Permit I. 4 �i.
GITY OF TIGARD . '' ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00445
TIGARD DATE ISSUED: 12/11/2007
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 25101 DC - 03700
SITE ADDRESS: 07095 SW SANDBURG ST ZONING: C -P
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: UNITED FOOD LOCAL 555
Project Description: Low voltage for data telecommunications. Job No. 74 - 00117
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:
UNITED FOOD + COMMERICAL WORKERS CHRISTENSON ELECTRIC, INC.
UNION LOCAL #555 111 SW COLUMBIA STREET # 480
PO BOX 23555 PORTLAND, OR 97201
TIGARD, OR 97281
Phone: Contact #: PRI 503 -419 -3300
FAX 503 -419 -3695
FEES Reg #: ELE 26 -34C
L1C 458
Description Date Amount SUP 1994S
[ELPRMT] ELR Permit 12/11/2007 $75.00
[TAX] 8% State Surchar€ 12/11/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspende • : : - han 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules a set forth in O' - •5 P. -0010 through OAR 952 - 001 -0100. You may obtain copies o • -se rules or direct questions to OUNC at
503.2 •.6699 or 1.800.33. = , -.
Issue By: ji1 Permittee Sig - iILA, ----
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: ( 'i�� DATE:
� I jiL _:Y
LICENSE NO:
/ Call 503.63 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
DEC -10 -2007 MON 03 :17 PM CHRISTENSON ELECTRIC,INC FAX NO. 95034193695 P. 01
L' 1C�fILAI rer « 24
E D
Re / By: � 7 PemutNo.: £ / / / —00
• City of Tigard Date/By:
0125 SW Hall Blvd, Tigt O 97223 , \ -I Phut Review Other Permit:
Phone: 503.639.4171 Fax 503,598.1 c x, I ; On e _ ,,,,,. _ ® Page Inspection line: 503.639.4175 U'- s = =� I � pata Re edy/BY; Sup pkmeatsl Information
Notified/Method'
Internet: www.ci.tigard.or.lu of S1 aia, .r ;;„ s' <� ; ,:kf;„ ^ra
#i' >'s5: .iii ?` •'`: t,
... .,. . .,.:.:.:.r�:: >:., . .5 .�. ,���. �.k: a .: � v.:: :Ylik:�: �:.x$!e �? ' �
.�* ;15,' ..Y..� . ...
:» ~« > <; ':ias� -: '� ..v S A ,.:�.....� t ! ..: . �.. . Please cheek all that apply.. [] New construction ry !: dttion/altemtionlreplacemellt DServicc over 225 amps. comm'I ❑Hazardous location
❑ Demolition 0 Other: ❑ Service over 320 amps - rating ❑ Buildng over 10,000 sq, ft..
y .�:i„ >." :.' >; A., i:�;} of I- and 2- family dwellings 4 or more new residential
z3..: q . chore
��r�y x <. „r % %�i;.r.; or m one Slru
?s #. {;z >.a.,; >; .:. > ver 600 v olts namirml
:! q ' ( ; > Commercial/industrial ❑Accessory building ❑ Sy hem o
I - and 2-family dwelling � Cotlun pHuilding over throe stories ❑ Feeders, 400 amps or more
p Multi - family ❑ Master builder ❑ Other: ['Occupant load ova 99 persons ❑Ma ufactured structures or •
;�:. R park
..,z•� .y:: .;:'i;` ,;.Sn.: vy <:• B e 4.4/li tin an
:r> !1tJip!;;.�PC`¢k. ,P1k> ?`! ; l Other:
' •sr }:,a?s. >; #;.�i;.,•�six . ? .. , , :.. � ❑ Health -case facility ❑
Job no.: 114 Q D `rt . Job site address : Oq S SW
504-101.111:5__�— Submit? sea of plans with any of the above.
i . The above are not applicable to temporary construction service- ;>
Cl /state/ZIP: t , , R q . , k , - -- .77 :: • >$.3:
! r'''.r ?�: ?;r °.'. ;:jY;:h <;�,.;;;�.aii' "`.":.' ,i::.i: ,Y • « •,
Q� 55 i; r i lo
Pem�lron ' - »” . : ree ut ,
Suite/bldg./alit. no.: „, [ �f Project na me: « T :Lac- or l ttultl- homily dwelling utsit.
