Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
4 DEVELOPMENT SERVICES PERMIT #: ELR2004 -00208
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/15/2004
SITE ADDRESS: 09020 SW WASHINGTON SQUARE RD 350 PARCEL: 1S126BC-01506
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
•
Project Description: Installation of voice /data wiring.
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:
WYSE INVESTMENT SERVICES CO. T & L COMMUNICATIONS INC
111 SW 5TH AVE. STE. 1100 PO BOX 87387
PORTLAND, OR 97204 VANCOUVER, WA 98687 -7387
Phone: 503- 294 -0400 Phone: 360 - 737 -9725
Reg #: LIC 67787
ELE 37- 428CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 7/15/2004 $75.00 Elect'I Final
[TAX] 8% State Surchart 7/15/2004 $6.00
Total $81.00 v
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 fol es adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
thro OAR 952-651-0100. Y. may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
Is ed by k_ 4 / /G„./7'. > 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
ElectricA1 Permit Application FOR OFFICE USE ONLY
City of Tigard • Received
13125 SW Hall Blvd., Tigard, OR 97223 DateB : 7�� Permit No.: ,,e" Ot '
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 �� "s Np:' D : Other Permit:
Inspection Line: 503.639.4175 I Date Ready/By: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: MI Supplemental Information
R µ ., TYPE OF WORK PLAN REVIEW
❑ New construction %Addition /alteration/replacement Please check all that apply:
El Demolition ❑ Other ❑Service over 225 amps, comm'l ❑Haaardous location
0 Service over 320 amps – rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION a. , of I- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling . Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder CI Other: ['Building over three stories ['Feeders, 400 amps or more
['Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION �� - ❑Egress /lightingplan RV park
Job no.: Job site address: � Q SW 64511;+, 1 hi-le c3 ❑Health -care facility ['Other: 90
412 - S 41 Si0 Submit 2 sets of plans with any of the above.
°1 y arc! , �, - ci ?� .3 The above are not applicable to temporary construction service.
T'
t .�
FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name: a $ F14 "r) * /a CO t( eription I Qty. 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'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
_ >n, ,,,,,„ >,,k, k :t- ;ea_,�.M,_ , -- Each manufactured or modular
3(9 )1-e. � L o � / dA f d'(OP5 dwelling, service and /or feeder 90.90 2
{ rl // Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
e 201 amps to 400 amps 106.85 2
PROPERTY O 11 TENANT 401 amps to 600 amps 160.60 2
7
Name: vv d E 66 V t ,77 N rS 601 amps to 1,000 amps 240.60 2
Address: /1/ (.0 0 & 4f �' /a9
Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP' 7 �� 7 � �/ Temporary services or feeders installation, alteration, and/or
Phone: ( ) a9L.f — D C(DO Fax ( ) T relocation
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
El APPLICANT El CONTACT PERSON A. Fee for branch circuits with
or feeder fee, each 6.65 2
Business name: branch circuit
Contact name: B. Fee for branch circuits
without service or feeder fee, 46.85 2
Address: each branch circuit
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-
? ~s A Ii _` ° energy panel, alteration, or eio
extension. Descri e: / Page 2 75 2
- A 1 + L (....0m",(441" f_A o el 5 Vor ff / , #9- '1- _
?SOD N � � Each additiodal inspection over allowable in any of the above
Per inspection 62.50
)`u?► (D CAller 1)4 98 lib( Investigation per hour (i hr min) 62.50
- ? 7- 7 .5 Fax: ( ) Industrial plant per hour 73.75
` ELECTRICAL PERMIT FEES*
7 g 7 . y 4.4.E Suprv. Lic.: Subtotal 4'U
�
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee) 6.00
TOTAL PERMIT FEE S . , O
-1 `/) .,5,„/� This permit application expires if a permit is not obtained within 180
i - days after it has been accepted as complete
„ „ • a5a w SLrea Da w:rf !I -)- 6' O • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
is\ Building \Permits\ELC- PemlitApp.doe 12/03 440- 4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
•
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
is \ Building \Permits\ELC- PermitApp.doc 04/03