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Permit ELECTRICAL PERMIT - CITY OF TIGARD RESTRICTED ENERGY J I B,• DEVELOPMENT SERVICES PERMIT #: ELR2004 -00109 ---' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/26/2004 SITE ADDRESS: 07125 SW HAMPTON ST PARCEL: 2S101AC 01400 SUBDIVISION: BEVELAND NO. 2 ZONING: MUE BLOCK: LOT: 020 JURISDICTION: TIG Proiect Description: Voice /data install. 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: SPECIAL DISTRICTS ASSOCIATION OF OR SUPERIOR TEL 727 CENTER STREET, NE #208 20 PO BOX 69599 SALEM, OR 97301 PORTLAND, OR 97239 Phone: 503- 371 -8667 Phone: 503 -242 -1109 Reg #: ELE 26- 712CLE LIC 78741 FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 4/26/2004 $75.00 Elect'I Final [TAX] 8% State Surchaq 4/26/2004 $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 Permittee Signature >-1 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 Elect -al Permit Application �E• FOR OFFICE USE ONLY City of Tigard APR 2 Received l f ,/ R �{ Y g R � 6 2004 Date /B : "! c)4 0 / c[�e[J Permit No� ir pi/ ��d !0 13125 SW Hall Blvd., Tigard, OR 97223(, Plan Review Phone: 503.639.4171 Fax: 503.598.1960ITY OF TIGAA ���i 1 Date /B : Other Permit D'VIS. Inspection Line: 503.639.4175 BUILDING �f� o 8 - " i+ Da Ready /By ® See Page 2 for Internet: www.ci.tigard.or.us W Notified/Method: Supplemental Information <. ..,x ,.:��::�; ,:s. -„ •..a:, t , n. ., .,•" ., ,,. 411:- 5'= x„g =r. .. .., .`l r., �. ., z <, �,,� ,. «.,,." ,:: G-.=.., ,�. :: -:its -< ;;, �.,_. <: x 4Y , TES:` <x:�.� }. <_' ��' -. �PL`AN��REVIE 3� > TYP E. =� ,�: z E = =.0 WORK - ❑ New construction 1 Addition/alteration /replacement Please check all that apply: S ervice over 225 amps, comm 'l Demolition El Other: ' Hazardous location ,;, < =e;,. <.¢,. wx „ -¢, ,,,,, , <`t.: ;_:.;;:: �; =.4 ¢ x: ¢ - rating ft., ['Service over 3�0 amps rati B uildn g ov er 10,000 sq. ft. tgc�: '>; - « r�, `���� < �,..: `. � "¢,,,, <�•;;- ::_:_���..�C of I -and _ famil dwellin s 4 or more new residential ,�, A�TEGORY� : >OR<::`. GONSTRIJGTION,�= >, ;,, °�;�. ,�:� g rw- ❑ 1- and 2- family dwellingf Commercial /industrial � Accessory building System over 600 volts nominal units in one structure El Multi - family ❑ Master builder I=I Other: Building over three stories ❑Feeders, 400 amps or more ”. .,,,,.¢ >:- ;.;.,._, w::- :_..,:.:_:;. persons red structures or ❑Occupant load over 99 e Manufactured park C1B�� T �I ORMATIONi> 'ND.I;OCATI IV= a >J O P l i in plan a. -< E ress/ h a ..,_.,.::_:,_- ,-„ Z. �..,. �:<, �.<,_.. � - �' xr", � <a. =- ,t�z��v.N::;<„'��;.�z�;�e✓ g g gP Job no.: Job site address: 7 1 LS S 'V' INI ❑ Health -care facility ❑Other: Submit 2 sets of plans with any of the above. City /State /ZIP: - \G fis The above are not applicable to temporary construction service. :tea, _" EEWSCIIEDUT E Suite/bldg. /apt. no.:2C_'E'� �� Project name: s\� A� ; D esc ri p ti o n I Qty. I Nee. Total Cross street/directions to job site: 0,A.,../ C\- --\-- New residential single or multi - family dwelling unit. W Z \ / Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 Tax map /parcel no.: 7 00 energy, non-residential _ . DESGR[PT'IQNa.OF' °?WORK.`< � >�.< .,. Each manufactured or modular � n �� dwelling, service and /or feeder 90.90 2 L i ��(� V . ( ' v s 4- '� Services or feeders installation, alteration, and/or relocation W \g- \ G 200 amps or less 80.30 2 a, .