Permit CITY TI ® ELECTRICAL PERMIT -
RESTRICTED ENERGY
20/11 DEVELOPMENT SERVICES PERMIT #: ELR2001 -00212
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/27/01
SITE ADDRESS: 14865 SW 74TH AVE 130 PARCEL: 2S112AC -01200
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -P
BLOCK: LOT: 020 JURISDICTION: TIG
Proiect Description: Installation of data telecommunications.
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:
KNHS DEVELOPMENT CO PAVELCOMM INC
26262 S MERIDIAN RD 1640 NW 14TH AVE
AURORA, OR 97002 PORTLAND, OR 97209
Phone: Phone:
Reg #: ELE 26- 559CLE
LIC 00063963
FEES Required Inspections
Type By • Date Amount Receipt Low Voltage Inspection
PRMT CTR 8/27/01 $75.00 2720010000 Elect'l Final
5PCT CTR 8/27/01 $6.00 2720010000 EXPIRED
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 -0080. You may obtain copies of th- .e r lu es • .'rest qt stions to OUNC at (503)
246 -1987.
Issued by i 4•P - ' Permittee • i • n tur /�
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. ELECN: DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an insp . V b '- c' I ext business day
ElectricalPerinitApp • n
' A
Date received: , 27 D/ Permit no.:� /. a 2/ 2,
, ?,!,„ City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 722 Date issued: B ,, Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
D 1 .. , Commercial/industrial
❑ N� constru d on lling or accesso ' �; ddion/alraon/re lacement ❑Other ;family El Tenant improvement
accessory �LJA
p ❑ Partial
' - ' . ti ' . a• , d , .: JOB SITE INFORMATION
J 8 &5 .
Job address: 5. . i� Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision: i -
Project name: L cyE- J 7 SEZIO 4 Description and location of work on premises: U Y i_Q f w i
Estimated date of completion/inspection:
CONTRACTOR APPLICATION 'r '' FEE. SCHEDULE, ., ' ,
Job no: a Fee Max
Business name. Description Qty. (ea.) Total no. insp
Adder : l , 0 M l New residential - single or multi-family per
dwelling garage.
unit. Includes attached
IWO b L A • BMA ZIP: imam Service included:
..%- o .. - -fir �i► /�im � E -mail: 1000 sq. ft. or less 4
►�
CCB no.: � IN � y� Each additional 500 sq. ft. or portion thereof __
, Elec. bus. lic. no: _J Q _—
Limited energy, residential ___ 2
Cit /metro lic no •
� � / Limited energy, non - residential ___ 2
Each manufactured home or modular dwelling
nature of supervising electrician (r• . •. ► : - Service and/or feeder ■■. 2
. S Services or feeders — installation,
Sup- elect name (print •
G tr ��
la
alteration or relocation:
200 amps or less 2
Name (print): 201 amps to 400 amps _—_ 2
401 amps to 600 amps ___ 2
Mailing address: 601 amps to 1000 amps ___ 2
City: State: ZIP: Over 1000 amps or volts ___ 2
Phone: Fax: E -mail: Reconnect only ___ 1
Owner installation: The installation is being made on property I own Temporary services or feeders - -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps ___ 2
Owner's signature: Date: , 401 to 600 amps ___ 2
ENGINEER Branch circuits - new alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: ■S 2
Phone: Fax: E-mail: Each additional branch circuit: __
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle ■■ ■ 2
❑ Service over 320 amps- rating of I &2 ❑ Hazardous location Each sign or outline lighting ___ 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
0 System over 600 volts nominal more residential units in one structure alteration, or extension* �■ 2
❑ Building over three stories 0 Feeders, 400 amps or more *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lightingplan ❑ Other: Per inspection __ --
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not alt jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ _.5 ►
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ - -�
Expires TOTAL $
accepted as complete.
Name of cardholder as shown on credit card $ EXPIRED .
Cardholder signature Amount 440 -4615 (6 /00 /COM)
Electrical Permit Fees: Limited Energy Permit Fees:
Number of Inspections per permit allowed
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Service included: Items Cost Total 4
4a. Residential - per unit Restricted Energy Fee $75.00
1000 sq. ft. or less $147.15 4 (FOR ALL SYSTEMS)
•
Each additional 500 sq. ft. or
portion thereof $33.40 1 Check Type of Work Involved:
Limited Energy $75.00
Each Manutd Home or Modular - ❑ Audio and Stereo Systems
Dwelling Service or Feeder $90.90 2
4b. Services or Feeders Burglar Alarm
Installation, alteration, or relocation ❑
200 amps or less $80.30 2 Garage Door Opener'
201 amps to 400 amps $106.85 2
401 amps to 600 amps $160.60 2 0 Heating, Ventilation and Air Conditioning System'
601 amps to 1000 amps 5240.60 2
Over 1000 amps or volts $454.65 2 Vacuum Systems'
Reconnect only $66.85 2 •
4c. Temporary Services or Feeders Other
Installation, alteration. or relocation
200 amps or less $66.85 2 TYPE OF WORK INVOLVED - COMMERCIAL ONLY
•
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Fee for each system $75.00
Over 600 amps to 1000 volts, (SEE OAR 918 - 260 -260)
see "b" above.
