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Permit P,_ , CITY OF TIGARD ELECTRICAL PERMIT - RESTRICTED ENERGY uu..111 DEVELOPMENT Tigard, 1 639 -4171 DATEISSUED: I E�R90 -00385 SITE ADDRESS: 09900 SW GREENBURG RD 235 PARCEL: 1S126DC-03300 SUBDIVISION: LEHMANN ACRE TRACT ZONING: C -P BLOCK: LOT: 005 JURISDICTION: TIG Project Description: DATA CABLE 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: ATHERTON REALTY PARTNERSHIP COMMUNICATION RESOURCES INC MARTHA ATHERTON PO BOX 2685 2100 S WOLF WILSONVILLE, OR 97070 DES PLAINES, IL 60018 Phone: 847 -298 -8600 Phone: 503- 699 -9300 Reg #: LIC 154557 ELE 3 -561 CEA FEES Required Inspections Description Date Amount Ceiling Cover [ELPRMT] ELR Permit 12/19/03 $75.00 Wall Cover Elect'I Final [TAX] 8% State Surchart 12/19/03 $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 throuc Issued by Permittee Signature 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 INST L -IN ONLY SIGNATURE OF SUPR. ELEC'N / I DATE: /Z / ' LICENSE NO: 7/ ��p � 1- Call 639 -4175 by 7:00 '.M. for a inspection needed the next business day Z Electrical Permit Application F OR OFF USE ONLY: •- • . 1 i Received ! `` o -- �� Date/By: / - ►i 3 Permit No l . OD3 v-6 38: 5 City of Tigard Planning Approval Sign Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use /,� Date /By: Case No.: u•' Internet: www.ci.tigard.or.us I Contact W .. Juris.: ®See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information. _ •,'_ _ _ r V _ : ;�:�';„zk� -a `~TYPE *OF`.. �:4�, :� - >a:� _° �_`_ :tci >� �•�� ,:� �� . w -.' .: s:� � = =�`< -�< . °'��:� ��'•ti��`t�,�PLANRE1!EW .leas "e,`Cti 'ck�a - '�,:'i�.;��.� ; = ..v: , � ,° e - I1 tttataPPIY )z��,,..:,�_'��;�� ❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility ® Addition/alteration/replacement ❑Other: commercial Hazardous location A . _.,, t o n /a l � . E _ S ervice over 320 amps-rating f Bu i ding over 10,000 square fee t, ❑ r of ❑ , I q - ' ;',.:_;• *, ,CATGORY OF CONSTRUCTION = : " .:.; ,k n;' I & 2 family dwellings four or more residential units in ❑ 1 & 2- Family dwelling ® Commercial/Industrial ❑ System over 600 volts nominal one structure ❑ Building over three stones ❑ Feeders, 400 amps or more ❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park ❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other: ,' , ` F= JOB SITE'•INEORMATIO a CATION. Submit sets of plans with any of the above. The above are not applicable to temporary construction service. Job site address: 7f'ee' ,�c o ,,,,, fir , _e) - . ..t :;., ,., r r ... t _ „ .._ _ .. „:, :t . '.'�:n ;,vim -.,C' i : , :., ,,z . -! SCHEI ,U E: , a �= ; ' -&,' !.a; G Suite #: .`Z 3 _s / Bldg. /Apt. #: Number of inspections per permit allowed Project Name: / ` Q, ® _�i` G £- D e sc r iption Qty Fee (ea.) Total New residential- single or multi - family per v Cross street/Directions to job site: dwelling unit. Includes attached garage. Service included: 1000 sq. ft. or less 145.15 4 Each additional 500 sq. ft. or portion thereof 33.40 1 Limited energy, residential 75.00 2 Subdivision: Lot #: Limited energy, non residential 75.00 2 Tax map/parcel #: Each manufactured home or modular dwelling /1 / (-tiz/ �w 447/ n '` ' °'^ ' ` . � . � =, 4"-,.4,=' a '_` service d/ ce an or eeder �. , fi : .c� 3,,� ^,_Y,�� _, w• ...,DESCRIPT= ON=;OF. W,ORKs ��,�� .