Permit III a - CITY O F TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00400
TIGARD DATE ISSUED: 10/30/2007
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S112DD -00900
SITE ADDRESS: 15700 SW UPPER BOONES FERRY RD ZONING: C -G
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: HOLIDAY INN EXPRESS
Project Description: Low voltage for data installation.
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:
BHGAH TIGARD MATRIX COMMUNICATIONS
PO BOX 1670 4243 SE INTERNATIONAL WAY
WILSONVILLE, OR 97070 PORTLAND, OR 97222
Phone: 503- 783 -5222 Contact #: PRl 503 - 513 -9152
FAX 503 -513 -9352
FEES Reg #: ELE 26- 694CLE
LIC 74332
Description Date Amount SUP 1202LEA
[ELPRMT] ELR Permit 10/30/2007 $75.00
[TAX] 8% State Surchar€ 10/30/2007 $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 rf 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 se in 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503.246 99 or 1.80 33 .
Issued Permittee Signature ! /�L�
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.
O Y . /�
i � � Application PERMIT # f !� ?"40 7`l/�
illih. Electric al Permit pp R` DATE RCV'D �� 0 7
}• PO Box 369 • 380 A Avenue
: *l RCV'D BY
„ L a k e O swego, OR 97034
Phone: (503) 635 -0390 IN Fax: (503) 697 -6574 DATE ISSUED / ° 13 0 /7
Website: www.ci.oswego.or.us •
:= TYPE OF , WORK• . , ' , •PLAN,: REVIEW - REQUIRES 2 SETS OF PLANS
❑ New construction it Addition /alteration /replacement Please check all that apply ❑Health -care facility
['Service over 225 amps, ['Hazardous location
❑ Demolition ❑ Other: commercial ['Building > 10,000 sq. ft., 4
CATEGORY OF'tCONSTRUCTION -• ['Service over 320 amps - rating or more new residential
of I- and 2- family dwellings units in one structure
❑ I- and 2- family dwelling Commercial /industrial ❑ Accessory building ['System over 600 volts nominal ['Feeders, 400 amps or more
❑Building over three stories ['Manufactured structures or
❑ Multi- family El Master builder l=1 Other:
❑Occupant load over 99 persons RV park
JOB SITE INFORMATION ;AND LOCATION , , ['Egress/lighting plan ❑Other:
1571369 60) Job no.: Job address: 15Q) The above are not applicable to temporary construction service.
� FEE" SCHEDULE
City /State /ZIP: � tS L/ / Description Qty I Fee. [ Total I -
Suite/bldg./apt. no.: Project name:44 J New residential single- or multi - family dwelling unit.
y O Includes attached garage.
Cross street/directions to job site: 1,000 sq. ft. or less 143 10 4
Subdivision: I Lot no.: Ea. additional 500 sq. ft 27.00
Limited energy, residential 54.00 2
Tax map /parcel no.: Limited energy, non - residential M N/A 2
' DESCRI_PTION ' OF ORK • Each manufactured or modular 67.50 2
dwelling, service and /or feeder
/� ,�� r � � i �.��r Services or feeders installation, alteration, and/or relocation
200 amps or less 85.05 ' - 2
201 amps to 400 amps 101.25 2
401 amps to 600 amps 168.75 2
. ❑ PROPERTY' OWNER ' ' . - I - - ❑':TENANT= 601 amps to 1,000 amps ' 220.05 2
Over 1,000 amps or volts 506.25 2
Name: Reconnect only 67.50 I
Address: Temporary services, feeders installation, alteration /relocation
200 amps or less 67.50 2
City/State/ZIP: 201 amps to 400 amps 93.15 2
Phone: ( ) I Fax: ( ) 401 amps to 600 amps 135.00 2
Owner installation: This installation is being made on property that I own, which is not Branch circuits - new, alteration, or extension, per panel
intended for sale, lease, rent, or exchange. A. Fee for branch circuits with
service or feeder fee, each 6.75
• branch circuit 2
Owner signature: Date: B. Fee for branch circuits
❑ : APPLICANT • .❑ . CONTACT PERSON without service or feeder fee, 62.25 2
• each branch circuit
Business name: Each additional branch circuit 6.75
Miscellaneous (service or feeder not included)
Contact name:
Pump or irrigation circle 67.50 2
Address: Sign or outline lighting 67 50 2
Signal circuit(s) or limited -
City/State/ZIP: energy panel, alteration, or 1 67.50 2
extension
Phone: ( ) J Fax: ( ) Each additional Inspection over allowable in any of the above
E -mail: Per inspection 1 62.25
- - CONTRACTOR Investigation fee 75.00
ry : ti ,... ,. - '"''CANCELLED PERMIT NOTICE
Business name: R I1- .I 7, e Cancellation of Permit must be at Owner's request; in
Address: 1 � ` �� // f !/"e.... • event of any fee refund, check will be Issued to Owner. -
/ , / A / vii W _ •ELECTRICAL - PERMIT ' FEE3* r,- f •
fil City /State/ZIP: mj, " ice. ;11, ' 9 at c. ,- -7 ` r.
.✓ i I • � 0
Phone: / �' Plan review, if required, 25% o permit fee
CCB lic. No.: r Elec. Bus. lic. N& 0 a State surcharge (8% of permit fee)
E -mail: Metro /City lie. No.: • TOTAL. PERMIT FEE
Supervising electrician. ��•��..�- Su etv i
ising Etc. #: Thls permit application expires If a permit s not obtain
signature, required: i" /�.. within 180 days after it has been accepted as complete•
�� Fee set T Industry Service Board (�
Print name: Ate t. t: Date: l K- Number of er inspections allowed per r permit
x0200+ Internet ol lmna rarmnsl a , Po F, .NRwkaticaleta riod Ap dlanin doe 12129/05
1
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007- 001400
1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/30/2007
Phone: (503) 639 - 4171 , 1
Inspection Requests (24 Hrs.): (503) 639-4175 1 1.
INSPECTION WORKSHEET FOR DATE: 6/25/2008 TIME: 7:00AIVl PAGE: 31
SITE ADDRESS: 15700 SW UPPER BOONES FERRY RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: HOLIDAY INN EXPRESS
DESCRIPTION: Low voltage tor data installation.
OWNER: BHGAH TIGARD, PHONE #: 503 - 5222
CONTRACTOR: MATRIX COMMUNICATIONS PHONE #: 503-513-9152
Inspection Request Scheduled For: Date: 6/25/7003 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 071805 -01 50.513.9152 N
Corrections/Comments/Instructions:
-%
`. PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑
FAIL CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: G ---- b f ®€ Li Date: Phone #: (503) 718- i 4