Permit ELECTRICAL PERMIT -
C ITY OF TIGARD RESTRICTED ENERGY
�, - 13125 DEVELOPMENT H BMENT Tigard, SERVICES 1639 -4171 DATE ISSUED: 03 -00026
ED: 2% 023
SITE ADDRESS: 13088 SW PRINCETON LN PARCEL: 2S104DA -20100
SUBDIVISION: QUAIL HOLLOW - SOUTH ZONING: R -4.5
BLOCK: LOT: 027 JURISDICTION: TIG
Project Description: A
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: AL ENCOMP : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
BROWNSTONE QUAIL HOLLOW LLC AZIMUTH COMMUNICATIONS INC
12670 SW 68TH PKWY STE 200 P.O. BOX 508
PORTLAND, OR 97223 WILSONVILLE, OR 97070
Phone: 503 -598 -7565 Phone: 503- 639 -0110
Reg #: ELE 36 -94CLE
SUP 2312LEA
LIC 145828
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 2/4/03 $75.00 Elect'I Final
[TAX] 8% State Tax 2/4/03 $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 A lit ` � / Permittee Signature c7' 1.AV
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
Date received:g.,,y 0 Permit 6, oa(
� 1 I ��,
_A . I City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: I Receiptno.:
Phone: (503) 639 - 4171
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
(New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: f dm( 5 , A AJGETi tt1 I-Ai Bldg. no.: _ Suite no.: Tax map /tax lot/account no.:
Lot: 0 2 7 I Block: ISubdivision:4u4kL 1•-- 0LU) -2
Project name: Qtz $tt_ }Ep LLw I Description and location of work on premises: Up t Gel U 1 3 t0
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCIIEDU.E
Job no: Fee Max
Business name: 4.2 i i i.c i+ Comm i i (A TI u�JS Description Qty. (ea.) Total no. insp
New residential - single or multi - family per
Address: o2f3gs - 57c,), gAQ 40 dwelling wit. Includes attached garage.
City: Lui LS Doui,LLc I State:6) Z ZIP: q >U ?b • Service included:
Phone: 503 6,341 01ia I Fax:$03 439oks I E -mail: 1000 sq. ft. or less 4
S �Z� I Each additional 500 sq. ft. or portion thereof
l
CCB no.: Elec. bus. lic no: 3 -9� C Limited energy, residential ] 2
City /metro lic. no.: 0 Limited energy, non - residential 2
8 ,11P yet . ..2/. Jo3 Each manufactured home or modular dwelling
Signature of supervising electric(' (required) Date f Service and/or feeder 2
Sup. elect. name (print): L � [a6 License no:� /L LE
Services or or feeders relocation:
installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): RectoJOSTMJE 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only i
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E-mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2
O Service over 320 amps -rating of 1&2 0 Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
Cl System over 600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over three stories 0 Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons 0 Manufactured structures or RV park Each additional Inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other. Per inspection I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee $ —7C
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: I / within 180 days after it has been State surcharge (8 %) .... $ t'' . co
Expires accepted as complete. TOTAL $ ql • CJ !)
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (6100/COM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:,--.
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
•
Service included: Items Cost Total 4, Check Type of Work Involved:
Residential - per unit ❑
1000 sq. ft. or less $145.15 4 Audio and Stereo Systems
. Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular ❑ Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation
200 amps or less $80.30 2 ❑
201 amps to 400 amps $106.85 2 Vacuum Systems'
401 amps to 600 amps _ $160.60 2
601 amps to 1000 amps $240.60 2 ❑ Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918 - 260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see "b" above. ❑ Audio and Stereo Systems
Branch Circuits ❑ Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or Irrigation circle $53.40 ❑ Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control' .
Minor Labels (10) $125.00
Each additional inspection over ❑ Medical
the allowable in any of the above
Per inspection $62.50 ❑ Nurse Calls .
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting
Fees: ❑ Protective Signaling
Enter total of above fees $ ❑ Other
8% State Surcharge $ Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ * No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
All New Commercial Buildings require 2 sets of plans.
i:\dsts\forms \elc- fees.doc 08/30/01