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Permit 'J • C ITY OF TI GA R D ELECTRICAL RESTRICTED ENERGY PERMIT i DEVELOPMENT SERVICES PERMIT #: ELR2005 - 00289 ' . 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/19/2005 PARCEL: 1 S 126BC -01506 SITE ADDRESS: 09020 SW WASHINGTON SQUARE RD 550 ZONING: C - G SUBDIVISION: LOT: JURISDICTION: TIG Project Description: Voice /Data. 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 A -REBS COMMUNICATIONS INC BY TC PORTLAND, INC 5855 SW TARALYNN AVE 8930 SW GEMINI DR BEAVERTON, OR 97005 BEAVERTON, OR 97008 Phone: Phone: 520 -0625 • Reg #: ELE 34- 558CLE LIC 86096 FEES SUP 2340RET Description Date Amount REQUIRED ITEMS AND REPORTS [ELPRMT] ELR Permit 9/19/2005 $75.00 [TAX] 8% State Surcha 9/19/2005 $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 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699. • Issued By: // j P 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 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Electrical Permit Application ,, vim ()Frio usr ONi ' / i d City of Tigard 4 '` i -- Date/B I J Permit No . wi 1 4 2 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone CEP 1 9 200 503.639.4171 Fax 503 598 1960 v */p!..., i j , i ";,. Date/B . Other Permit Inspection Line: 503.639.4175 , Date Ready/By: IVIA PI See Page 2 for Internet: www.ci.tigard.or.us Noufied/Method Supplemental Information TYI I-�� TIGARD PLAN REVIEW A �O;'r ag [ New construction ❑ A dd orriillaalteration/replacement Please check all that apply: El Demolition El Other: ❑Service over 225 amps, comm'I ['Hazardous location OService over 320 amps — rating ❑ Buildng over 10,000 sq. ft., CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential ❑ 1- and 2 family dwelling 181 Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure El Multi - family ❑ Master builder ❑ Other: ['Building over three stories 0 Feeders, 400 amps or more DOccupant load over 99 persons ❑Manufactured structures or ' - JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park Job no.: Job site address: So to SW WAS -roN.) �,P ❑Health care facility DOther: Submit 2 sets of plans with any of the above. City/State/ZIP: -(' IGAR0 r o _ R . CJ 7 22 3 The above are not applicable to temporary construction service. S ldg. /apt. no.: 65 0 Project name: (nu T dm- o- (9,,,,,,-, A FEE* SCHEDULE uit Description I Qty. I Fee. I Total 1 . 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'l 500 sq. ft. or portion 33.40 I Limited energy, residential 75.00 2 Tax map /parcel no.: Limited energy, non - residential 1/ 75.00 2 DESCRIPTION OF WORK Each manufactured or modular dwelling, service and/or feeder 90.90 2 ' /O (Cc ` — .d7.A C". PsL 1 to Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER I _ ❑ TENANT _ 201 amps to 400 amps 106 85 2 - 401 amps to 600 amps 160.60 2 Name: oNc nm q 55 _ras 601 amps to 1,000 amps 240.60 2 Address: t TO ` S ( 0 Over 1,000 amps or volts 454.65 2 ` Reconnect only 66.85 2 City /State/ZIP: 71 6_ t' a n � p t © � , y 7 Z Z 3 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 ' I - ❑ CONTACT PERSON A. Fee for branch circuits with 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'l branch circuit 6.65 2 City /State/ZIP: Miscellaneous (service or feeder not included) Phone: ( ) Fax :: ( ) Pump or irrigation circle 53.40 2 Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited- , . ' CONTRACTOR - - energy panel, alteration, or extension. Describe: Page 2 2 Business name: ( _TZEBS _ Cz9)vn1 Z1f c_ Address: 8 —�A RA L N N A J E- Each additional inspection over allowable in any of the above Per inspection 62.50 City/State/ZIP:P =/,U ERTO i 9 7 00 S Investigation per hour (I hr mm) 62.50 (Go 5Z0 062_S (503) Co* 52/ ( o Industrial p lant per hour 73.75 Phone: Fax: ELECTRICAL PERMIT FEES* CCB Lic.: X36096 Electrical Lic.:CLE• 33-sStituprv. Lic.: Le/5 2e{ Subtotal Suprv. Electrician signature, required: Parbo Plan review (25% of permit fee) Print name: -130B STRo»J & Date:e( S State surcharge (8% of permit fee) TOTAL PERMIT FEE 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 \ Budding \Permits\ELC -Pe mitApp doe 12/03 410.4615T(10/02/COM/WEB Electrical Permit Application - City of Tigard ° Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: r'RESIDENTIAL WORK ONLY' • :.} 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: r COMMERCIAL WORK ONLY: --• 1 Fee for each commercial system $75.00 (SEE OAR 918-260-260) Check Type of Work Involved: El Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems S .-Data Telecommunication Installation ❑ Fire Alarm Installation El HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical • ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling El Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations \Building\Permus\ELC- PermrtApp doc 04/03 p 1 ow-dy OF TIGARD 3u IL ®ING DIVISION PERMIT #: ELR200 00289 3125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/19/2005 Phone: (503) 639-4171 Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: q/22/2O05 TIME: 7:12AM PAGE: 24 SITE ADDRESS: 09020 SW WASHINGTON SQUARE RD 5��J CLASS OF WORK: SUBDIVISION: L'OT #: TYPE OF USE: PROJECT NAME: MUTUAL OF OMAHA DESCRIPTION: Voice/Data. OWNER: PHONE #: CONTRACTOR: PORTLAND OFFICE ASSOCIATES A -REBS COMMUNICATIONS INC PHONE # : 520 0625 Inspection Request Scheduled For: Date: 912212 005 Pour Time: Code # Inspection Description Confirm # Contact # Message 135 L l t* Itage 016374 -01 503 - 520.0625 N (∎ - Co re c ons /Co ents / 1► • : q.44J • • • PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL ❑ CA 'iR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: � i Date: 9 ?' Phone #: (503) 718- ,