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Permit CITY OF TIGARD ELECTRICAL PERMIT - RESTRICTED ENERGY ! DEVELOPMENT H BMENT Tigard, SERVICES 639 -4171 DATE ISSUED: 3/3 /04 4 -00088 SITE ADDRESS: 06960 SW VARNS ST PARCEL: 2S101 DA -02100 SUBDIVISION: VARNS ACRES ZONING: C -P BLOCK: LOT: 003 JURISDICTION: TIG Project Description: Data network cable 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: X NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: : HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: TOTAL # OF SYSTEMS: 1 Owner: Contractor: HEALTH RESOURCES, INC COMPUTER TELEPHONY COMMUNICATIONS PO BOX 987 PO BOX 879 TUALATIN, OR 97062 NEWBERG, OR 97132 Phone: Phone: 503 - 554 - 9232 Reg #: LIC 158001 ELE 36 118CLE FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 3/31/04 $75.00 Elect I Final [TAX] 8% State Surchart 3/31/04 $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 ,.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 rical Permit Application FOR OFFICE USE ONLY R d I o f Tigard / P No b g Date/By 3 ONO —O 13125 SW Hall Blvd , Tigard, OR 97223 Plan Revte Phone 503.639.4171 Fax 503 598.1960 "VIA I Date/By Other Permit Inspection Line 503.639 4175 ,,, y - ell. Date Ready/By 1 its, /� 0 See Page 2 for Internet www.ci tigard or us Notified/Method Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction [Addition /alteration /replacement Please check all that apply: Service over 225 amps, comm'I EHazardous location ❑ Demolition ❑ Other: ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq ft , CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential ❑ I- and 2- family dwelling [Commercial /industrial ❑ Accessory building S over 600 volts nominal units in one structure ['Building over three stories ['Feeders, 400 amps or more ❑ Multi - family ❑ Master builder ❑ Other: ❑Occupant load over 99 persons ['Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park A 1/4767 (09 0 5 W v ar K S A U- above ❑Health -care facility ID Other Job no.: Job site address: Submit 2 sets of plans with any of the above City/State /ZIP: ` ( 4v _ a © 9 - 7 01 3 The above are not applicable to temporary construction service I (( FEE* SCHEDULE Suite/bldg. /apt. no.: Project name: �IAzEL7, i\i_ 0444 f n 4- ...zi- Description I Qty. I Fee. I Total I •' Cross street/directions to job site: 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'I 500 sq. ft or portion 33 40 1 Limited energy, residential 75.00 2 Tax map /parcel no.: Limited energy, non-residential 75 00 2 DESCRIPTION OF WORK Each manufactured or modular dwelling, service and /or feeder 90.90 2 o -rA ).J 1 0-Y0 tl—K C4A(�rL Services or feeders installation, alteration, and /or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454 65 2 Reconnect only 66 85 2 City /State /ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) Fax: ( ) 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 [APPLICANT ❑ CONTACT PERSON A Fee for branch circuits with service or feeder fee, each 6 65 2 Business name: e ` tJc -4,... -1-- ( g_�t"� Caw. A' - branch circuit B . Fee for branch circuits Contact name: 0 -1 ■ -c 7 without service or feeder fee, 46 85 2 Address: r each branch circuit �� ( �. J �C" LT Each add'I branch circuit 6 65 2 City/State /ZIP: / r //s r ao oR - 1 1 ( c Miscellaneous (service or feeder not included) ( Pump or irrigation circle 53 40 2 Phone: (5 - OJ) cs' % • / q 2.3 Z Fax • ( 3 ) 5 3.S- - ?Goer Sign or outline lighting 53 40 2 E -mail: Signal circuit(s) or limited - CONTRACTOR energy panel, alteration, or p 1 / extension Describe. I Page 2 1; 2 Business name: Co wt �t „.t`- rJ ( ESP r`O�r� en_ n1 a h i c,4 i c ,,,, s 1 Address: t 1 3 ,L' $ � Each additional inspection over allowable in any of the above l t Per inspection 62 50 City/State /ZIP: N c R • O ( 3 a Investigation per hour (I hr min) 62.50 i Phone: (SD ;) 5S - 5?,_3 Fax: (S s 3k • 6-Y6 & Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* CCB Lic.: 1 ' C) ( Electrical Lic.:34,- 'CLE Suprv. Lic.:3a7a.Le4 Subtotal r S ,C ) Suprv. Electrician signature, required: a+'7? • 1 Plan review (25% of permit fee) State surcharge (8% of permit fee) (o , cAo r- P Print name: 0 ` L. Date: 3 r T _ 6 TOTAL PERMIT FEE G O (•� < r Authorized signature: e <- . (--? This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: , l \ ` , �-� f x `- L Q ` ,. Date: S '- O ft ” Fee methodology set by Tn- County Building Industry Service Board `�v�7 7 «( "" Number of inspections per permit allowed i \Building\Permits\ELC- PermiApp doc 12/03 440- 461 5T(10 /02/COM/WEa IIIFF TIGARD 24 -Hour ILDING Inspection Line: (503) 639 -4175 IGN DIVISION Business Line: (503) 639 -4171 MST 2 BuP Received I Ldp P Date Requ d ` PM BOP Location .1/I.L - c Suite MEC Contact Person W Ph (,D ) 5S 9 2 PLM Contractor Ph ( ) 5-0 5-- SWR • BUILDING Tenant/Owner ELC Footing Foundation ELC Ftg Drain Access: / D �� 420 Crawl Drain � Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall �V �"\(1 1NI c- R , �_I, � ( Fire Sprinkler � J ) �C � Fire Alarm 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 ow V ag Fire arm final' ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. ART FAIL S qE J 1 � Please call for reinspection RE: O .Unable to inspect - no access Fire Supply Line ADA Approach/Sidewalk Date" \ Inspector . — .h Ext Other: Final DO NOT REMOVE this inspection record fro . the Jo site. PASS PART FAIL