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Permit CITY OF TIGARD ENERGY RESTRICTED G ESTRICTED RGY 1�I��. DEVELOPMENT SERVICES PERMIT #: ELR2004 -00097 `-" 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/13/2004 SITE_ADDRESS: 07632 SW DURHAM RD PARCEL: 2S113BA-00400 SUBDIVISION: SW CENTER SDR1999 -00020 ZONING: I -P BLOCK: LOT: JURISDICTION: TIG Project Description: Install cable from 1st floor fire alarm to 3rd fl. access control for door unlock. A. RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: DATA /TELE COMM: NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: X OUTDOOR LANDSC LITE: OTHER: : HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: TOTAL # OF SYSTEMS: 1 Owner: Contractor: HAMBACH, MICHAEL V + HSI SECURITY SYSTEMS, INC SATTLER, SANDRA E + 3424 NE 35TH AVE. BROWN, LORENE PORTLAND, OR 97212 TIGARD, OR 97224 Phone: Phone: Reg #: ELE 26 -755C LIC 42140 FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 4/13/2004 $75.00 Elect'I Final [TAX] 8% State Surcharf 4/13/2004. $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 44- Permittee Signature ory? 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: c`(& Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day 1. r APR. 12. 2004 7:48AM P 2 FR : HS I PHONE NO. : 503 287 1345 �® . ,. 0 • ` Z ri City of Tigard ���� i l Cnnit N ' 13 15 SW Hall Blvd., Tigard c3V*3 ` �O � 0 � + 4._ ��� �� Plan Rcvi . Phone: 503.639.4171 Fa ection Line; 503,63 S 0 98,19GU O lMt + +� Date/By: Other Pemmn: R + R c ins i .,,.l. __-, Date Re ady /By: 1e,15: p � Q 0 See Pngc 2 for Internet; www,ci.tigard.or.u_s Q� 'C „AV- ,...\0 Notitied/M j ethod: 7- Supplemental Information t : ,,.,...... ,. 1 ,•.rte, .......,., :. .. ,,.... .. ................... .. ,.,......,.......,..,...,... . ❑ New construction ®' ion/alteration /replacement Please check all that apply: ❑ Demolition then: ervtce over amps comm' Hazar pus location sq. 11 1 .....:. ..:.. :.....:... :.. .:.. : : A QR't >.::.t;'C .hf ...1tYt x10110 :„: „, :;,: :<.: ,..,. ., >.. Of 1- and 2 -famil a dwellin asn ❑ 4 or more new r re s id e ntial ❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building System over 600 volts notninal units in one structure ❑ Multi- family El Mader builder 0 Other: OBuilding over thrcc stories ❑Feeders. 400 amps or mor ;:•;< ..:..:....:...... ....> T . persons Manufactured structures c :: ....... .....:........:. ..:....J "E . EN FU M ' N ; ,, (;) t ` ` '' V park Job no,; 13415 Job site address: ..::....: :, :.....:....:� :. a ) k ` � '�� „ ; :.;.Y ��' 1 1�!.,:, � : ��.,.:. . . ❑ E �resr /li ht ng '. `` ::::ii b g plan 7632 SW Durham Rd. ❑Hw1th -care facility ❑Other: Submit 2 sets of plans with any of the above, City /State /ZIP: Tigard, OR 97224 The above arc not applicable to temporary construction service, Suite/bldg./apt. no.: Project name: Fire Unlock ;... :., :.:. .. :.:.....:...:.. ...... „;;.... ..,; ; . ..,. ,: :,::,..:.., .::.. ,, < . tec Urlptlon j Qty. I Fee. I Total Cross street /directions to job site: New residential single- or multi- family dwelling unit. Includes attached garage. ),(190 sq. ft. or less 145.15 Subdivision: Lot no.: Ea. addi 500 sq, ft, or portion . 33.40 energy, Limited Tax map /parcel no, residential , ...........:.. Limited energy, non 75.00 ;.. >.::... .,. �IF , :. ,.. . , . .................. _:.:.:.:... ._ :.......,.:..,...,:::......:. .,..;.,;.,:;:;„.;.,;,::; ;<;..... Each manufactured or modular Install a cable from the 1st floor fire alarm panel to the 3rd floor access control dwelling, service and/or feeder 90.90 Services or feeders installation, alteration, and/or relocation system for Fire Unlock. 200 amps or less 80.30 ` 401 amps to 600 amps 160.60 Name: United Health Group 601 amps to 1,000 amps 240.60 Address: Same Over 1,000 amps or volts 454.65 Reconnect only 66,85 City /State /ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: (503)213 -2225 p ax; ( ) 200 amps or less 66.85 Owner installation; This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701, 401 amps to 600 amps 133.75 Owner signature: Date: Branch circuits - new, alteration, or extension, per panel : ©. ::'.:::. '<;';..:....'::..:.,.:.. r fee, each A FCC for branch circuits with . ..:.....:...:..::.:.....: :,. :;. :..,: service or feede CC, C ' 13usinessname: United Health Group branch circuit 6.65 B. Fee for branch circuits Contact name: Linda Bernard wilhvtct service or feeder tee, each branch cireuil 4(5.45 Address: Same ' Each add'I branch circuit 6.65 City /State /ZIP: Miscellaneous (service or feeder not included) Phone: (503) 213 - 2225 pa : ( ) Pump or irrigation circle 53.40 Sign or outline lighting 53,40 E -mail: Signal circuit(s) or limited- C. ..T AC I I.:•: energy P j; :,; >i ro;,ew >..; , al teration, Or Business name: iSI Security Systems, Inc. extension. Describe: Page 2 • Address: 3424 N.E. 35th Ave. Each additional inspection over allowable in any of the above Per inspection 62.50 City /State /ZIP: Portland, OR 97212 Investigation per hour (1 hr min) 62.50 Phone: (503) 287 -4604 Pax: (503287 -1345) Industrial plant per hour 73.75 CCB Lie.: 42140 Electrical Lie.: 26 - 755C � Suprv. Lie 68S Subtotal Suprv, Electrician signature, required: ` Plan review (25% of permit tee) Print name: e,, ,� `, 4) 20 ,5 of Date: I” _ i2. —'vu State surcharge (8% of permit fee) TOTAL PERMIT FEE t/ 6 J 180 Authorized signature: .. "� This permit application expires if a permit is not ob ained within / //�� d ays after it has been accepted as complete Print name: v�� /' , u ' ir'm G, Date: — 7..- d r l' methodology set by Tri County Building Indest,y Service Board •' Number of inspections per permit allowed. CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503).63.9 -4175 INSPECTION DIVISION Business Line: (503) 639-4171 MST BUP Received // ' 2 Date Requested - 30 '6 M' �\ PM BUP Location 7 2- 2 L(/1%-C[ /f-CC Suite MEC Contact Person `7361 /liyl ,P.r Ph ( 503) 9 & - /0 70 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC l / C, Ftg Drain Access: ELR ��` — 000 < Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors • Ext Sheath/Shear Int Sheath /Shear Framing Insulation Drywall Nailing Fi rewal I Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL �LErRICAL Service Rough -In U U. otta Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. • f• ' • S PART FAIL SITE Plea e call or reinspection RE: D Unable to inspect — no access Fire Supply Line ADA © , I — A �. .. . . y Ext Approach /Sidewalk Date I nspec t or Other: Final DO NOT REMOVE this inspection record from he job ite. PASS PART FAIL