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Permit • CITY OF ' GA R D ELECTRICAL PERMIT - RESTRICTED ENERGY 1I1n DEVELOPMENT Tigard, (503) 639 -4171 DATE PERMIT ELR2004-00003 13125 SITE ADDRESS: 12323 SW 66TH AVE PARCEL: 2S101AA -06400 SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: C -G BLOCK: LOT: 024 JURISDICTION: TIG Project Description: Installation of (3) voice /data drops. Job No. 104100 -10101 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: DICK SOUTHARD DYNALECTRIC 20400 NE 122ND ST 2904 SW FIRST AVE. BRUSH PRAIRIE, WA 98606 PORTLAND, OR 97201 Phone: 360 - 256 -5764 Phone: 503 - 226 -6771 Reg #: MET 00002545 LIC 066793 SUP 4817S FEES ELE gegliVed Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 1/12/04 $75.00 Elect'I Final [TAX] 8% State Surchart 1/12/04 $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 fo ru e 'opted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throuc Iss ed by _.� :. . '- Permittee Signature jla i � 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 JRN 12 2004 10:32RM DYNRLECTRIC 503 226 7720 p.2 . a Electrical Permit Application ` ' 7 M Datereceived: / fz, "' Penult no.: R. ,, . r > >, � • � of Tigard Projcct/appl.no.: "`�daoe: City of Tigard Address: 13125 SW Hall BIv4, B • ; 97223 Date issued: Em Receipt no.: Phone: (503) 639 -4171 jA 1 Z 2004, Fax: (503) 598 -1960 Case file no.: Payment type: Land Lisa approval: ow OF TI D :. W , , ` . T11 I., oi PLI i 11 ,* 0 1 & 2 family dwelling or accessory Commercial/industrial 0 Multi - family 0 Tenant improvement construction 0 New s� n/alteration/replacement 0 Other , 0 Partial Ala 2 1 ::.1`',:-':.":' 4 l+ +: .. =. A r ho . IOB SfI E INFORMATION : ' Job address: . _ - � ... / � � � _ ,;" Bldg. n Suite no.: Tax map/tax lot/account no.: Lot Bloc.: Subdivision: Project name: i.._,Iii .. � scdption and location of work on premises: 6 - p ' , i u• _ r 4, .,e. / j Estimated date of completion/inspection: J r s' - (:ONTRACTOIt API'LI[:A 1 ION FEE SCIILUt11 I ': ` _ : /6•Z, f d — /Q c / , Total as j . Business name: /-)p i e____ Nenres l- Angle°multi-badly per Address: a :. qp // 51,) � anellbagmat. Inchdes attached garage. Ci � 0 1S - I ZIP: 97eA 40 1 sexvlmladnded: 4 Phone: Fax y . a E-mail: 1000 >� ft. or less f • , � u s. lie. no: .� � �1� Each additional Soo sq. ft or portion thereof CCB no.: , , !MIN ec. su r . c Lin�itedenergy,r�idenQal 2 • etro lic. no.: e ; Limited energy,non-residential MI 2 diiM iii► r i Each manufactured home or modular dwelling [ � Servicaand/or feeder 2 feeder Signature o supervising electric • requi •) Date / /o ! Services or or f e en — Insfal latioty Sup. elect name (prints d v Ucense no: 5 _ alteration or relocadon: `" i - : PROPCRTY:o1✓Ni;Lr , 2oo ampso r l ess 2 201 amps to 400 amps 2 Name (print): 401 amps to 600 amps 2 Mailing address: 601 amps to 1000 amps 2 City: 1 State: J ZIP: Over 1000 amps or volts • 2 Phone: Fax: 1E-mail: • Temporary services or feeders - Reconnect only 1 . Owner installation: The installation is being made on property I own installation, alteration,orrelocation: which is not intended for sale, lease, rent, or exchange according to ' 200 amps criers 2 ORS 447, 455, 479, 670, 701. 201 amps to 400 amps II 2 Owner's signature: Date: 401 to 600 am s 2 s } ) :;. ' ENGIN EI R _: r ora nch circuits new, alteration, Name: A. Fee for brancbdre itawithpurchaseof Address: service or feeder fee, each branch circuit 2 ZIP: B. Fee for branch circuits without purchase City: State: • of service or feeder fee, first branch circuit: III 2 • Phone: Fax: E-mail: Each additional branch circuit•. ME i"1 `.' ItLVI'FW:(Please check all that apply); Misc. (Service or feeder not tncbuded): 0 Health-care Eaeh pump or irrigation circle 2 D Serervice over 2TS amQs�ortnrtercial facility . Each sign or outline lighting 2 0 Service over 320 amps-rating of 1&2 0 Hazardous location Signal eircoit u limited ewer anal, family dwellings 0 Building over 10,000 square feet four or final () or a W' p � 7 2 0 System over 600 volts aominat more residential units in one structure alteration, or extension* 0 Building over three stories 0 Feeders, 400 amps or more *Description: o Oompant load over99 persons 0 Manufactured structures or RV park Each additbnml inspection over the allowable in any of the above: 0 Egress/lightingplan 0 Other: Perinspection 1 i i I Submit — sets of plans with any of the above. investigation fee The above are not applicable to temporary construction service. Other l t cation Permit fee $ 7.1. N ali Jud erious accept credit cards, please call )uds ; Aron for more informal= ' N o ti ce: This p ermit app expires if a permit is not obtained Plan review (at _ %) $ visa ❑ Mss " • . 4 within 180 days after it has been State surcharge (8 %) $ 041 . r 1 _ xn a • Expires accepted as complete. TOTAL $ 1./ Name • • • • der as `• own• i... t card . S J ., ♦ carT s -r7— Amouat 440.4615 (&00 /COM) CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION . Business Line: (503) 639 -4171 MST / BUP Received X2-7 8 1 '{(o D ate Requested ` -2 C -b 41f AM PM BUP Location /2,51 _ dad Suite // MEC Contact Person 2a . Ph ( � gq9 -4/ 07 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner 4 ; ELC Footing Foundation ELC Ftg Drain Access: LR - ��� Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL - • e UG /Sla• 'Low Voltage v G 6 c ILC O - G lag .r• —421) E J Fire i e 1 Final ❑ Reinspection fee of $ • required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL SITE ❑ Please call for reinspection RE: .Unable to inspect — no access Fire Supply Line A Date oach/Sidewalk -6 Inspecto _ / /�i�# Ext PP / Other: Final DO NOT REMOVE this inspection record rom the • b site. PASS PART FAIL