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Permit CITY OF T I GA R D ELECTRICAL PERMIT - RESTRICTED ENERGY Ai DEVELOPMENT SERVICES PERMIT #: ELR2004 -00357 AI 13125 SW Hall Blvd., Tigard, OR 97223 (5031 639 -4171 DATE ISSUED: 11/18/2004 SITE ADDRESS: 07632 SW DURHAM RD 125 PARCEL: 2S113BA-00400 SUBDIVISION: SW CENTER SDR1999 -00020 ZONING: I -P BLOCK: LOT: JURISDICTION: TIG Project Description: Limited energy for protective signaling. 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: OUTDOOR LANDSC LITE: OTHER: • HVAC: PROTECTIVE SIGNAL: X INSTRUMENTATION: OTHER: TOTAL # OF SYSTEMS: 1 Owner: Contractor: OPUS REAL ESTATE OREGON IV LLC COOK SECURITY GROUP 1000 SW BROADWAY 4252 SE INTERNATIONAL WAY SE 1130 MILWAUKIER, OR 97222 PORTLAND, OR 97205 Phone: Phone: 503 786 - 5173 • Reg #: LIC 151552 ELE 3 -541 CCLE FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 11/18/2004 $75.00 Elect'I Final [TAX] 8% State Surcharl 11/18/2004 $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 throu AR 95 - 1 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 - 6699. Iss ed by flag. 1401-44 Permittee Signature �2,1,� r 0tivtyL 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 7:00 P.M. for an inspection needed the next business day Electrical' Permit Application FOR OFFICE USE ON LY City of Tigard Received . / /�� 4 2,0 Permit No.: 914 j, —ao_35 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 ' + ' *Y,t` �i�,u� �'V D . Other Permit: Inspection Line: 503.639.4175 asi DateReadyBy: Efi El See Page 2for 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'I ❑Hazardous location OService over 320 amps — rating ❑ Buildng over 10,000 sq. ft., CATE 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 DOccupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND. LOCATION ❑ Egress/lighting plan RV park 3 Z S W pt.. ❑Health -care facility ❑Other: Job no.: Job site address: a 1 „, ^+ ol.- Submit 2 sets of plans with any of the above. City / State/ZIP: - e A P-- 0 A_ - The above are not applicable to temporary construction service. ■ Suite/bldg. /apt. no.: f Z Project name:ao y ,40. e° - ti. .i FEE* SCHEDULE 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. add'1500 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 Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: ,6),,,_, 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 ❑ CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each 6.65 2 Business name: branch circuit B. Fee for branch circuits Contact name: without service or feeder fee, 46.85 2 Address: each branch circuit Each add'l branch circuit 6.65 2 City /State/ZIP: Miscellaneous (service or feeder not included) Phone: ( ) Fax : : ( ) Pump or irrigation circle 53.40 2 Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited- CONTRACTOR energy panel, alteration, or qtension. / Page 2 2 Business name: C J O K .g e. c vs n i 't - I / G 6 uQ Year n tllr I p Address: L / Each additional inspection over allowable in any of the above Li L . (Z S ( T >J TE h tJo7 l. p >.. / L 5 �// u j t - . . E, Per inspection 62.50 City/ State/ZIP: M; L �n ►.t„ 1Ct L � o 0 - / - 7 Z L. L Investigation per hour (1 hr min) 62.50 � Phone: (�''�p) 7 t C ., c, 7 > Fax: ( S' s) 7 & C 3 -) 7 Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* CCB Lic.: Electrical Lic.: Suprv. Lic.: Z l i 9 4,t Q Subtotal 75 • pO Suprv. Electrician signature, required: Plan review (25% of permit fee) Print name: ZI Date: ) / ) / State surcharge (8% of permit fee) ( • 0 0 L L; L t3 &a e1 / TOTAL PERMIT FEE $ / • �� • Authorized signature: f i3 .. This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board •” Number of inspections per permit allowed. i:\ Building \Permits\ELC- PennitApp.doc 12/03 440.4615T(10/02JCOM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: ritESLIANTIAL WORK ONLY:. . _., Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: ( CO WORK ONLY: — Fee for each commercial system $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* • ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* Protective Signaling ❑ Other Total number of commercial systems: .) *No licenses are required. Licenses are required for all other installations is Building \Permits\ELC- PermitApp.doc 04/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: `Z503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received D to R nested Z 3(04\---- AM PM BUP Location 76,3 AiAA Suite �� MEC Contact Person Ph ( ) PLM Contractor L-L Ph ( ) 8 425 C _ SWR BUILDING Tenant/Owner 1 ELC Footing ELC - Foundation Access: � Ftg Drain _ %\ U . 5 a 1� ELR -603 Crawl Drain Slab Inspection Notes: . b SIT Post & Beam Shear Anchors '7' �' /�Jf4 ,' Ext Sheath/Shear �' �''� '�' r; - en - W/56AP i\ Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain 1 Shower Pan Other: Final PASS PART FAIL MECHANICAL ' Post & Beam Rough -In Gas Line Smoke Dampers Final , PAS$ PART FAIL ` L- E.CR Service Rough -In UG /Slab Fire Alarm Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL SIT Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA �� , � Approach/Sidewalk Date !2 Inspect r lo�'� `' �� Ext Other: Final DO NOT REMOVE this inspection record f m the job site. PASS PART FAIL