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Permit
CITY TI GARD ELECTRICAL RESTRICTED ENERGY PERMIT DEVELOPMENT SERVICES PERMIT #: ELR2005 -00447 - ,i 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 12/28/2005 PARCEL: 2S 110 D C -02300 SITE ADDRESS: 11545 SW DURHAM RD B -6 ZONING: C -G SUBDIVISION: WILLOWBROOK BUSINESS PARK LOT: JURISDICTION: TIG Project Description: Data cabling. 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: DURHAM /99 ASSOCIATES LTD PTNSH TELECOMM MANAGEMENT INC BY CRIIMI MAE SERVICES LP 15611 PARTRIDGE DR ATTN: LOAN SERVICING LAKE OSWEGO, OR 97035 -3121 ROCKVILLE, MD 20852 Phone: Contact #: PRI 503 639 - 8209 FEES Reg #: ELE 3- 463CLE LIC 135355 Description Date Amount [ELPRMT] ELR Permit 12/28/200` $75.00 [TAX] 8% State Surchar€ 12/28/200E $6.00 REQUIRED ITEMS AND REPORTS 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 95 001 -0100. You y obtain copies of these rules or direct ques . o s to OUNC 03 246 -6699. Issued By: �� i/1, Permittee Signature: I/ C 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 O gilca r I E D FOR . Q FICI USE ONLY . . City of Tigard Received .1 2'70 Permit No '1w)a,!'_- tam 13125 SW Hall Blvd., Tigard, OR 972Z 8 Y /// ��`��"` �- t t 2005 Plan Review Phone: 503.639.4171 Fax: 503.5981 O "% t'h�. ' ��M I'I "" Date /By: Other Permit: Inspection Line: 503.639.4175 `-1 11,, Date Ready/13y: tsu(d El See Page t for Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: Supplemental Information 6 UE TWK3P'WAPN PLAN R VIEW. ❑ 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 I- and 2- family dwellings 4 or more new residential ❑ I - and 2 family dwelling a Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi family ❑Master builder ID 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 / / 5''5 � � 1 j'� ,(� ❑Health -care facility ❑Other. Job no.: Job site address: i1 1�(,/ y6v t'l .B Submit 2 sets of plans with any of the above. • City /State/ZIP: ' / / o ✓n( l 7 / % - .' - 3 The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: � / j � ✓ ✓ Project name: 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'l 500 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 'r a � / dwelling, service and/or feeder 90.90 2 �� ( / to Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 _ 201 amps to 400 amps 106.85 2 ❑ PROPERTY OWNER g TENANT 401 amps to 600 amps 160.60 2 Name: ErcJ� /, Ji /� l� 601 amps to 1,000 amps 240.60 2 Address: HS ‘...„4.) / / e . 5 ,.. j3 Over 1,000 amps or volts 454.65 2 e Reconnect only 66.85 2 City /State /ZIP: Mil j il Md Temporary services or feeders installation, alteration, and/or / ` relocation Phone: (SD) � Oe.> V f z 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 . la APPLICANT &CONTACT PE R SON ' A. Fee for branch circuits with / service or feeder fee, each Business name: e�Pem,r,. ✓et 4,Mar 9.04 v.bli branch circuit 6.65 2 Contact name: r � j l B. Fee for branch circuits r without service or feeder fee, 46.85 2 Address: ! O 7 ��" /en© � IL, first branch circuit v ( t Each add'I branch circuit 6.65 2 City /State/ZIP: j/,2 hva.d ke 6 Miscellaneous (service or feeder not included) • Phone: ( 7 '� t &5 / ' 0� 2 Fax: : Pump or irrigation circle 53.40 2 - _ I (��) / �ca. �/ �f V ¢ Cam / �iJ Sign or outline lighting 53.40 2 E -mail: r K klfi iz, p t / „ j Signal circuit(s) or limited- . CONTRACTOR energy panel, alteration, or extension. Describe: Page 2 2 Business name: I ek /14 7if.