dot. a--
City /State /Zip: pin, 2 0 Each additional inspection over] he allowable in any of the above:
Per inspection per hour (min. 1 hour) 62.50
Phone; .-ti I2 -7- ?00 Fax:s(o -6111-1-70 ! Investigation fee:
Other:
CCB Lic. #: f ' j 11 2. Lic. #: a 6 -1/6/ C L Electrical Permit Fees*
Supervising electrician atr 2.--- Subtotal $ ;15 e-
signue required Plan Review (25% of Permit Fee) $
Print Name: 0j f:-. ivs Lic. #: F „?di Lf State Surcharge (8% of Permit Fee) $ 6o6
TOTAL PERMIT FEE $ $ O2
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
is \Dsts\Permit Forms\ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard "5 r►
Page 2 - Supplemental Information
•
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
El Audio and Stereo Systems
0 Burglar Alarm
❑ Garage Door Opener
❑ Heating, Ventilation and Air Conditioning System
0 Vacuum Systems
Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
El Audio and Stereo Systems
E Boiler Controls
0 Clock Systems
0 Data Telecommunication Installation
D Fire Alarm Installation •
HVAC
0 Instrumentation
0 Intercom and Paging Systems
0 Landscape Irrigation Control
0 Medical
0 Nurse Calls
❑ Outdoor Landscape Lightirig
0 Protective Signaling
Ei Other
' Number of Systems
* No licenses are required. Licenses are required for all
other installations
•
i:\Dsts\Permit FormsElcPermitAppPg2.doc 01/03