Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
k DEVELOPMENT SERVICES PERMIT #: ELR2004 -00060
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/8/04
SITE ADDRESS: 09826 SW TIGARD ST PARCEL: 2S1026A -00304
SUBDIVISION: NO.TIGARDVILLE ADDITION AMEND. ZONING: I -P
BLOCK: LOT: 021 JURISDICTION: TIG
Project Description: Install low voltage for data /telecommunication.
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:
TIGARD INDUSTRIAL LLC CABLE RUNNERS
11336 SW BULL MOUNTAIN RD #103 10500 SW BOONES FERRY RD
TIGARD, OR 97224 PORTLAND, OR 97219
Phone: Phone: 503 245 - 3669
Reg #: LIC 122854
ELE 26-951CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 3/8/04 $75.00 Elect'I Final
[TAX] 8% State Surchari 3/8/04 $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 forth in OAR 952 -001 -0010 throuc
Issued by .tia - /r te ' 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 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Ectrcal Permit Application FOR OFFICE USE ONLY
City of Tigard
Date/By: _9 / Permit Nom /' —00(.260 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
ip Phone: 503.639.4171 Fax: 503.598.1960 - , , � Ab. ' b Date/By: Other Permit:
Inspection Line: 503.639.4175 � '' I Date Ready/By: lard/ El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: / Supplemental Information
YPE OF WORK PLAN REVIEW
❑ New construction Addition /alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'I ❑Hazardous location
OService over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling [ ommercial/industrial ❑ Accessory building OSystem over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑ Other: 0 Building over three stories ❑Feeders, 400 amps or more
['Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION 0 Egress/lighting plan RV park
Job no.: Job site address: y /6 51- ❑Health -care facility ['Other:
Submit 2 sets of plans with any of the above.
City /State /ZIP: - 7 - 76A ./,�/ n f �f 9 7 Z Z3 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: � Z C?770/nWS FEE* SCHEDULE
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.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
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
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
each branch circuit
Address:
Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or /
/�� " extension. D tribe: Page 2 2
Business name: 6 Adt�' �C,t:�'/t//1/,J/J O4 721 - aa. Ce bi ' i
Address: Each ad itional inspection over allowable in any of the above
/���� �� 'v" / �N�S � r ��7 �� Per inspection 62.50
City /State/ZIP: A,� /Gi.L� l Q/t? 9 7 / 0 f 5' Investigation per hour (I hr min) 62.50
Phone: (S( ) 25/5 3L GS' / Fax: ( zef - -7& Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: / L2854 Electrical Lic.: - - 5/ Suprv. Lic.: 7e271 lit Subtotal -7
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: ig 6 Date:g fr 2Cv 1 State surcharge (8% of permit fee) k
TOTAL PERMIT FEE .,l c1O
Authorized signature: gn 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:\ Building \Permits\ELC- PemtitApp.doc 12/03 440- 4615T(10 /02ICOM/WEB
Electrical Permit Application - City of Tigard _- It.
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*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
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
i:\Building\Pemi ELC- PemutApp.doc 04/03
Case Activity Listing 11/16/2004
y g 10:33:45AM
TIDEMARK Case #: ELR2004 -00060
COMPUTER SYSTEMS. INC.
Assigned Done Updated
Activity Description Date 1 Date 2 Date 3 Hold Disp To By By Notes
ELRC001 Application Received 3/8/2004 None DONE BB 3/8/2004
BLD
ELRC003 Permit Created 3/8/2004 None DONE BB 3/8/2004
BLD
ELRC725 Low Voltage 3/10/2004 None PASS HFY 3/10/2004 See report
Inspection HFY
ELRC799 Elect'l Final None 3/8/2004
BLD
ELRC500 (F) Issue permit 3/8/2004 None DONE BB 3/8/2004
BLD
ELRA510 (F) Reprint permit 3/29/2004 None DONE RLB 3/29/2004
RLB
ELRC800 Case Finaled 3/31/2004 None PART HFY 3/31/2004
HFY
Page 1 of 1 CaseActivity..rpt