<' 201 amps to 400 amps 106.85 2 P �1:c,`:t , P R PERTY "'..0 R ?`.; =`` � t. EN O AF WN E ';'I' ,, _,..�,.,..., __�,�:�'• � , _, , „, , N ,,, , ' ,, �' -�1�i� <': 401 amps to 600 amps 160.60 2 Name: `��A-AYL 'b\S'Se:=TC.„ X55 ©C : CT- ©� 601 amps to 1,000 amps 240.60 2 Address: 7 i as .„,_., ‘.44,-/-7.-\-(-3 Over 1,000 amps or volts 454.65 2 �(�` Reconnect only 66.85 2 City /State /ZIP: i�� Y'�` l�)1` Temmpoorary y services or feeders installation, alteration, and/or ( 563) c,-7d , -70 ( Fax `—� c. (gc) ,2O t 9 z-\---/ relocation Phone: J 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 a'>ry. = :? ,:x ” Yr: - .' =M :T fSSy :<y}•.' A Fee for br n h circuits with s +' > A. N`1': < �:�. > �:C, . T`AC RSO '.,,,.,_:' ,, ..T... .., -,:>�: > «�. . : ,._.,_. . � � :-,,:.-.- x�: �,: � . �- ..• >- ...;,.Wr : x ...;,,__,,, -. service or feeder fee, e h 6.65 2 Business name: SLI VV. \p5 \*tiL' branch circuit . B. Fee for branch circuits Contact name: �` W without service or feeder fee, 46.85 2 Address: VG '270)‹ L 1 SC-, each branch circuit CA r� �j�� C - Each add'l branch circuit 6.65 2 s1 i City /State /ZIP: 7G ` _S) (' \ '7� ` "j\ Miscellaneous (service or feeder not included) \ r Pump or irrigation circle 53.40 2 Z Phone: ( 90) 2 -■ \ V^ c\ Fax: : (503) �t 1, 370 L I Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited - tier panel, alteration or r ,k= '��.. C 12A energy ONT OR =:.< - � extension. Describe: P age 2 2 Business name: S `�+�\ JL_ 5 pA \S Address: V:7� � .,C\ S C t q Each additional inspection over allowable in any of the above ` Per inspection 62.50 City/State /ZIP: 7 - asz,.._ C 2 7 Z i Investigation per hour (1 hr nun) 62.50 :tin - -- ( j Industrial plant per hour 73.75 0 Phone: ( ' 2 - 1 ` �j� Fax: ( 503) Zy + - 3 7 '°� 2`` "`:: °'r `i gIECTRIC- WAI2I4TC FEES *, ';;`i= c CCB Lie.: -72 Li 1 Electrical Lic.: -7 /2CLl Suprv. Lie.: 1 Wy ? Subtotal - s' Suprv. Electrician signature, required: /0 -/ -ma Plan review (25% of permit fee) Print name: V j i c QQ f Date: ///2216 L/ State surcharge (8% of permit fee) _ ,S�` ,/� t. P TOTAL PERMIT FEE 4g I Authorized signature: C���- C j ! J L . 1 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 -Cowry Building Industry Service Board ** Number of inspections per permit allowed. i:\ Building \Permits \ELC- PermitApp.doc 12/03 440- 4615T(10 /112 /COM/WEB CITY OF TIGARD 24 -Hour BUILDING Inspection 'Line: 1503) (503) 639 -4175 MST INSPECTION DIVISION Business Line: • 1503) 639 -4171 BUP Received Date Requested 6 AM P BUP Location ►ap�ri4—af !� Suite° MEC Contact Person G/t/l.r ' / Ph (77/ ) ItD 30 ( 7 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: ELR c „ ,,, 7 / O /d7 Ftg Drain Crawl Drain Slab Inspection Notes: SIT Post & Beam --z -J Shear Anchors V7-0 Ext Sheath/Shear / ( �L Int Sheath /Shear Framing Insulation Drywall Nailing Firewall MAUL D ,� ,' t (/K -t(-- V Fire Sprinkler Fire Alarm N711../ 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 ELECTRICAL Service • Rough -In UG /Slab Low Voltage �F Alarm Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. • PART FAIL Please call for reinspection RE: Unable to inspect — no access Fire Supply Line 16/14 ADA Approach/Sidewalk Date J L/ `� Inspector l `' AIPLVOR-a-- PP Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL