Permit { 4 CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 -00009
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/10/2008
PARCEL: 2S113AB -00300
SITE ADDRESS: 16037 SW UPPER BOONES FERRY RD 300 ZONING: I -L
SUBDIVISION: FANNO CREEK PLACE LOT: JURISDICTION: TIG
PROJECT: PROFESSIONAL LIABILITY FUND
Project Description: Low voltage for 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:
INSTRUMENTATION: OTHER: SECURITY X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
OPUS NORTHWEST LLC BERGELECTRIC CORP
1500 SW FIRST AVE SUITE 1100 6026 NE 112TH AVE
PORTLAND, OR 97201 PORTLAND, OR 97220
Phone: 503 -916 -8963 Contact #: PRI 503- 255 -1818
FAX 503- 255 -1919
FEES Reg #: ELE 37 -682C
LIC 110521
Description Date Amount SUP 5121S
[ELPRMT] ELR Permit 1/10/2008 $75.00
[TAX] 12% State Surch 1/10/2008 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
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 questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: _ A 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 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.
•
El Permit Appl a s fin ; ' G , FOR OFFICE USE ONLY
City Of Tigard Received iii 0 /Oil 8 Permit Nia g anq
1, - . 13125 SW Hall Blvd , Tigard, OR 9724 1 u 2UUti Plan Revte
Phone. 503.639.4171 Fax 503.598 X060 Date/B Other Permit
T I GARD Inspection Line. 503 639.41 5 ��1 1 Ug' ilk r t' �.• Date Ready /By. Suns ® See Page 2 for
Internet: www tigard or.gov N^ *�,� Notified/Method Supplemental Information
K "t " ;'?`� ®.., - .. ' - P L A N:REVIEW •,' , , e�, n
Ne W construction ❑ Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below)
❑ Service or feeder 400 amps or more ❑ Building over three stories
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
' - . • CATEGORY OFeCONSTRUCTION ' - •;:; : ', , i exceeds 10,000 amps at 150 volts or ❑ Floating buildings
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 - and 2- family dwelling ❑ Commercial /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•' ;, :.
'. 0 Addition of new motor load of ❑ "A "E", "I- 2 ". 'I -3",
I OOHP or more occupancy.
❑ P
Job no.: 10300 �(l, �7 5ly — Job site address: /� ' / e r OO/ta_ I U'1 / �, Recreational vehicle parks
❑ Six or more residential units.
City/State /ZIP: f q t ❑ Health - care facilities. ❑ Supply voltage for more than
i 1 � � J ( 1 / ❑ Hazardous locations 600 volts nominal.
Suite /bldg. /apt. no.: ✓ Project name: _ ❑ Service or feeder 600 amps or more
. — :-,:ut.•' _ II I A . , FEE- SCHEDULE 4' i;` •.'
Cross street directions to job site: , � 1 "- � �� er; - CE'1!®
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'I 500 sq. ft or portion 33 40 I
Tax map /parcel no.: Limited energy, residential
... :DESCRIPTION OF' WORK - `t " ,: , (with 75.00 2
•; - with above sq fl.)
Limited energy, multi - family 75.00 2
C L TY residential (with above sq. fl )
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
_ ' • - PROPERTY• :OWNER•`.`: - ;I l: ,.'t0:TENANT`, ° :' f;;; 201 amps to 400 amps 10685 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
h 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
Branch circuits — new, alteration, or extension, er panel
Owner signature: Date: A Fee for branch circuits with
' ®; /APPLICAIyT ,'; , `:I ' -CY CONTACT: PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: Bergelectric Corp. B. Fee for branch circuits
without service or feeder fee, 46.85 2
Contact name: �yP. N• first branch circuit
Each add'I branch circuit 6 65 2
Address: 6026 NE 112th Ave.
Miscellaneous (service or feeder not included)
City/State/ZIP: Portland, OR 97220 Each manufactured or modular 9090 2
dwelling, service and/or feeder
Phone: ( ) 503 -255 -1818 Fax: : ( ) 503 - 255 -1919 Reconnect only 6685 2
E -mail: ulcui/Kj fC�tj pioric hA Pump or irrigation circle 53.40 2
,/ ''.,:',..14.'S.1. r . 53 40 2
,, �� ;, CONTRAC d'OR . -,. .':r.'_ r , . ,:f��" •1 i . ;,,,;, Sign or outline lighting
Business name: Signal circuit(s) or limited -
Bergeleetric Corp. energy panel, alteration, or
Address: extension. Describe. 1 Page 2 75 0 2
6026 NE 112th Ave_ I
C ity/State /ZIP: Portland, OR 97220 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) 503-25 I Fax ( ) 503 q 1 9 Investigation per hour (1 hr min) 62 50
CCB Lic.:1 1 0 5 21 Electrical Lic.: 37_68 S ' ic.: 47 2/5 Industrial plant per hour 73.75
("--- • „- ; ELECTRICAL PERMIT'FEES • . •
!
Suprv. Electrician signature, required: Subtotal: 7.5 0
I Date: �— i - Plan review (25% of permit fee):
Print name:
, AV_ ► ; . . 401.11g1111 /D — /IBS State surcharg of permit fee): ,OD
Authorized signature: TOTAL PERMIT FEE.
This permit application expires if a permit is not obtained within 180
Print name. Date: days after it'has been accepted as complete.
• Number of inspections allowed per permit q/�
i \Building\Permits\ELC- PermitApp doe 0523/06 440-4615T(1 I /05 /COM/WEB (/
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2008.00009
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/10/2000
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 . • 1!,.
INSPECTION WORKSHEET FOR DATE: 9/15/2008 TIME: 7:00Aidi PAGE: 22
SITE ADDRESS: 16037 SW UPPER BOONES FERRY RD 300 CLASS OF WORK:
SUBDIVISION: FANNO CREEK PLACE LOT #: TYPE OF USE:
PROJECT NAME: PROFESSIONAL LIABILITY FUND
DESCRIPTION: Low voltage for security.
OWNER: OPUS NORTHWEST 1.LC, PHONE #: 503 - 8963
CONTRACTOR: BERGELECTRIC CORP PHONE #: 503
Inspection Request Scheduled For: Date: 9/15/2008 Pour Time:
Code # Inspection Description (C nfirm # Contact # Message
199 Electrical final 07 1 -01 503 -849- 8478 N
4
Corrections /Comments /Instructions:
(PE4\1 CAN 5crE
•
(-\\
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G W68LE Date: Q 151 Phone #: (503) 718- 1
l