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Permit � • C ITY OF F TI GARD ELECTRICAL RESTRICTED ENERGY PERMIT �V‘ DEVELOPMENT SERVICES PERMIT #: ELR2005 -00134 '�� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 5/26/2005 PARCEL: 1 S136CD -00600 SITE ADDRESS: 08060 SW PFAFFLE ST 100 ZONING: C - SUBDIVISION: SPRINT PCS WIRELESS MONOPOLE LOT: JURISDICTION: TIG . Project Description: Voice /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: FINKE, ALEX TRUSTEE MILESTONE ELECTRIC FINKE, LOTTE I TRUSTEE 2056 NW ALOCLEK # 411 PO BOX 23562 HILLSBORO, OR 97124 PORTLAND, OR 97281 Phone: Phone: 503- 645 -5323 Reg #: ELE 34 -618C LIC 153480 FEES SUP 2113S Description Date Amount REQUIRED ITEMS AND REPORTS [ELPRMT] ELR Permit 5/26/2005 $75.00 [TAX] 8% State Surcha 5/26/2005 $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 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: P 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 INST LLATION ONLY SIGNATURE OF SUPR. ELEC'N: DATE:. ; L- - N: NO: «5 2 ,<S 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. e etrf - cal Permit it#lion . FOR OFFICE USE ONLY ' J Received 7` -)1 Electrical _ � �� C , \� Date/By: L� U� Permit No.: ( al..a `� aj f gCf ,7 / City of Tigard V�� and Planning Approval Date/By: Permit No.: 13125 SW Hall Blvd. M ` �� Plan Review Other Tigard, Oregon 97223 Date./By: Permit No.: Phone: 503- 639 -4171 FaxG501=3 &� c : ' +� l ow 4 , yid ,, , r� Post-Review ew Land Use Internet: www.ci.tigard.or.ugjj9WiNG '' I li i y: Case No.: - ■ y,. e Contact Jurii.• ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 - Name/Method: �A Supplemental Information. '• 4' T 1 Pg O`' • ` ORK .,,, .. •„:',',:,' .R .'' 1S .11 AN, REVIEW ease check ,all - that a i - n''' ❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility commercial ❑ Hazardous location Addition /alteration/replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet, : E -;4 ;+: :CATEGORY OF CONSTRUCTION 4 . 1 & 2 family dwellings four or more residential units in ❑ 1 & 2- Family dwelling CommerCial/Industrial ❑ System over 600 volts nominal one structure ❑ Building over three stories ❑ Feeders, 400 amps or more ❑ Accessory Building Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park ❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other: '. ' '`JOB SITE INFORMATION and LOCATION ::',,' ` Submit _ sets of plans with any of the above. The above are not applicable to temporary construction service. Job site address O S i� FEE* SCHEDULE '•'Z :.. .°: r_: Suite #: 1 Bldg. /Apt. #: Number of inspections per permit allowed Project Name: Te -f - ,T & o.-"/" Description Qty Fee (ea.) Total 1 New residential- single or multi - family per Cross street/Directions to job site: dwelling unit. Includes attached garage. Service Included: 1000 sq. ft. or less 145.15 4 Each additional 500 sq. ft or portion thereof 33.40 1 Limited energy, residential 75.00 2 Subdivision: I Lot #: Limited energy, non residential 75.00 2 Tax map /parcel #: Each manufactured home or modular dwelling r t - service and/or feeder 90.90 2 '. ' ''," R ;' , DESCRIPTION OF'WORK Services or feeders - installation, ( ( VO 1 c / xtkri.. Ciatja .p ir alteration or relocation: 200 amps or less 80.30 2 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 -° ❑ PROPERTY OWNER : ' 1 .TENANT : : 601 amps to 1000 amps 240.60 2 � + Over 1000 amps or volts 454.65 2 Name: L �'^ Q .�,� . ) n /C —/ , ( o S' Reconnect only 66.85 2 Address: Temporary services or feeders - installation, alteration, or relocation: City /State /Zip: 200 amps or Less 66.85 1 Phone: Fax: 201 amps to 400 amps 100.30 2 401 to 600 amps 133.75 2 PFLIGANI, r,, .� ' ._ 0 CONTACT PERSON .• Branch circuits - new, alteration, or Name: extension per panel: Address: A Fee for branch circuits with purchase of service or feeder fee, each branch circuit 6.65 2 City /State /Zip: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit 46.85 2 Phone: 1 Fax: Each additional branch circuit 6.65 2 E -mail: Misc.(Service or feeder not included): CONTRACTOR Each pump or irrigation circle 53.40 2 Each sign or outline lighting 53.40 2 Job No: S/ 6, c._ Signal circuit(s) or a limited energy panel, Business Name: ( alteration, or extension / Page 2 75 2 /l'Lr �eS Ear°f/^/ �' Description: Address: 400 VI tat /109 t place 5 13? 0 oyj y � � ©r, Each additional inspection over the allowable in an of the above: City /State /Zip: 97 62 Per inspection per hour (min. 1 hour) 62.50 Phone:50 -6,445 Fax so3— , 9 0 - e/e443 Investigation fee: CCB Lic. #: /Sj Lic. #: 3 -( / r ° d • • Supervising electrician ( �- , � � . : Electricatptrrtglt Fees' .. , .. ; r� -Q {: Subtotal $ signature required: e' Plan Review (25% of Permit Fee) $ Print Name / e-- 4 6 1 L-1. #: 4z-r7 $4 Si State Surcharge (8% of Permit Fee) $ TOTAL PERMTT FEE $ Authorized �/� / Notice: This permit application expires if a permit is not obtained within Signature: �' Date: ��2 b 0S 180 days after it has been accepted as complete. /' — �, /� *Fee methodology set. by Tri -County Building Industry Service Board. 6C (Please pri>St name i:\Dsts\Permit Forms\ElcPermitApp.doc 01/03 CITY OF TIGARD ` - .. BUILDING DIVISION PERMIT #: 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: ELR2005-00134 Phone: (503) 639 -4171 � �n d Npu4�� � Cd�(�� � 5/26/2445 Inspection Requests (24 Hrs.): (503) 639 -4175 -_' ` INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 6/1/2005 7:15AM 65 SITE ADDRESS: CLASS OF WORK: SUBDIVISION: 08060 SW PFAFFLE ST 100 LOT #: TYPE OF USE: PROJECT NAME: SPRINT PCS WIRELESS MONOPOLE DESCRIPTION: EMARK Voice/data. OWNER: PHONE #: CONTRACTOR: FINKE, ALEX TRUSTEE, PHONE #: MILESTONE ELECTRIC 503 - 645 -5323 Inspection Request Scheduled For: Date: Pour Time: 6/1/2005 Code # Inspection Description Confirm # Contact # Message 199 Electrical final 008036 -01 503 - 645 -5323 N Corrections /Comments / Instructions: G. F - - e . i l- i j PP / ®V r PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED ( (WI" Inspector: Date: i;A Phone #: (503) 718-