Permit h
C ITY OF T I GA R D ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2006 - 00070
A '� II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/4/2006
PARCEL: 1 S 126C0 -01403
SITE ADDRESS: 09300 SW WASHINGTON SQUARE RD ZONING: C -G
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Phone & Data.
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:
PNWTG CABLING SERVICES
3000 MARKET ST #541
SALEM, OR 97303
Phone: Contact #: FAX 503- 393 -3800
PRI 503- 393 -3391
Reg #: ELE 29944
FEES LIC 168128
Description Date Amount
Total REQUIRED ITEMS AND REPORTS
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.
Issued By: - 72 - 7, 0 Permittee Signature:
ti
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") o CE V Iectrica, Permit ApoI a FOR OFFICE USE ONLY -
City o Tigard APR 0 4 20 p ed " ,i t.,4( ), 4 ' Permit No e L - 1� ad i i
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
i''.
Phone: 503.639.4171 Fax: 503.598.1960 OF , '' °q ` I ' Date/B . Other Permit
Line: 503.639.4175 CITY U � .^ �� - 1 Date Ready/By. UM El See Page 2 for
Internet: www.tigard- or.gov ITT ITJST
I TO Nobfied/Method. Supplemental Information
_ ._ -DING / 7 ,
- TYPE 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 ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other: ['Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: Job site address: C 22 J J ❑Health - care facility ❑Otherr
f.70 S , L % -r f, i► ? • Submit 2 sets of plans with any of the above.
City/State/ZIP: ��, o 9 72 23 The above are not applicable to temporary construction service
Suite/bldg./apt. no.: Project name: J - FEE* SCHEDULE
J /'
tier / r�n 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
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
/ i dwelling, service and/or feeder 90.90 2
hone. J ll cal._ GG �/� 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,
first branch circuit 46.85 2
Address:
Each add'l branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax:: ( ) Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
. CONTRACTOR - energy panel, alteration, or
extension. Describe: Page 2 2
Business name:
pAi l✓TG- 42. 0.1 0,5 .t, \ on
Address: 30 /'!a/hei ,cot S..,,,At-..4 yl Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/Z)P: leM Or G7 .7 7 30 - Investigation per hour (1 hr mm) 62.50
Phone: (S03 ) 393- 3.q/ / Fax: 3) 393-3 Industrial plant p 7
ELECTRICAL PERMIT FEES*
CCB Lic.: )6g Jag I Electrical Lic.: Zyy LEA Suprv. Lic.: Subtotal '
C 491'
Suprv. Electrician signature, required: �� Plan review (25 % of permit fee)
Print name: � l/, � � e Lc e- k Date: 17 -y State surcharge (8 % of permit fee)
TOTAL PERMIT FEE j 1 G'J
Authorized signature: 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
1 • \BwtdingTermas\ELC- pennnAppdoe 12/30/05 440-4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard ,r
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL .WORK ONLY: _ 1
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:
Ft NIIVIERCIAL 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 \Buddmg\Pamits\ELC- Pmn0App doc 17/10/05
CITY OF TIGARD EL ,
BUILDING DIVISION c PERMIT #a 06 _ 60 0 7 6
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 l r t
Inspection Requests (24 Hrs.): (503) 639 -4175 ' "IL_.
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: 930 t / S O. CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
•
Inspection Request Scheduled For: Date: q- -10 ( Pour Time:
Code # Inspection Description Confirm # Contact # Message
i3S 9 1..,\I. `t 1A 4. ,; u ` 16-- .-7
Corrections /Co nts /Instructions: Q(ZigN . - 5 I-211. b/
f
•
. *s. .
\--.----- PASS 111 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: oil p% Date: 44 7 Iorb Phone #: (503) 718 -1-