��.,� ,-.� �� � �.� • �� £ j/ S ervices or feeders f - installation 90.90 2 ,� (� alteration or relocation: , 200 amps or less 80.30 2 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 ' ;PROPERTY >OWNE'R }',"i't 5c.'-'`;F..k?;.tn':;' < °" :'r 601 amps to 1000 a ,-,s;r.. . �. �:�''.TENANT ��...,� � `ti<'7:2".c.S ° »�`�., P amps 240.60 2 Over 1000 amps or volts 454.65 2 Name: 1,,:,,,, s / , - , C- Reconnect only 66.85 2 Address: f feagg 6..., f , k � A p e ) s)cx z 31 Temporary services or feeders - installation, alteration, or relocation: City /State /Zip: , c,- d 200 amps or less 66.85 1 Phone: Fax: 201 amps to 400 amps 100.30 2 . . . 401 to 600 amps 133.75 2 . ": . APPI ICANT _``,,,`«:�:; =`" „ - ' `' ':�. < CON.TACT, PERSON= ; ^ >; a'” Branch circuits - new, alteration, or Name: , /a...,- /s lX7` extension per panel: Address: /02 5' ,t i-4/ , 1, ,.tom A. Fee for branch circuits with purchase of service or feeder fee, each branch circuit 6.65 2 City /State /Zip y © 9 773 'Z— B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit 46.85 2 Phone: . _.53? 2/ 2 — I Fax: Each additional branch circuit 6.65 2 E -mail: Misc.(Service or feeder not included): ' ' I ,I Z 9 it a pz • 5 . 4 Each um or irrigation circle 53.40 2 ��i:,.,?�'.s.. ;e�',�: , - ��'r.CONTRAC�TQR'.;��„. �::.,'�> "��;,��' pump g " ' ' Each sign or outline lighting 53.40 2 Job No: Signal circuit(s) or a limited energy panel, Business Name: alteration, or extension Page 2 ' 2 O hr ,vr i„.4....; - ✓ f...5 d:s �6 Description: Address: to 3 0 x 2 6 s" City /State /Zip: a ..�G, //G ©�` Each additional inspection over the allowable in any of the above: Per inspection per hour (min. 1 hour) 62.50 Phone: 5i 6F1' 4 Fax: Investigation fee: CCB Lic. #: /s 7 Lic. #: Other: ''/';..?.4 _ 0; . Lp , 5 .t, • t H' IX -�:.;;C .was*-' „ -:_ �- � , - �:' .... Fees'= ��;z���s . gi;;R= ��4� - `s�' ^ Supervising electrician Subtotal I $ `75 d c �� signature required: ���/ Plan Review (25% of Permit Fee) $ Print Nam . ✓ e•,� ;l� �� C . #. / /Lis �' 67,9 State Surcharge (8 /o of Perm TOTAL PERMIT FEE $ Authorized Notice: This permit application expires if a permit is not obtained within Signature: Date: 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building industry Service Board. (Please print name) is \Dsts\Permit Forms \ElcPermitApp.doc 01/03 1 - Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all systems $75.00 Check Type of Work Involved: Audio and Stereo Systems Burglar Alarm Garage Door Opener n Heating, Ventilation and Air Conditioning System [ J Vacuum Systems n Other COMMERCIAL WORK ONLY: Fee for each system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: El Audio and Stereo Systems n Boiler Controls n Clock Systems n Data Telecommunication Installation n Fire Alarm Installation n HVAC ri Instrumentation n Intercom and Paging Systems Landscape Irrigation Control n Medical n Nurse Calls n Outdoor Landscape Lighting n Protective Signaling n Other Number of Systems * No licenses are required. Licenses are required for all other installations • is \Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03