4d. Branch Circuits Check Type of Work Involved:
New, alteration or extension per panel ❑
a) The fee for branch drcuits Audio and Stereo Systems
with purchase of service or
feeder fee. n Boiler Controls
Each branch circuit $6.65 2
b) The fee for branch circuits ❑ Clock Systems •
without purchase of service . _
or feeder fee. Data Telecommunication Installation
First branch circuit $46.85
Each additional branch circuit 56.65 ❑
Fire Alami Installation
•
4e. Miscellaneous
(Service or feeder not included)
•
HVAC
Each pump or irrigation cirde 653.40
Each sign or outline lighting 653.40 Instrumentation
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑
Minor Labels (10) $125.00 Intercom and Paging Systems
•
4f. Each additipnal inspection over ❑ Landscape Irrigation Control'
the allowable in any of the above
Per inspection 562.50 n Medical
Per hour 562.50
In Plant _ $73.75
r7 Nurse Calls
5. Fees:
5a. Enter total of above fees $ Outdoor Landscape Lighting`
8% Surcharge (.08 X total fees) $
Subtotal $ n Protective Signaling
5b. Enter 25% of line 5a for
Plan Review it required (Sec. 3) $ n Other
Subtotal $
Number of Systems
❑ Trust Account # • No licenses are required. Licenses are required for all other installations
Total balance Due $
FEES:
ENTER FEES $
•
8% SURCHARGE (.08 X TOTAL ABOVE) $
•
TOTAL $
•
•
. 03/26/2009 17:23 5032230104 PAVELCOMM PAGE 02
i I FY
Is
711 Q Community Development
.1:6°
OAR 21 2009
'II Cr A I- D Request for Permit Action CM 0f TIGARD
•
g0112°M DIVISION
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 SW flail Blvd., Tigard, OR 97223
Phone: 503 - 718.2430 Fax: 503.598.1960 www.tigard- or.gov
•
FROM: ❑ Owner ❑ Applicant txf Contractor ❑ City Staff
(check one)
T..
REFUND OR Name:
INVOICE TO: (Bu5ine5a ot. Individual) Pave) c,o m viA
Mailing Address: I (p (1.0 nw by, kV._
City /State /Zip: R>AtC 'l C . V- GO 2,0
Phone No.: j 223 5D(D
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): y 10 0 I i -
CANCEL PERMIT APPLICATION. � 6
REFUND PERMIT PEES (attach receipt, available). ll�l
( pt, salable). � � (�
El I NVOICE FOR FEES I
INVOICE DUE (attach. case fee schedule and explain, below). Q 1� �
El REMOVE CONTRACTOR FR QM PERMIT (do not cancel .`F
Q ( at ancel peroatt). G �
,( fi e
Permit #: C LI 1O01 — 0021 2, o
l'!'
Site Address or Parcel #: 2 S I L 2AL, -01200 VP V / V
ti ra 0 F aL m r'pj n �� `�
Project Name:
1 S C� Yj c a h 4 .� y ,So z f
Subdivision Name: Lot #: 6 2 0 p" La _,. 14 5
EXPLANATION: LC V)O I ' 7. Yi/1 0 I Qj T VAZ * a . - •
Signature: CUXY s r`QA 1.— Date: 3/20/
Print Name: ai rn L l" a,vc,1 •
llatunslEnliGy
1. The Director or Building Official may authorize the refund of
a) any fcc which was erroneously paid or collected.
b) not mote than 80% of the land use application fee when an application is withdeuwn or canceled before any review effort has been expended.
c) not more than 80% of'the land use application fce for issued permits,
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended,
c) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payet M. the same method in which. payment was received. Please allow 1 -2 weeks for processing refunds.
Rte to Sys Admin: Date, '.7 y& Rte to Bldg Admire Date By
Refund Processed: Date y Invoice Processed: Date By
Permit Canceled: Date By Parcel Tag Added: Date By
Recent # Date Method Amount $
I:\BuildinR \ Forms \RcqPertnitAction.doc Rev 07/26 /07
A i Roo/ eO00000000 553/
.. •
14 CITY OF TIGARD RECEIPT
J I 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
T [GAR.D
Receipt Number: 27200100000000003531 - 08/27/2001
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELR2001 -00212 [TAX] 8% State Tax 100 -0000- 207020 $6.00
ELR2001 -00212 [ELPRMT] ELR Permit 220 - 0000 - 431510 $75.00
Total: $81.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check TAAA CONV 08/27/2001 $81.00
Payor:
Total Payments: $81.00
Balance Due: $0.00
•