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Permit CITY TIGARD RESTRICTED E ERGY 4 F1 , 41 DEVELOPMENT DEV W H BMENa Tigard, SERVICES 639 -4171 DATE PERMIT 11/4/2004 00343 SITE ADDRESS: 14807 SW KENTON DR PARCEL: 2S112CB -13800 SUBDIVISION: ASHFORD OAKS NO. 3 ZONING: R -7 BLOCK: LOT: 147 JURISDICTION: TIG Project Description: Installation of stereo wiring A. RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: X 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: INSTRUMENTATION: OTHER: TOTAL # OF SYSTEMS: Owner: Contractor: MYERS, TERRY & NANCY TELEPHONE CONNECTION SERVICE 14807 SW KENTON ST PO BOX 2075 TIGARD, OR 97223 BEAVERTON, OR 97075 Phone: 503- 691 -9878 Phone: 642 -7374 Reg #: LIC 50013 ELE 34- 142CLE SUP 458LEA FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 11/4/2004 $75.00 Elect I Final [TAX] 8% State Surcharl 11/4/2004 $6.00 Total $81.00 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you t ow rules opted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 th ugh OAR 952 -001 0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699. Is ued by Permittee Signature , Alt, OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF- SUPR.- ELEC'N- - -- — DATE: LICENSE NO: Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day Electrical Permit Application FOR OFFICE USE ONLY CX Received lll #Tigard DateB : �� PermitNo.: eL r.� 13125 SW, Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 /�xiar'NiM. iY >� Date Other Permit: Inspection Line: 503.639.4175 ll I' Date Ready/By: Juri • H See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: ( la. Supplemental Information !"" , � . «� > ,a: , Y' - : ��;r�: s�a. :saw ° .cur. �c*�� :� �.;:ra +;r:�;; x: .: ;•rw-r r.�.;r:� ...,n� . :3 rP.i .. .$ ; 'k_ ,= a -, ..:. - - "` k , ,, .d...: 3 ;°€ - vt : „x. , .,. .. z. tk v ,.. ` ” E O d,j 2 , 7 R "+< _:" ,; t1,i :: W, 3 n (k; ., ,:.. ,P rl :: :: �"� ;#`: � :.¢� n:#,£_�� a".-'=' �' �="t nivt%.'.. six` �.YF,.�....- :i� „ -��s.. :..�'` "��x r� ?�:f ya,n,: .. .,W • ❑ New construction Addition/alteration/replacement Please check all that apply: ❑ Demolition ❑Other: EService over 225 amps, comm'l ❑Hazardous location , .w °t- x- r ° ".. s z r x .c . _ xi s .. e T ... ,. ;: , ,�: ,Y.t d 2-family ❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft, 4e - lfr `: afrd" rz - 0 -CO1*t RTIt TI5W.c iirizX ;, it r of 1- and g -a , A T '� .,,i,, ,. .., 4 ._xf. '- 4. _...a�:ri : 4 . s:;.,.4 dwellings 4 or more new residential Err- 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 0 €3' r a „ ,° ilmv ['Occupant load over 99 persons ❑Manufactured structures or rn k , ,. v, .„ ;. O A!TA I O I ° t, - :, ❑Egress/lighting plan RV. park �� ❑Health -care facility ❑Other: r Job no.: . Job site address: / Li6 Si) F-�A (�j`f Submit 2 sets of plans with any of the above. City/State /ZIP: ri il4,2D i OR: The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: Project name: EiNingi "w'TIF: = : " liar a ;_ - 7. , ; Description Qty. Fee. Total Cross street/directions to job site: /44.-0___ — 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 i 2 .. „., ,,,,,, „, ,:. . . t; , , Limited energy, non - residential 75.00 2 ,. ^. stn $ `,41 ' Xa X' M a Each manufactured or modular dwelling, service and /or feeder 90.90 2 by/ e,ti 7 Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 . 2 ,t4I ; °. ' v . :-,; ��ta : i :,:, -: y: ` t} ° + g`sl° . • n is , ^ rz fit 201 amps to 400 amps 106.85 2 Mia ff qE , , � .� LLIWA 'M 1 *� s� 42 M” . ` = 1„a,_` M?Wa � 401 amps to 600 amps 160.60 2 Name 4 ., v ?) C'( Hy 601 amps to 1,000 amps 240.60 2 Address: 1 4 g 7 ,,,) his ,..)TOpi 'r Over 1,000 amps or volts 454,65 2 Reconnect only 66.85 2 City/State/ZIP: 2 t (' b 0 a, q 7 a-2-9j Temporary services or feeders installation, alteration, and/or Phone: (aS) C.O! ! — c{g7g I Fax: ( ) relocation 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 ''” ' t ",'r°` ^9 �I ,, A ,11. 7 „; ' *• t'" �;QN T �°' ' ' A. Fee for branch circuit with ., a °. a.:x #t 5 . . B 4'. ;zz v� - .sr = -w,' ;? �,....'. ,o- s-' a - 'Yu:. it , s, S 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'I branch circuit 6.65 2 City/State /ZIP: Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 2 Phone: ( ) Fax: : ( ) Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited - € ly ;: ;af .�y.? O otial , . ? - ,,. alpir, � . energy panel, alteration, or a OW :2'A ` ��:�r��� ._.�.�.�, :n- ».��,�.�i.," .a.��x3�; mo t ` - _ ni ,- ;���:,�s� �tia�. extens n. D 'be: Page 2 2 7 Business name: j C/5! �� JG�l •n©,j S'L,01/ i& f Address: �� �� "'r' / Each additional inspection over allowable in any of the above Per inspection 62.50 City /State /ZIP:. 6 ( 9 ( 97073 Investigation per hour (1 hr min) 62.50 Phone: ( g93) G 4 a • 737&/ Fax (SO2.) bqp- tr511Q Industrial plant per hour 73.75 l .< t. ACtRG; EE'1t I ,;FEES ;,, CCB Lic.: S 06 j '' E lectrical Lic.: 39 1 It Suprv Lic.: 4/56/...6A Subtotal '75, 070 Suprv. Electrician signature, required: W Plan review (25% of permit fee) Print name: / 4— VA- i dr• 1 - - _ i i ' ( Date: /' f 0 Li' ?)- State surcharge (8% of permit fee) ( fit �Q / / ! TOTAL PERMIT FEE 8 Authorized signature: 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 \Petmits\ELC- PermitApp.doc 12/03 440- 4615T(10 /02/C0NI/WEB Electrical Permit Application - City of Tigard Page 2.- Supplemental Information • LIMITED ENERGY PERMIT FEES: me - -bn anw ° , 17 . ro a 3,67:V. Zvi ltei 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: ‘ 4 ,1111 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 \ Building \Pemuts\ELC - PermitApp.doc 04/03