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Permit CITY TI GARD ELECTRICAL RESTRICTED ENERGY PERMIT DEVELOPMENT SERVICES PERMIT #: ELR2005 -00183 e �'l l 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/11/2005 PARCEL: 1S135BA-03302 SITE ADDRESS: 10520 SW CASCADE AVE ZONING: I -P SUBDIVISION: OFFICE DEPOT LOT: JURISDICTION: TIG Project Description: Install limited energy for 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: MARX, ERNEST L + BARBARA R 3D ELECTRICAL SERVICES INC TRUST PO BOX 173 2140 VELOZ DR OREGON CITY, OR 97045 SANTA BARBARA, CA 93108 Phone: Phone: 503 657 - 9173 Reg #: ELE 3 -460C LIC 135234 FEES SUP 4478S Description Date Amount REQUIRED ITEMS AND REPORTS [ELPRMT] ELR Permit 7/11/2005 $75.00 [TAX] 8% State Surcharl 7/11/2005 $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 start- • - :0 days of issuance, or if work is suspended for more than 180 days. ATTE ON: Oregon law requires ye. to follow rules :.opted • the Oregon Utility Notification Center. Those r are s- i OAR 952 - 001 -0010 t rough OAR 952 -00 -I S O. • may obtain copies of these rules or dire questio OUN' at 46 -6699. I- sued By: / / 41_,A4_,.. ' - Permittee Signature: z t!� 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 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. Electrical Permit Application 1 ioi OFFICE US ONLY ' City of Tigard Dale /B Na W�'1 Perm „ Permit No.: 1.0 = 00 d • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 / /rey. i ;;�1 W . Date/B Other Permit: Inspection Line: 503.639.4175 1 r-' I Date Ready/By: MI H See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction Addition/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 ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi- family ❑Master builder ❑Other: ❑Building over three stories ❑Feeders, 400 amps or more ❑Occupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION . ❑Egress/lighting plan RV park • Job no.: Job site address: /06;2 6 c: C4 C` c/ ,mot ` ❑Health -care facility ❑Other: Submit 2 sets of plans with any of the above. City /State/ZIP: The above are not applicable to temporary construction service. • FEE* SCHEDULE Suite/bldg. /apt. no.: Project name: t c e Depo Description I Qty. I Fee. I Total I ** 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. Well 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 Tax map /parcel no.: Limited energy, non - residential 75.00 2 ,DESCRIPTION OF WORK Each manufactured or modular dwelling, service and/or feeder 90.90 2 ,t//►7 / 7 �iI'/e /'� �/h 5 l Services or feeders installation, alteration, and /or relocation W / 200 amps or less 80.30 2 ❑ PROPERTY OWNER ' ❑ TENANT 201 amps to 400 am 106.85 2 401 amps to 600 amps 160.60 2 Name: � C -/ / ,� (7 r /I e S 7 601 amps to 1,000 amps 240.60 • 2 Address: /y(91 f� e /C.4 7), Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City / State/ZIP: s G / � 'r r / �4 C r ( O 9 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 ❑ CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each 6.65 2 Business name: 3_,D T 4 . /, r l - c , branch circuit ../ / B. Fee ou service circuits Contact name: �Q ,/ 7 without service or feeder fee, /? ,49 '"� / 3 each branch circuit 46.85 2 Address: Q �� / Each add'1 branch circuit 6.65 2 • � City /State /ZIP: W J / err/ ©e 6? E `� Miscellaneous (service or feeder not included) $) 5 C—/ � ( ) Pump irrigation circle 53.40 2 Phone: Fax: Sign or r outline lighting 53.40 2 E -mail: f� Signal circuit(s) or limited - . ' CONTRACTOR energy panel, alteration, or stwaizt. DescrAbe: _ Page 2 2 Business name: ,(..14- Address: Each additional inspection over allowable in any of the above ' Per inspection 62.50 City /State /ZIP: Investigation per hour (1 hr min) 62.50 Phone: ( ) Fax: ( ) Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* CCB Lic.:/ /2306 Electrical Lic.:, r, ZE,. Suprv. Lic.: SCrnl (' Subtotal 75 ,47a Suprv. Electrician signature, required: 41,--4: . , Plan review (25% of permit fee) // Print name: Zia ry�i !. Date: �� O State surcharge (8% of permit fee) S TOTAL PERMIT FEE !!1 O Authorized signature: permit application expires if a permit is not obtained within 180 - �/ days after it has been accepted as complete Print name: Vr4 as ry / Date: • Fee methodology set by Tri- County Building Industry Service Board • I •• Number of inspections per permit allowed. i:\ Building \Permits \ELC- PermitApp.doc 12/03 440.4615T(10 /02/COM/WEB Electrical Permit Application - City of Tigard 1 Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: : :RESIDENTIAL WORK ONLY: . • Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* El Burglar Alarm El Garage Door Opener* El Heating, Ventilation and Air Conditioning System* El Vacuum Systems* El Other: COMMERCIAL, WORK ONLY 7.. 1 Fee for each commercial system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: • ❑ Audio and Stereo Systems • El Boiler Controls ❑ Clock Systems • Data Telecommunication Installation El Fire Alarm Installation _ ❑ HVAC • ❑ Instrumentation El Intercom and Paging Systems ❑ Landscape Irrigation Control* El Medical • ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling _ - ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations is \BuildingWennits\ELC -Perm itApp.doc 04/03 TY O ING DIVISION PERMIT #: ELR1005-00183 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/11/7005 Phone: (503) 639 -4171 �niiir +l I Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 71 SITE ADDRESS: 10520 SW CASCADE AVE CLASS OF WORK: SUBDIVISION: OFFICE DEPOT LOT #: TYPE OF USE: PROJECT NAME: OFFICE DEPOT DESCRIPTION: Install limited energy for data telecommunications. OWNER: MARX, ERNEST L + BARBARA R, PHONE #: CONTRACTOR: 3D ELECTRICAL SERVICES INC PHONE #: 503 -657 -9173 Inspection Request Scheduled For: Date: 7/14/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 135 Low voltage 011367-01 503-582-1190 N Corrections/Comments/Instructions: S f l PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS (l FAIL fl CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 0 Date: ' 7 — 1 7 - 6-S Phone #: (503) 718-