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Permit CITY TI GARD ELECTRICAL PERMIT - Mb ,: a r^ RESTRICTED ENERGY DEVELOPMENT SERVICES PERMIT #: ELR2000 -00270 Ai' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/8/00 SITE ADDRESS: 09300 SW WASHINGTON SQUARE RD PARCEL: 1S126C0 -01403 SUBDIVISION: ZONING: C -G BLOCK: LOT: JURISDICTION: TIG Project Description: Burglar Alarm located in customer pick -up area A. RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING: BURGLAR ALARM: X BOILER: LANDSCAPE /IRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: DATA/TELE COMM: NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: : HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: TOTAL # OF SYSTEMS: Owner: Contractor: MAY DEPT STORES COMPANY, THE ADT SECURITY SERVICES, INC ATTN: PROPERTY TAX DEPT 2815 SW 153RD DR 611 OLIVE STREET BEAVERTON, OR 97006 ST LOUIS, MO 63101 Phone: Phone: 503469 -7100 Reg #: LIC 0059944 ELE 26- 209CLE FEES Required Inspections Type By Date Amount Receipt Elect'l Final PRMT CTR 11/8/00 $75.00 2720000000 5PCT CTR 11/8/00 $6.00 2720000000 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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -1987. _� 1 Issued by ( 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 Electrical Permit Application Date received: Permit no.•, / # i i a70 L .j�t Alli . City of Tigard RECE . "',i t/appl.no.: Exptre date: City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no.: Phone: (503) 639 -4171 Fax: (503) 598 - 1960 N Q V 02584110 no.: Payment type: Land use approval: COMMUNITY DEVELOPMENT .. - TYPE OF PERMIT • 0 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial • • JOB SITE INFORMATION Job address: � 4` l.i Ski � 0 , Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: Block: Subdivisio '• Project name: V • • L' -� j Description and location of work on premises: 4 ,,_ ! - Q/ !J A, Estimated dat- of completion/inspection: it CONTRACTOR APPLICATION. ., FEE SCHEDULE . 13111170412111.1 Fee Max . Description Qty. (ea.) Total no. insp Business name: '� "r C( ,( c �('�J�� New residential - single or multi-family per Address:Q& lc'j ,C- '( dwelling unit. Includes attached garage. City: (ti\ I States � Zug � Q Service included: Phone - � Zy �l(P1�i'Y I Fax: I E- mail: ; 1000 sq ft. or less 4 1 C t e ' ( I 0-e ;p I / 1 E' Each additional 500 sq. ft. or portion thereof CCB no.: G "f Elec. bus. lic. no: 4 1� Linuted energy, residential 2 City /metro lic. no.: Limited energy, non- residential 2 v a / / ti , f � j/} �� v � )/f 3 " Ir t! /' y y Each manufactured home or modular dwelling Signature of sup ising ele tri an (require) / Da Service and/or feeder 2 Sup. elect. name (print): - /) k r / License no: Services or feeders – installation, alteration or relocation: Y;. - - PROPERTY CIWNER ------ _ - - - - -- - - - 200 amps orless 2 Name (print): 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 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, alteration,orrelocation: 200 amps or less 2 20 ORS 447, 455, 479, 670, 701. 201 1 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: 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 . (Serviceorfeedernotincluded): ❑ Service over 225 amps-commercial ❑ Health -care facility Each pump or irrigation circle 2 ❑ Service over 320 amps- rating of I &2 ❑ 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, ❑ System over 600 volts nominal more residential units in one structure alteration, or extension* f 16I 2 ❑ Building over three stories ❑ Feeders, 400 amps or more *Descnption: ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above: ❑ Egress/lighting plan ❑ 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 Permit fee $ '-f�-,bt� Not all jurisdictions accept credo cards, please call jurisdiction for more information. Notice: This permit application � ❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at %) $ Credit card number: / I within 180 days after if has been State surcharge (8 %) .... $ Expires accepted as complete. TOTAL $ Name of cardholder as shown on credit card $ Cardholder signature Amount 440 -4615 (6/00 /COM) t V, Electrical Permit Fees: Limited Energy 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 y Check Type of Work Involved: Residential - per unit I � 1000 sq. ft. or less .- $145 15 4 I I Audio and Stereo Systems . Each additional 500 sq ft. or , portion thereof $33.40 1 ❑ Burglar Alarm Limited Energy $75.00 Each Manuf'd Home or Modular Garage Door Opener Dwelling Service or Feeder $90.90 2 El Services or Feeders pi 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 200 amps or less - _ . _ $66 85 2 Fee for each system $75.00 201 amps to 400 amps $100 30 2 (SEE OAR 918 - 260 -260). 401 amps to 600 amps $133 75 2 Over 600 amps to 1000 volts, Check Type of Work Involved: see "b" above. Branch Circuits n Audio and Stereo Systems New, alteration or extension per panel a) The fee for branch circuits Boiler Controls with purchase of service or . feeder fee. n , Clock Systems Each branch circuit $6.65 2 b) The fee for branch circuits n Data Telecommunication Installation without purchase of service or feeder fee. n Fire Alarm Installation First branch circuit $46 85 Each additional branch circuit $6.65 ri HVAC Miscellaneous (Service or feeder not included) n Instrumentation Each pump or irrigation circle $53.40 Each sign or outline lighting $53.40 0 Intercom and Paging Systems Signal circuit(s) or a limited energy panel, alteration or extension $75 00 Minor Labels (10) $125.00 n Landscape Irrigation Control Each additional inspection over ❑ Medical the allowable in any of the above Per inspection $62 50 Per hour $62 50 Nurse Calls In Plant $73.75 n Outdoor Landscape Lighting Fees: ❑ Protective Signaling Enter total of above fees $ 8% State Surcharge $ n Other Number of Systems 25% Plan Review Fee See "Plan Review" section on $ front of application. * No licenses are required Licenses are required for all other installations Total Balance Due $ Fees: ❑ Trust Account # Enter total of above fees $ 8% State Surcharge $ Total Balance Due $ 1 \dsts \forms \elc -fees doc 10/09/00 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -He�lr Inspection Line: 639 -4175 - Business Line: 639 -4171 - BUP Date Requested / 2.2_ - O/ AM PM BLD . Location ?39O 5 (,�4 - s 7 S �, Suite MEC Contact Person Ph! - 7241y PLM Contractor , r) 7 Ph SWR BUILDING - Tenant/Owner • /7/i51-Al/C._ ELC Retaining Wall ELR [�97 - Footing Access: Foundation / FPS Ftg Drain � ~ ' ' '/ t-e f� v SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear d&ter 4.J Int Sheath /Shear Framing Insulation - Drywall Nailing Firewall ` Fire Sprinkler ��� /' Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL PLUMBING - Post & Beam Under Slab Top Out _ - Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL Post & Beam Rough In Gas Line Smoke Dampers Final PA FAIL E TRICAL • ervit,e Rough In UG /Slab Low Voltage Fire Alarm Fi PASS PART FAIL srrE Backfill /Grading Sanitary Sewer - Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: nable to inspect- no access ADA Approach /Sidewalk / ' Other Date / .Z ©/ Ins Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. •