Cross streetldirr. tiers to job site: fu rl s 1, K..d. 6,1 New residttttlsl sln>; —
Includes attaches ear
r0 � -, lg- 3 1,000 s fl- or less 145.15 I 4
03 Ea add'I 500 sq. It or portion 33.40 1 _ 1
Subdivision: 1 Lot no.: Limited energy, residential - 75.00 2
Tax map/parcel no.: Limited energy, nonresidential 75.00 _ 2
...., .,,,: •.: c:.: .. n ;::..a,.�.. ., % Sm� sdbr,.: manufactured modular
'¢:: .;. � ,�::�` ` "R �s-u Each rodM
<s - u... < ^Ka "" ? :... _;:,::... ..:...4r: or feeder 90.90 2
;. .:s>' ' `' - dwelling. service and/
La 4. • 5< /lrrl • ` r "'' I L Services or feeders Ration, alteration, and/or relocation
_200 amps or lest 80.30 2
" 201 amps to 400 amps 106.85 2
T, 60.60
2
,.tea ��
s
':t�... 0 amps :�Y...:..... S l0 60
. .. >: :: :. .I�'fE�'Flf:.:x� ,; �s ^.. 401 amp
.:..x.. �[�.. :: ;. .,, „,:: d
� r �.(o / 601 amps o n ett w 1 amps amps or vela 2 40 60
Z
Name: t �`� 100 100 i i 454.65 2 •
O �`�� J �_�_� ec
Address: _ _ R econncet only 66.85 J 2
City/State/ZIP: �c co, 4 70`n8 / Temporary services or feeders lttstalbulaa, alteradon, and/or
relocation _
—
Phone: ( ) Fax: ( ) 200 amps or leas 66.85 l
Owner installation: This installation is being made on property that I own wh is not 201 amps to 400 amps •1 00.30 2
intended for sale, tease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 snips to 6 0o a 1p 133.7 2
Date: Branch circuits - new, atteratloa, or extension, p panel
Owner signature: :.,.
'
cirw
, A. Fee f or bran
::T �: '1T''i
A ; >PERB y
,•: �� '� :.�, :.�.....,.., loch
^!'•: .:.... , ceder fe
`t '% «, ... . . , servirx or f 6.65 • ..
� - ' branch circuit :
Business name: B. Fee for branch circuits
Contact name: wirhvrrr service or feeder fee, 46.85 2
first branch circuit
Address:
• _ _ Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Pump or irrigation ccle 53.40 2
Phone: ( ) I Fax:: ( ) _ Sign or outline lighting 53.40 2
• ,
Signal circuit(s) Of hmitYd-
E -mail: .: #: „,'::, E's. energy panel, alteration, or
;i'r, ..,.. >; "< ` ir%::'•<::.,` s:,: >;; ?_s:''c..:::•: . s, . e,rig am c: � - • Business name: Christenson Electric, Inc sic Des •h T '�'�
Each additional Inspection over allowable In any of the above
Address: 111 SW Columbia Street, Suite 190 Per inspection 62.50
Investigation per hour (t to min) 62.50
Ci /StatelZIP: Portland, OR 97201 _ - 73.75
h Ind plant per h our
Phone: (S03) 4193300 Fox: ( S03) 3 19 33 4 ':: <; :,< i ECr: IC10 s F si -: w : s.:;'
CCB Lic.: 45$ 1 Electrical Lic.: 26-34C S Irv. Lic.: 199• subtotal
Plan review (25% of permit fee) _
Suprv. Electrician signature, required State surcharge (8% of permit foe) 62 62,0-D Print name: ) Q)(-. {�(� Date: ,9 TOTAL PERMIT FEE g , Q
-
Authorized signature v / • This permit application expires ire permit is nut obtained within t80
soya after It has been accepted as complete • I Date: • Fee methodology set by Tn•C:ounty &slams tndusuy Service Board
Print /lame: 1 • j ] _ �� ----- " Number of inspections r permit allowed.
r1alul dame lPelmitslC•L('- penntrApp.dac 17101 X.I�a�
d p (yI 1 � ' R Sf' - r Jaa.do15Tt1iNLCOMvWOn CI i i - 1 tW~ ' /
DEC -10 -2007 MON 03:17 PM CHRISTENSON ELECTRIC,INC FAX NO. 95034193695 P. 02
Electricg1 Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee f n ,Y. ,� WtiiwIPtK'itili t;w;:.+ ?!:: _ __Iii r"rrr rn.,;.
o r all residential systems combined........ $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Gara Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
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
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
toDWIdflay.Thn\EU:vemitAppdoo oana
CITY OF TIGARD
BUILDING DIVISION PERMIT #: . ELR2007 -00445
1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/11/2007
Phone: (503) 639 -4171 J ,= .:�, - �i�
Inspection Requests (24 Hrs.): (503) 639 -4175 `_ _..
INSPECTION WORKSHEET FOR DATE: 1/16/20 TIME: 7 :00AM PAGE: 38
SITE ADDRESS: 07095 SW SANDBURG ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: UNITED FOOD LOCAL 555
DESCRIPTION: Low voltage for data telecommunications. Job No. 74 -00117
OWNER: UNITED FOOD + COMMERICAL WORKERS, PHONE #:
CONTRACTOR: CHRISTENSON ELECTRIC, INC.
�OVj 5 -5 PHONE #: 503-419-3300
Inspection Request Scheduled For: Date: 1/16/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
139 Electrical final 063303 -U1 503-703 -71 Y
M 3
Corrections /Comments /Instructions:
4
I
l
A ic i ,
it
PAS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G ---, rV(C\v Date: I 1 Phone #: (503) 718- MIA