Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
Zolfi DEVELOPMENT H BMEN SERVICES (503) 639 -4171 DATE ISSUED: 9/24/02 2 -00190
SITE ADDRESS: 13530 SW SANDRIDGE DR PARCEL: 2S105DD -04300
SUBDIVISION: PACIFIC CREST ZONING: R -7
BLOCK: LOT: 019 JURISDICTION: TIG
Project Description: All- encompassing low voltage.
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: ALL ENCOMP : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
D.R. HORTON INC AZIMUTH COMMUNICATIONS INC
5125 SW MACADAM AVE STE 145 P.O. BOX 508
PORTLAND, OR 97201 WILSONVILLE, OR 97070
Phone: 503 - 222 -4151 Phone: 503 - 639 -0110
Reg #: ELE 36 -94CLE
SUP 2312JLE
LIC 145828
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 9/24/02 $75.00 2720020000 Elect'l Final
5PCT CTR 9/24/02 $6.00 2720020000
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 starte in 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requi s you to fo rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 01 -0010 throug OAR 952 -001 -00 0. You may obtain copies of these rules or direct questions to OUNC at (503)
246 1987.
Issu d by Permittee SignatureQ( i ;I/ e `0
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
As. Electrical Pit 'cation
Date received: 9/4/ Permit no. DOJ OD /9,4
of Tigard Fapire date:
u� .. �'�' City SE 1 COQ ') Project/appl. no.:
13125 SW Address: a O72 Receipt City of7igard � $glust, Tigrd, R 11. 4 ;�.' .� • � -.� 97223 Date issued: By >�:. � t no.:
p
Phone: (503) 639 •
1 T• . ..
Fax: (503) 598 -1960 - - • ` ; Case file no.: Payment type:
-
Land use approval: 6 '757.200e -de 3A D P 2 - d
� Zoo oink?
TYPE OF PERMIT
1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
ew construction 0 Addition/alteration/replacement 0 Other. 0 Partial
JOB SITE INFORMATION
Job address: ( D114Di p' Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot: lot Block: S ubdivision: 2 s' /D -.5 /1 4 /300
Project name: P rt I Description and location of work on premises: side (,E p Hems.
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCIIEDU,E
Job no: Fee Max
Description Qty. Business name: A ZIkii i COMAI tla) i /A -7"/ S -single or per
(ea) Total ao.iasp
Address: 0 11695 - S, a D6E0 &effluvia. Includes attacbedgarage.
City: (,b ,SpaNtt`LE I Stance I ZIP: V4170 • Serviceinekuletk
Phone: j63 1.5 d 11 U I Fax:503631 E - mail: 1000 sq. ft. or less 4
E additional 500 s ft. or p ortion thereof
CCB no.: / ,5�'?� I Elec. bus. lie. no: 36 — 2
f Limited energy, residential
City/m, . ic. no.: 00007 Limited energy, non-residential 2
9 1 Iflf I0 y . Each manufactured home or modular dwelling
Si of supervising el (required) Date Se neand/or feeder 2
Sap. elect. name (print): 0 aci26 License no: 2 . LE Services or feeders- installation,
alteration or relocation:
200 amps or less 2
201 amps m 400 amps 2
Name (print): �` • 401 amps to 600 amps 2
Mailing address: NI _ 601 amps to 1000 amps 2
City: pot„ I St at e °1ID Over 1000 amps or volts 2
Phone: 1.2.1.• 1 1 'Fax: E -mail: Reconrceaonly 1
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, °'Orread0m
200 amps or less 2
ORS 447, 455, 479, 6 ! . 201 amps to 400 amps 2
Owner's signature: _ I Date: a1 l �� 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, fast branch circuit: 2
Phone: Fax: E Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder uotIncluded:
O Service over 225 amps-commercial 0 Health -care facility Each pump or irrigation circle 2
O Service over 320 amps -rating of 1•3c2 O Hazardous location Each signor outline lighting 2
family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
U System over 600 volts nominal more residential units in one structure alteration, or extension* 2
0 Building over three stories O Feeders, 400°mpsormore *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park ''o' Each additional inspection over the allowable in any of the above:
O Egrressss/lightingplan 0 Other. Per inspection I I I I
Submit _ sets of plans with any of the above. - Investigation fee
The above are not applicable to temporary construction service. Other
4',2
Permit fee $ ?S, C)
Not all iurisdict;co, accept credit cum., please call jurisdiction for more information. Notice: This permit application
O Vi Plan review (at _ %) $
Visa O MasterCard, , expires if a permit is not obtained
Credit card number: / / within 180 days after it has been State surcharge (8%) .... $ 6 • t)
E accepted as complete. TOTAL $ • f/ . �)
Name of cardholder as shown on credit card
S
Cardholder signature Amount 440-4615 (6IO01COM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT F
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: 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 g Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 �f Burglar Alarm
Limited Energy $75.00
Each Manuf'd Home or Modular Door Opener
Dwelling Service or Feeder $90.90 2 El
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2 ❑ Vacuum Systems'
201 amps to 400 amps $106.85 2
.401 amps to 600 amps , $160.60 2 fD1 Other �ljlCl�� J� i :T , .
601 amps to 1000 amps, $240.60 2 yE'
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, Audio and Stereo Systems
see "b" above. .
Branch Circuits Controls
New, alteration or extension per panel •
a) The fee for branch circuits Clock Systems
purchase of service or
feeder fee.
Each branch circuit $ 2 El Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service 0 Are Alarm Installation
or feeder fee.
First branch circuit $46 HVAC - •
Each additional branch circuit $6.5 .
Miscellaneous ' ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 - Intercom and Paging Systems
Each sign or outline fighting $53.40
Signal circuits) or a limited energy Landscape Irrigation Control'
panel, alteration or extension $75.00 El
Minor Labels (10) $125.00 , ❑
Medical
Each additional inspection over
the allowable in any of the above Nurse Calls
Per inspection $62.50
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 appfcation.
Fees:
Total Balance Due $
Enter total of above fees $
❑ Trust Account # 8 `Y. State Surcharge $ ��
Total Balance Due $ «) r t
All New Commercial Buildings require 2 sets of plans.
i:\dsts\forms\elc- fees.doc 08/30/01
' CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 --00 3 Zd
INSPECTION DIVISION Business Line: (503) 639 -4171
/ BUP
Received , Date Requested / / 3 AM PM BUP
L • 33 0 �� d4- - ,s % Suite MEC
Contact Person Ph ( ) S 1 v 34( PLM
• Contractor I t •Z_) )_ Ph ( ) SWR
• BUILDING Tenant/Owner ELC
• Footing
Foundation ELC
Ftg Drain
Access: - O O I `� Q dr
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation •
Drywall Nailing
Firewall
' Fire Sprinkler /,.
Fire Alarm Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL L PLUMBING (10 tid O! l y
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
arm
/ PART FAIL ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE ❑ Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date JcPdl a 3� en Inspector . AL v Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
� -