Permit }
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CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2006 - 00181
� 111 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/1/2006
PARCEL: 1 S135BD -00300
SITE ADDRESS: 09735 SW SHADY LN . ZONING: C -
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Low voltage for HVAC
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:
HAZEL INTERNATIONAL, INC AND WILLAMETTE HVAC
HIGASHIYAMA HIGHLANDS CO, LTD 27655 SW LEPLEY LN
BY NORRIS + STEVENS REALTORS HILLSBORO, OR 97123
PORTLAND, OR 97204
Phone: Contact #: PRI 628 -6841
Reg #: ELE 34- 346CRE
FEES LIC 56951
Description Date Amount
[ELPRMT] ELR Permit 8/1/2006 $75.00
[TAX] 8% State Surcha 8/1/2006 $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 obtai copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: y .e... Permittee Signature: XC
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.
1 Electrical Permit Application
m FOR OFFICE USE ON
R
City of Tigard tar Dat . / ob 46 ' permit No.' ' -� ob,-.04 1
Ci /
13125 SW Hall Blvd., Tigard, OR � Plan Revie
a Phone: 503.639.4171 Fax: 503.598.1960 Date/By.. Other Permit:
T I G A It [7 Inspection Line: 503.639 Date Ready/By: 3 u ris : El See Page 2 for
Internet: www.tigard- or.gov AUG U U l 2006 Notified/Method: Supplemental Information
TYPE (0 er F ,t i� G b y I i PLAN REVIEW
12 New construction dd' ' vd n��LJ P lease check all that apply (submit 2 sets of plans w /items checked below):
/ � jois,, ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
El 1- and 2- family dwelling ommercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "I - 2 ", "1 - 3 ",
Q � C-' /, / 1001-11 or more. occupancy.
Job no.: Job site address:
• L 3 J JW S yi.1 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. t 7 Project name: , D J 04 � j / all ❑ Ser or feeder 600 amps or more.
6 FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
, �r C in ee - ca /4/./A G t , N Or- residential (with above sq. ft.)
A r � ' Services or feeders installation, alteration, and/or relocatio
/{� , K �� r v 200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/ State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I 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 599 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee, 46.85 2
Contact name: first branch circuit
Address: Each add'I branch circuit 6.65 _ 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E - mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
J / Signal circuit(s) or limited -
Business name: �� *//, w ` - k .L AevA C- energy panel, alteration, or �1
Address: ) 7� [3 d . 2 3 3 ,/ extension. Describe: -` Page 2 2
City/ State/ZIP: . 7:: - } „.,... psi q /2- et Each additional inspection over allowable in any of the above
I Fax: ( ) Per inspection 62.50
Phone: ( )
S " 6' / Investigation per hour (I hr min) 62.50
CCB Lic.: 5 ej $") I Electrical Lic.: Z Ve 3 Y - J91E$ prv. Lic.: xe /71 .2 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Print name: ! 4../, G Date: 9/ fyog Plan review (25% of permit fee):
�� .� G t:. ✓ State surcharge (8% of permit fee):
Authorized signaturei� _C TOTAL PERMIT FEE: ( f - 77
Print name: Date: This permit application expires if a permit is not obtained within 180
• days after it has been accepted as complete.
• Number of inspections allowed per permit.
I :\ Building \Pennits\ELC- PermitApp.doc 05/23/06 3+ � - 7D 4 02 te- 4615T(I1 /05 /CO)VWEB
Electrical Permit Application - City of Tigard N
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
El Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
El Vacuum Systems*
❑ Other.
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
E l Fire Alarm Installation
• Z‘ HVAC
❑ Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
El Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
[: 1Building \Pamits1ELC- PennitApp.doc 03/23/06
CITY OF TIGARD -
BUILDING DIVISION PERMIT #: ELR2006- 00181
13125 SW HaII Blvd., Tigard, OR 97223 DATE ISSUED: 8/1/ 2006
Phone: (503) 639 -4171u
Inspection Requests (24 Hrs.): (503) 639 -4175 .�' �+L I L
INSPECTION WORKSHEET FOR DATE: 8/17/2006 TIME: 7 :01AM PAGE: 53
SITE ADDRESS: 09735 SW SHADY LN CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TIGARD MEDICAL MALL
DESCRIPTION: Low voltage for HVAC
OWNER: HAZEL INTERNATIONAL, INC AND, PHONE #:
CONTRACTOR: WILLAMETTE HVAC PHONE #: 628.6841
Inspection Request Scheduled For: Date: 8/1712006 Pour Time:
Co Inspection Description Confirm # Contact # Message
199 Electrical final 035134-01 503 -71 2423
Corrections /Comments /Instructions:
3 R_. 'i c ' f.
SAL
( t
P ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
IL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
I\166 Date: D 411 qt Phone #: (503) 718- V(tt6
CITY OF TIGARD .. ti --
BUILDING DIVISION - PERMIT #: ELR2005-00101
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/1/2006
Phone: (503) 639 -4171 �� �� I
Inspection Requests (24 Hrs.): (503) 639 -4175 ..
INSPECTION WORKSHEET FOR DATE: 8/16/2006 TIME: 7:05AM PAGE: 10
SITE ADDRESS: 09735 SW SHADY LN Vv CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TIGARD MEDICAL MALL
DESCRIPTION: Low voltage for HVAC
OWNER: HAZEL INTERNATIONAL, INC AND, PHONE #:
CONTRACTOR: WILLAMETTE HVAC PHONE #: 628 -6841
Inspection Request Scheduled For: Date: 8/16/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 035084 -01 503 N
Corrections /Comments / Instructions:
5 . / NO t " Co 0 h
; 014 Q' ii w 4 4 CO el 0 /n s . '1
/V ;1 1G 4vy
❑ PASS PARTIAL APPROVAL CE ✓ ANCEL ❑ NO ACCESS
frgjo@ ' FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
A
Inspector: `/ 6 - 0 3 Date: -) Phone #: (503) 718-