Permit CITY OF TIGARD ELECTRICALPERMIT -
RESTRICTED ENERGY
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DEVELOPMENT H BMENT r SERVICES � 639 -4171 DATE SSU 9/22/03
03 -00284
SITE ADDRESS: 09020 SW WASHINGTON SQUARE RD 350 PARCEL: 1S126BC -01506
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Install data elecommuniction.
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:
PORTLAND OFFICE ASSOCIATES T & L COMMUNICATIONS INC
BY TC PORTLAND, INC PO BOX 87387
8930 SW GEMINI DR VANCOUVER, WA 98687 -7387
BEAVERTON, OR 97008
Phone: Phone: 360 - 737 - 9725
Reg #: LIC 67787
ELE 37- 428CLE
FEES Required Inspections
Description Date Amount Elect'I Final
[ELPRMT] ELR Permit 9/22/03 $75.00 w VOLTi3GE
[TAX] 8% State Tax 9/22/03 $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 -- - _ �7_ _ / Permittee Signature
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
` FOR OFFICE USE ONLY
t lectrleal Permit Application Received R DD -- --
RECEIVED
Planning y: p a�3 8 f Electrical Permit No F � — 00.) 2(1 Cl of Tigard V Planning Approval Sign
City g Date/By: Permit No.:
13125 SW Hall Blvd. 6 Plan Review Other
Tigard, Oregon 97223 SEP 2 2 2003 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 - 598 -1960 4,0471 Post - Review Land Use
tt Date/By: Case No.:
Internet: www.ci.ti ard.or. CITY OF TIGARD II ® g Contact J s See Page 2 for
U7=0�.i
24 - hour Inspection Request: P- 1 7 SIO - _ � Name/Method: 1 i L\ Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health-care facility
commercial ❑ Hazardous location
❑ Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
In I & 2- Family dwelling jCommercial/Industrial ' f L ❑ System over 600 volts nominal one structure
❑ Building over three stones ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other.
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: 90 as) S W 0 Srj�4c A re FEE* SCHEDULE
Suite #: 3 Bldg. /Apt. #: �! Number of inspections per permit allowed
Project Name: S'FA &ii [ 'tap e r J Description Qty Fee (ea.) Total
New residential - single or multi - family per 1
Cross street/Directions to jOlo site: dwelling unit. Includes attached garage.
Service included:
1000 sq ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Lot #: Limited energy, residential 75 00 2
Subdivision: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
Services or feeders - installation,
0A'+ f eA or ,e . alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85 i
F ax: 201 amps to 400 amps 100.30 2
Phone: 401 to 600 amps 133 75 2
❑ APPLICANT ❑ CONTACT PERSON Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
Business Name: i J_ Co Description.
i n. extension Page 2 2
T Yh M k r+ (C i RTI t)NS Description.
Address: P. o . Kok 87387
c, / G Each additional inspection over the allowable in any of the above:
City /State /Zip: V�,vC o a W Y �O C�0 Per inspection per hour (min. 1 hour) 62.50
Phone: 3/,o - 737 - Fax: -737 - y698 Investigation fee:
Lic. #: 37 - ii 28 C L o t h er:
CCB Lic. #: 6 77 8 7 Electrical Permit Fees*
Supervising electrician Surcharge (8% of Permit Fee) $ $ Subtotal $ — 7 5
d Plan Review 25% of Permit Fee $
Signature required: S tate Surc Co. Print Name: L,��i� �Kl�i✓Ir� Lic. #: &S y Cr�l TOTAL PERMIT FEE $ �( I . ()()
Authorized (z _ � Lj Notice: This permit application expires if a permit is not obtained within
Signature: nA-Ad_ 16 1 - Q 421" Date: I - 2 - 2 -o 3 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
(Please print name)
i:\Dsts\Petmit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Burglar Alarm
❑ Garage Door Opener
n Heating, Ventilation and Air Conditioning System
n Vacuum Systems
• Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
E Boiler Controls '
E Clock Systems
3 l/ Data Telecommunication Installation
r
0 Fire Alarm Installation
❑ HVAC
0 Instrumentation
0 Intercom and Paging Systems
DI Landscape Imgation Control
❑ Medical
n Nurse Calls
O Outdoor Landscape Lighting
E Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03