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7320 SW HUNZIKER ST 101
ELECTRICAL PERMIT-
CITY OF TIGARD
RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT#: ELR2004-00074
3125 SW Hall Blvd., 'Tiaa d, OR 97223 (503) 639 4171 DATE ISSUED: 3/17/2004
PARCEL: 2S101 DB-00100
SITE ADDRESS: 07320 SW HUNZIKER ST 101
SUBDIVISION: ZONING: C-P
BLOCK: LOT- JURISDICTION: TIG
Proiect Description: Install data/telecommunications system.
FA.RESIDENTIAL _ L.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 L.ANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
_ TOTAL.# OF SYSTEMS:_ I
Owner. --- -- ----- Contractor: _ _—
ROBINSON DEVELOPMENT COMPUIER TELEPHONY COMMUNICATIONS
PO BOX 91305 PcE30X 879
PORTLAND, OR 97291 fJFWBL1',G, 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 3/17/2004 $75.00 Elect'I Final
[TAX] 8%State Surchart 3/17!2004 $6.00
Total $81.00
This Permit is Issued subject to the regulations contained in the Tigard Municipal Code, State of OR. SI Jalty 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.
l
Issued by t�� "7��JIt�__ Permittee Signature eA '4��L.iC'� O
OWNER INSTALLATION itNLY
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: -
Cad 639-4175 by 7:00 P.M. for an inspection nc-eded the next business day
Electrical Permit Auplicaflil VE D
Received
City of Tigard Date/By Permit NL,z z_q__l�OL c�(TyZ'—-f_
13125 SW hall Blvd.,Tigard,OR 97223 MA R 1 / t'1101i Plan Review Other Permit. ZAU—
phone: 503.639.4171 Fax: 503.598.1960 Date/By: WV
Date Rcady/9y: mrix 0 See Page 2 for
Inspection Line: 503.639.4175 CITY uF 11GAk, Notified/Melhod. Supplemental information
Internet www.ci.tigard.or.us 81111 n11,1r-, n1,,/117
PLAN REVIEW
TYPE OF WORK
-- Please check all that apply.
❑New construction Addition/alterationlreplacement []Service over 225 amps,comm'i ❑I Iazardous location
❑Demolition ❑Other: — — []Service over 320 amps-rating ❑Iluildng over 10,000 sq.It.
CATEG RV OF CONSTRUCTION of I-and 2-family dwellings 4 or more new residential
❑System over 600 volts nominal units in one structure
CM3 I-and 2-family dwcllm@ [B Commercial/industrial ❑Accessory building []Building over three stories ❑Feeders,400 amps or more
❑ Multi-family ❑Master builder ❑Other: []Occupant load over 99 persons ❑h1anutactured structures or
f'. ress/li htin
JOB SITE INFORMATION AND LOCATION _ ❑ g g 8 plan RV park
❑Other:
❑health-care facility ------
V Job ItfQ I 2 y� Job site address: '1 \ "vtZ,ISE C� Submit 2 sets of plans with any of the above.
City/State/'LIP: T' R. fhc uh,we are not applicable to temporary construction scrvtce ..
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FEE* SCHEDULE
Suite/bldg./apt.no.: t. Project name_ �� ,]. t� nerrrlpnnn Va>' Ft. ToUa
Cross street/directions to job site: New residential single-or multi-family dwelling unit.
_ Includes attached garage.
1,000 sq.R.or less 145.15 4
Lot no.: Ge.edd'I 500 sq.ft.or portion 33A0 1
Subdivision: Limited energy,residential 75.00 2
Tax map/parcel no.: Limited energy,non-residential 75.00 - 2
DESCRIPTION OF WORK _ Each manufactured or modular
:7
dwellin ,service and/or fccder 9090 2
yC i L >6:LA Cl� J t(1 L1 S Services or feeders installation,alteration,and/or relocatlon
200 amps or less W6685
2
TENANT 201 amps to 400 amps 2
❑ PROPERTY OWNER t _-_ ❑ 401 amps to 600 amps 2
Name: 'TL Tj ��ty a�.�_- `q, S Sic � N — 601 amps to t A00 amps — 2
1'' Over 1,000 amps or volts 2Address: • 3GJp SvJ i unz a 2 $i � _ 72a' 2
I� f -- Reconnect only
City/State/7.IP: "(',a a 0 Cl Z •2_ � Temporary services or feeders installation,alteration,and/or
relocation
Phone: �on
-0 1(li 5 200 amps or less 66.85 1
I hone:(503 )`1lc$- �3 K --.
Owner installation:"1'hts installation is bethat 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: __ Dal'.: —_----- - Branch circuits-new,alteration,or extension,per panel
CONTACT PERSON A.Fee for branch circuits with
[I APPLICANT _ ❑ —_ service or feeder fee,each 6.65 2
Business name. .} branch circuit
VA"k.tom r_d��-`m t t�----- B.Fee fbr branch circuits
Contact nutne: ��.t p -� t C-I' _ trithnut service or feeder fee, 46.85 2
`T- each branch circuit
Address: 1 St V Q�Ir K L a-6,% Q Each add'I branch circuit 6.65 2
City/State/7.IP: W'r �(v.�9t )� Miscellaneous(service or feeder not Included)
Pump or irrigation circle _53.40 2
St)5 Fax: :(501j) 5 3��� 5� �f-- Si n or outline li htin 53.40 2
Phone:( ei0'S) S c( oZ _ g B B
E-mail: LA�1 t^ �Ot k E -C C =- co Signal circuit(")or limited-
CONTRACTOR energy panel,alteration.or
— I -- — extension.Describe: Page 2 I 2
Business name: C C,^, GtMW1�� c1 ti c a^Ty tt S _-
Each additional inspection over allowable in any of the above
Address: ►� v_ 1 �Qh �,a.�-1 Per inspection 62.50
+ Investigation per hour(I hr min) 62.50
City/State"7.1f: (I,�_�¢>-�C f Zc
- l 13.
Industrial plant per hour 73 75
Phnne:(503) 55 N' c 'Zio,3 4 Far:('563 153 h ' 5"1k ELECTR_ICA FERMI I FEES"
UCB Lit:.: 15"000 ( Electrical Lic.:31d11 r-I-C Suprv.Lic.: 321ZL� Subtotal
Suprv.Electrician signnture.required: plan review(25°�of permit fee)
-- - _
� - State surcharge I8"%of permit fee) t:'b
Print name- Date:_ �' TOTAL PERMIT FEE -�
—T `L
Authorized signature: This permit applicationexpires ff s permit J%not obtained within Iso
days after It has been accepted as complete
Print name: wa { L�� Dote: "] (� • Fee methodulugy set by per
Building Industry Service n mrd
—+--- •'Numtxa of fmpecuons per permit allowed
ilouitdingTermiu\ELC-PermitAppdoc IM 440.46157-0W02WOMM'F.n
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