Permit CITY TIGARD � DEVELOPMENT SERVICES ELECTRICAL PERMIT -
13125 SW-Hall Blvd., Tigard, OR 97223 (50,3)639-4171 RESTRICTED ENERGY
' PERMIT #: ELR99 -0040
DATE ISSUED: 03/04/99
PARCEL: 1S135AB -00100
SITE ADDRESS...:10255 SW 90TH AVE
SUBDIVISION .TOWN OF METZGER ZONING:R -4.5
BLOCFC ... . ... ....: LOT :005 JURISDICTN: TIG
Project Descri pt ion : Installation of data telecommunications system.
A. ' RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO...: AUDIO & STEREO..: INTERCOM & PAGING..:
BURGLAR ALARM • BOILER • LANDSCAPE/ IRRI GAT. .:
GARAGE OPENER : . 1 " 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: FEES --
TIGARD- TUALATIN SCHOOL DIST 23 type amount by date recpt
13137 SW PACIFIC HWY M l PRMT $ 40.00 DEB 03/04/99 99- 313439
TIGARD OR 97223 -0060 5PCT $ 2.00 DEB 03/04/99 99- 313439
Phone #: 503-620-1620
Contractor: -•
OPTEC INC. $ 42.00 TOTAL
7324 SW DURHAM RD
REQUIRED INSPECTIONS
PORTLAND OR 97224 Low Voltage Insp
Phone #: '639 -2871' Elect' 1 Final .
Reg #..: 64137
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. 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 rule adopted by the
Oregon Litt' y No.tific ion Center. Those rules are set forth in OAR 952 -001 -0010 through OAR 952 -''1- 0080. You may obtain copies of
these r es or dire qu ti to t at� (503)2 -1987.
Issue by ( / _���td'I�� Permittee Signatu
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for
sale, lease, o,r rent.'
OWNER'S SIGNATURE: , DATE:
/ CONTRACTOR INSTALLATION ONLY
.SIGNATURE OF UPR. , ELEC' N: DATE:
i
LICENSE ( NO: t i
++++++++++++++++++ C+++++++++++++++++++++++++++++-+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 - 4175 by 7:00 P.M. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD Electrical Permit Application Plan Cr -ck #
` 13125 SW HALL BLVD. Rec'd By , _ WI
I Date Recd ` a
TIGARD OR 97223 q. Date to P.E. Phone (503) 639 -4171, x304
■ Print or Type UP Date to DST -
_-
Inspection (503) 639 -4175 Incomplete or illegible w 11 not be accepted Permit# g/_/z ?9- tX�ye7
Fax (503) 684 -7297 Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development /04:75 .5 - 9c) Number of Inspections per permit allowed
Sti►foe'e-
Name (or name of business) 77_ - //7 e .v4sr, Service included: Items Cost Sum
I
Address /3/ 3 7 S`-' S'A G' i 14" /C 7iiov y 4a. Residential - per unit
City /State /Zip 7 6,-7 , / •� . 77 2 2.. u Each additional it or less sq. $11 0.00 4
Each additional 500 s ft. or
Commercial l Residential El portion thereof $25.00 1
Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all current licenses) 4b. Services or Feeders
Electrical Contractor 0, /i✓ z Installation, alteration, or relocation
200 amps or less $60.00 2
Address 7 3z' - 1 5z,..) .k - ,6 d< 0 201 amps to 400 amps $80.00 2
City 776.4. State O Zip 9 71 2._'Y 401 amps to 600 amps $120.00 2
Phone No. • 948-9 3 7 5 601 amps to 1000 amps $180.00 2
Job No. A q4/8 Over 1000 amps or volts $340.00 2
• Elec. Cont. Lice. No. 3V - 2.8 6 Exp.Date Reconnect only $50.00 2
OR State CCB Reg. No. GV' 3'7 Exp.Date S - 30 - 0 0 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date Installation, alteration, or relocation
200 amps or less $50.00 2
,
201 amps to 400 amps $75.00 2
Signature of Supr. Elks - - - -. 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. .S+' -' ' 30f33 Exp.Date /6/99 see "b" above. J
Phone No. 5' 72 - .2s y 7
4d. Branch Circuits
-
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circuit $5.00 2
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee.
First branch circuit $35.00 2
The installation is being made on property I own which is not Each additional branch circuit $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00 2
3. Plan Review section (if required):* Signal circuit(s) or a limited energy //
bolo
panel, alteration or extension / $40.00 7 lJ 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units in one structure 4f. Each additional inspection over
Service and feeder 225 amps or more the allowable in any of the above
System over 600 volts nominal Per inspection $35.00
Classified area or structure containing special occupancy Per hour $55.00
as described in N.E.C. Chapter 5 In Plant $55.00
* Submit 2 sets of plans with application where any of the above apply. 5. Fees: /jy
Not required for temporary construction services. 5a. Enter total of above fees $ � �
5% Surcharge (.05 X total fees) $ '
NOTICE Subtotal $
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY '/^ pO
TIME AFTER WORK IS COMMENCED. ❑ Trust Account #
Total balance Due $
•
.. --1'� r l/l t� 4i G - ice`
a
I: \DSTS \ELC96.APP Rev 9/96
Page No. 1 CASE HISTORY FOR CASE NO.: ELR99 -0040
TIGARD - TUALATIN SCHOOL DIST 23
10255 SW 90TH AVE
03/26/99
Action Description Req/ Schd/ End/ Action Notes Disp Dy Update Upd
Code Sent Done Done Date By
ELRC001 Application Received / / / / 03/04/99 RECD DEB 03/04/99 DST
ELRC003 Permit Created / / / / 03/04/99 DONE DEB 03/04/99 DST
ELRCS00 (F) Issue permit / / / / 03/04/99 DONE DEB 03/04/99 DST
ELRC725 Low Voltage Inspection / / / / / / 03/04/99 DST
ELRC799 Elect'1 Final / / / / 03/05/99 data PASS CD 03/05/99 CD
ELRC800 Case finaled / / / / 03/08/99 03/08/99 VLN
•
1