(�r417# ' Address: ! !0 9 56 ) 0 it i / Ric additional inspection over allowable in any of the above Per inspection 62.50 City / State/ZIP: La ka 0-,,,, , , 97 3 4' Investigation per hour (I hr min) 62.50 n / Industrial plant per hour 73.75 p Phone: (�) �� / 6)832 I ax. ( ) ELECTRICAL PERMIT FEES* CCB Lic.: 13535' I Electrical Lic.: 413CZ Z. Suprv. Lic. . 9 e Subtotal 1' Suprv. Electrician signature, required: AO he arid, Plan review (25% of permit fee) Print name: oda /� /:,: j Date: �a�1Q State surcharge (8% of permit fee) / TOTAL PERMIT FEE 41 Authorized signature: ' / / This permit application expires if a permit is not obtained within 180 - / "�'` , days after it has been accepted as complete Print name: . �� j �SM I` � Date: ` 08 4y • Fee methodology set by Tri- County Building Industry Service Board " Number of inspections per permit allowed. i:\ Building \Pemiits\ELC- PermitApp.doc 12/03 440- 4615T(10/02/COM/WEB Electrical Permit Application - City of Tigard 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 ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* El Other: ,COMN•ERCIAL WORK ONLY: Fee for each commercial system $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: El Audio and Stereo Systems El Boiler Controls ❑ Clock Systems El Data Telecommunication Installation El Fire Alarm Installation ❑ HVAC ❑ Instrumentation El Intercom and Paging Systems ❑ Landscape Irrigation Control* El Medical ❑ Nurse Calls El Outdoor Landscape Lighting* ❑ Protective Signaling El Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i:\ Building \Permits\ELC- PennitApp.doc 04/03 CITY OF TIGARD BUILDING DIVISION PERMIT #: ELR200 'i -00447 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12J002005 Phone: (503) 639 -4171 //"8m4fi f 4i"` Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 1/6/2006 TIME: 7 :00AM PAGE: 18 SITE ADDRESS: 11 16 SW DURHAM f •. R - CLASS OF WORK: SUBDIVISION: WILLOWBROOK BUST SS PARK LOT #: TYPE OF USE: PROJECT NAME: DR. WILLCOX DESCRIPTION: Data cabling. OWNER: DURHAM /99 ASSOCIATES Lr.'D PTNSH, PHONE #: CONTRACTOR: TELECOMM MANAGEMENT I'',C PHONE #: 503 - 639-8209 Inspection Request Scheduled For: D te: 1/6/2006 Pour Time: Code # Inspection Description Con ; rm # Contact # Message 199 Electrical final 0245 + -r, -04 803-888-0214 N Corrections /Comments /Instructions: \ . PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: &'. e e Date: I° 6 . 0 Phone #: (503) 718- VA CITY OF TIGARD , ,. . • - BUILDING DIVISION A , . PERMIT #: ELR 2005- 00447 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12128/2006 Phone: (503) 639-4171 :Niltivtil Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: lie1/2006 TIME: 6: ti9AM PAGE: r ..1 SITE ADDRESS: 11545 SW DURHAM RD B'6 CLASS OF WORK: SUBDIVISION: WILLOWBROOK BUSINESS PARK LOT #: TYPE OF USE: PROJECT NAME: DR. WILLCOX DESCRIPTION: Data cabling. OWNER: DURHAM/99 ASSOCIATES LTD PTNSH, PHONE #: CONTRACTOR: TELECOMM MANAGEMENT INC PHONE #: 503 Inspection Request Scheduled For: Date: 1/4/2006 Pour Time: Code ,# Inspection Description Confirm # Contact # Message 13N Low voltage 014360-01 503969-6832 N Corrections/Comments/Instructions: ON \\1\). \\\N\N$ . ■St (e, ' \k, , 4\ • v 2 & PASS 0 PARTIAL APPROVAL El CANCEL Ej NO ACCESS I FAIL I I CALL FOR INSPECTION D ADDITIONAL FEES ASSESSED Inspector: 6 1-4,,a . ?„ Date: /`"1 Phone #: (503) 718--29,1