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Permit A 1.7' =CITY OF TIGARD , ELECTRICAL PERMIT PERMIT #: ELC2004 -00817 "i4 DEVELOPMENT SERVICES DATE ISSUED: 12/27/2004 ' IJI 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 - 4171 PARCEL: 2S113AA-01100 SITE ADDRESS: 16584 SW 72ND AVE B -11 SUBDIVISION: OREGON BUSINESS PARK I ZONING: I -L BLOCK: LOT : OOD JURISDICTION: TIG Project Description: (1) branch circuit. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10): SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amp /volt: >=4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: PACIFIC REALTY ASSOCIATES CUPERIINO ELECTRIC INC 15350 SW SEQUOIA PKWY #300 -WMI DBA: CEITRONICS, INC PORTLAND, OR 97224 27350 SW 95TH AVE # 3032 WILSONVILLE, OR 97070 Phone: • Phone: Reg #: LIC 77582 FEES Description Date Amount Required Inspections [ELPRMT] ELC Permit 12/27/200' $46.85 [TAX] 8% State Surcharge 12/27/200' $3.75 Rough -in Elect'I Final Total $50.60 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spe: alty 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 w' ink 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted b the,Ore. on Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of the- rul 's o • ect que tions t. • UNC a .03) 246-6699 or 1 -800- 332 -2344. / Issued By: 1 Permit Signature: 4 / 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:OOpm for an inspection the next business day Electrical $em "' itA� t 1 ED 1012 OFFICE USE ONLY a Cf of Ti and 1 Received n _ �' g �oo� DateB : /� . / y ' t / , 13125 SW Hall Blvd., Tigard, OR 97223 OCC 2 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 UL' /**atr "V���,.�y� Other Permit: iiim � DateB: Inspection Line: 503.639.4175 G ..�1 j ..- c'I I„ Date ReadyBy: 0 See Page 2 for Internet: www.ci.tigard.or.us CI TY pF T I N o tified/Me thod . Supplemental Information I�IVISIO PLAN REVIEW ❑ New construction INtA ition/alteration/replacement Please check all that apply: ❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ❑Hazardous location ❑Service 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 gCommercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure ❑Building over three stories ['Feeders, 400 amps or more ❑ Multi- family 0 Master builder 0 Other: ❑Occupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park ❑Health -care facility ❑Other: Job no.: Job site address: /6)l j Ls 1 L Submit 2 sets of plans with any of the above. City/State /ZIP: The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: \ Project name: TA \ FEE* SCHEDULE \ t"\ \ v , �1� 1>tly■ \ (S Description I Qty. 1 Fee. I Total 1 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 dwelling, service and/or feeder 90.90 2 //DO O. (/f ' AO 4fr1/ / Igo !id Cr C/IC 4'f( Services or feeders installation, alteration, and/or relocation A// .w t�'GK/4 UC ■72, c /A/ ,&e14,1 iv4teG. 200 amps or Tess 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: C2(P ,t O/l /CS- branch circuit B. Fee for branch circuits Contact name: /19442 e /� siec' without service or feeder fee, r 46.85 2 Address: ( 2 ? 3.0 , S4/ .s14c4ve2 .3r51.2 each branch circuit Ea ch add'I branch circuit 6.65 2 City/State /ZIP: j am/ G �y v /(fi / 9 74970 Miscellaneous (service or feeder not included) `� / Pump or irrigation circle 53.40 2 Phone: (S3) S-70 - ,elf/0 $ /0 Fax: : ) ) S -7, 0 _ es Sign or outline lighting 53.40 2 E -mail: / Via ..re4, /Cal 0 ( /G•f'. ©/`'j Signal circuit(s) or limited - CONTRACTOR energy panel, alteration, or extension. Describe: Page 2 2 Business name: CejTd,// / G f Address: a ?ASV S'/ 91 41/e ��02 P additional inspection over allowable in any of the above Per r i nspection 62.50 City/State /ZIP: iv/G.gebr./v /G e 5 ' 7070 Investigation per hour (I hr min) 62.50 Phone: (92 ) S . S I Fax: 072?) S 70 _ 5572 Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* CCB Lic.: Electrical Lic.: / Suprv.Lic.: s'(�s Subtotal y S_ a Suprv. Electrician signature, required: (� d � "' ` Plan review (25% of permit fee) .... 11- : -----71 Print name: /9�9CC2 R / 1 Date: Al � ,. o f/ State surch (8% of permit fee) — ? TOTAL PERMIT FEE4� Authorized signature: t �i 4 Y This permit application expires if a permit is not obtained within 180 Y/"' (/ U /f days after it has been accepted as complete _,-- ( D Print name: 064 .2 J �� 7ce i�yv Date: 42 .. �_O �/ • Fee methodology set by Tri-County Building Industry Service Board � �`-' Number of inspections per permit allowed. i:\Building \ Permits\ELC- PermitApp.doc 12/03 440- 4615T(10 /02/COM/WEB