Permit A CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• A.appar DEVELOPMENT SERVICES PERMIT #: ELR2005 -00354
..� 13125 SW Hall Blvd., Tigard, OR 97223 503- 6 39 -4171 DATE ISSUED: 10/19/2005
PARCEL: 1 S134BC -00300
SITE ADDRESS: 12280 SW SCHOLLS FERRY RD ZONING: C -G
SUBDIVISION: GREENWAY TOWN CENTER LOT: JURISDICTION: TIG
Project Description: Security.
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: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
VINNACOMBE CONSULTING SONITROL PACIFIC
12790 SE BLUFF RD 8220 N. INTERSTATE AVE.
SANDY, OR 97055 PORTLAND, OR 97217
Phone: 503- 826 -1726 Phone: 223 -5822
Reg #: LIC 53535
ELE 26- 370CLE
FEES SUP 4045LEA
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 10/19/200f. $75.00
[TAX] 8% State Surcharl 10/19/200: $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 • estions t• OU at 503 - 246 -6699.
•
Issued B Permittee Signature: � _ _ y �.� ! �J
y:_ — _
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.
F ���,ZO \`, 3 , S � ��`\ Electrical a Perm t Application C ` \ � \ •ei / � - 9 & 7 '� j •
3 t hin: on Colin • • : - . I - 846 -3470, Fax: 503- 846 -3993, Inspectio �te t 50
15 s ` • , urte - - lsboro, OR 97124 www.co.washington.or.us
• (skin ' Land Use Approval: roject # Permit # /)7) Q5' G /
- TYPE OF WORK - . • - PLAN REVIEW " ' •t -
❑ New construction Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'I ❑Hazardous location
['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
' • - ''CATEGORY OF - CONSTRUCTION. _ , , ... ' of l- and 2- family dwellings 4 or more new residential
• - ['System over 600 volts nominal units in one structure
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building ['Building over three stories OFeeders, 400 amps or more
❑ Multi - family • Master builder ❑ Other: DOccupant load over 99 persons OManufactured structures or
['Egress/lighting plan RV park
_ JOB SITE INFORMATION AND LOCATION.- ° `.. : .'; �. ❑Health -care facility ['Other:
Job no.: Job address: 2' �p+ t ) _ 1,, _ r Submit 2 sets of plans with any of the above.
` P d 54 ^ �``-� 0 a �" �V���� �� �` • The above are not applicable to temporary construction service.
City/ State/ZIP: --r-, c 1 Q C �7 FEE' SCHEDULE
Suite/bldg. /apt. no.: Project name:. & V • Description I j Fee. I Total I ••
Q G� Y11 h , Description 4 yat New residential single or multi-family - per dwelling unit.
Cross street/directions to job site: Include square footage for attachedparage.
1 ,000 sq. ft. or less 150.00 4
Ea. add'I 500 sq. ft. or portion 42.00
Subdivision: Lot no.: Limited energy, residential 60.00 2
Tax map /parcel no.: Limited energy, multi- family 66.00 2
Each manufactured or modular tot 00 2
: • DESCRIPTION OF WORK'-. = ' `, ' . ' - - '- dwelling, service and/or feeder
Services or feeders installation, alteration, and/or relocation
200 amps or less 90.00 2
201 amps to 400 amps 120.00 2
401 amps to 600 amps 180.00 2
- ❑ - PROPERTY OWNER.; - : • 4 `• ' . ' } -- 0 TENANT%
601 amps to 1,000 amps 270.00 2
Name: Over 1,000 amps or volts 504.00 2
Address: Reconnect only 78.00 1
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
200 amps or less 78.00 2
Phone: ( ) Fax: ( )
201 amps to 400 amps 108.00 2
Owner installation: This installation is being made on property that I own, which is not 401 amps to 600 amps 150.00 2
intended for sale, lease, rent, or exchange. Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
service or feeder fee, each 8.50
. ❑ APPLICANT.. . - : l l •.._.,Q,;CONTACT'PERSON - • - . branch circuit 2
Business name: B. Fee for branch circuits
without service or feeder fee, 60.00
Contact name: first branch circuit 2
Each add'I branch circuit 8.50
Address:
Miscellaneous (service or feeder not included)
City/State/ZIP: Pump or irrigation circle 60.00 2
Sign or outline lighting 60.00 2
Phone: ( ) Fax: ( )
Signal circuit(s) or limited -
E- mail: energy panel, alteration, or
extension. Describe: I / 0 2
. • . . CONTRACTOR .• : _ • . . , v
•
r Each additional inspection over allowable in any of the above
Business name: �� %� co `
��,t,4 c Per inspection I 90.00 I
Address: $ 210 make rS4oA Q - n (A 4 Investigation fee (SEE COMPLIANCE)
Other:
City/ State/ZIP: � C Q � (� � 1 7 a (� ELECTRIC AL PERMIT FEES* • _
Phone: (5 3) 223 -S $22 Fax: ( 50) 9 73-77 73 Subtotal $ F�CJ ([ )
Lic. no.: a (,...3 7 _e B lic. no.: 535 35 Plan review (25% of permit fee) $ •
Supervising electrician „ / J� State surcharge (8% of permit fee) $
signature, required -r • 7 L /DV5 / 1 �
-7 C /I TOTAL PERMIT FEE $ bR .8
Print name: ,p ,o Date:
/0 ���/ C �� / �% //► 45— This permit application expires if a permit is not obtained
Authorized within 180 days after it has been accepted as complete
signature: • Fee set by Tri-County Building Industry Service Board 4r f
•• Number of inspections allowed per permit (1 /
Print name: Date: 440 -4615T (7/03 /COM/WEB)
CITY OF TIGARD
4e . h •
BUILDING DIVISION PERMIT #: ELR2005-00354
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/19/2005
Phone: (503) 639 - 4171 Y I 0 I
Inspection Requests (24 Hrs.): (503) 639 -4175 �!±+�
INSPECTION WORKSHEET FOR DATE: 10/20/2005 TIME: 7:09AM PAGE: 84
SITE ADDRESS: 12280 SW SCHOLLS FERRY RD CLASS OF WORK:
SUBDIVISION: GREENWAY TOWN CENTER LOT #: TYPE OF USE:
PROJECT NAME: OREGON COMMUNITY CREDIT UN
DESCRIPTION: Security.
OWNER: VINNACOMBE CONSULTING, PHONE #: 5 503 -826 -1726
CONTRACTOR: SONITROL PACIFIC PHONE #: 223 -5822
Inspection Request Scheduled For: Date: 10/20/2005 Pour Time: •
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 018803 -01 503-380-0786 N
. Corrections /Comments /Instructions:
•
ic"?
A s PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / i_ '- Date: / /6 Phone #: (503) 718-