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Permit , , A CI TY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT J k DEVELOPMENT SERVICES PERMIT #: ELR2005 -00187 I DATE ISSUED: 7/12/2005 '= - ° " " 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S113AD -01800 SITE ADDRESS: 16798 SW 72ND AVE B14 ZONING: I -L SUBDIVISION: OREGON BUSINESS PARK I LOT: 011 JURISDICTION: TIG Project Description: Voice and data cabling. 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: PACIFIC REALTY ASSOCIATES ORE -COM TELECOMMUNICATIONS 15350 SW SEQUOIA PKWY #300 -WMI 13826 S. MEYERS RD.#2127 PORTLAND, OR 97224 OREGON CITY, OR 97045 Phone: 503- 624 -6300 Phone: 503- 381 -7281 Reg #: ELE 34-691CLE LIC 152834 FEES Description Date Amount REQUIRED ITEMS AND REPORTS [ELPRMT] ELR Permit 7/12/2005 $75.00 [TAX] 8% State Surchart 7/12/2005 $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. ATT 1 1 ION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are se te h in OAR 952 - 001 -0010 through OAR 9 - 001 -0100. Yo , ay obtain copies of these rules or direct que ons to NC at 503 - 246 -6699. Issued By: A l_, 4 ,..,_ A _ ' _ /L 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: CaII 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 Api icationV E (� - , t ` � ; ' '' l am ` Imo_ i lci u i O' ` . :?.15:t.1!-,44j1=1,"'' �� �,• • '� # City of Ti and Received I2 /�� j r ���) JQ f `J g ;1 ` Date/By . / // / P ermit No ltd /JVI� s (Jt/ //> 1 13125 SW Hall Blvd., Tigard, OR 97223 2 2005 Plan Review � - C �{N Phone: 503.639.4171 Fax: 503.598.1 -960 OF T( v6,� p��g ReY Other Permit. Inspection Line: 503.639.4175 Y (�p�(' [_ Dateady/By: q El See Page 2 for Internet: www.ci.tigard.or.us BUILDING DIVISION Notified/Method :( Supplemental Information TYPE OF WORK • PLAN.,REVIEW ❑ New construction ❑ Addition/alteration/replacement Please check all that apply: ❑ Demolition Other: ( (,v ©� ❑Service over 225 amps, comm'I ['Hazardous location ['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 ❑ 1- and 2- family dwelling / 0 Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi- family 0 Master builder 0 Other: DBuildin over three stories ['Feeders, 400 amps or more ❑Occupant load over 99 persons ❑Manufactured structures or ' JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park ❑Health -care facility ❑Other: Job no.: Job site address: 7 9 2 ,c,_„, 21 N/11/ Submit 2 sets of plans with any of the above. City /State /ZIP: n 6 r Q 7u 3 The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: n Project name: 0 I1 FEE* SCHEDULE _ 1 D escription I Qty. I Fee. I Total I "" Cross street/directions to job site: �� O c l'V New residential single- or multi - family dwelling unit. (� Includes attached garage. /� f;/ (`-t eri .' u t v iE : p s • 1,000 sq. ft. or less 145.15 4 Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 Limited energy, non - residential 75.00 2 DESCRIPTION OF WORK Each manufactured or modular `/ .� /� n dwelling, service and/or feeder 90.90 2 "♦�L� - ‘ apcg L• I AJ! r 1 NS A . Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER . J ❑ 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: 0 2_ G9 Ati —ic branch circuit f 1) - �-' `, ` B. without for service circuits Contact name: ` � /,, 1 . without service or feeder fee, 46.85 2 Address: 1 i rk' v �(w �,p ^ each branch circuit lam'' Y'i �. lC t`'� �V J � � � 7 Each add'I branch circuit 6.65 2 City / State/ZIP: h Miscellaneous (service or feeder not included) L 77,, © p � p � r V �� � � /� q Pump or irrigation circle 53.40 2 Phone: (0 / ) 5F, 1 ' 7 2_s,-( � Fax: : (5613) b S -/ - -( 7 -7 [ 3 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: �`� Address: Each additional inspection over allowable in any of the above �, Per inspection 62.50 City /State/ZIP: ,O Investigation per hour (1 hr min) 62.50 ( . �.) Industrial plant per hour 73.75 Phone: ( ) (11/C0° Fax: ELECTRICAL'PERMIT FEES* CCB Lic.: l 2,2)3 y Electrical Li . : -� , - Suprv. Lic.: '��'' ✓✓ 7/. Subtotal 1L '' Suprv. Electrician signature, required: Plan review (25% of permit fee) Print name: N poU / 1 Date: 7 _ 1 Z _ 05 State surcharge (8% of permit fee) (,/ TOTAL PERMIT FEE ) , 06 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:\ Building \Permits\ELC- PennitApp.doc 12/03 440- 4615T(10 /02/COM/WFB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: [ '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: • l ` COMMERCIAL WORK ONLY Fee for each commercial system $75.00 (SEE OAR 918- 260 -260) . Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls El ❑ Clock Systems Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* • ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i:\ Building \Permits\ELC- Pe mitApp.doc 04/03 CITY OF TIGARD BUILDING DIVISION PERMIT #: ELR2005 -00187 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/1212005 Phone: (503) 639 -4171 /�aav �' Inspection Requests (24 Hrs.): (503) 639 -4175 _'_;; "'�I INSPECTION WORKSHEET FOR DATE: 7/14/2005 TIME: 7:11AM PAGE: 1 SITE ADDRESS: 16798 SW 72ND AVE B14 CLASS OF WORK: SUBDIVISION: OREGON BUSINESS PARK 1 LOT #: 011 TYPE OF USE: PROJECT NAME: COOKSON DESCRIPTION: Voice and data cabling. OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 503624 -6300 CONTRACTOR: ORE -COM TELECOMMUNICATIONS PHONE #: 503-381 -7281 Inspection Request Scheduled For: Date: 7/14/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 135 Low voltage 011436-01 503 - 381 -7284 N Corrections /Comments / Instructions: ( ■ t C CQ r( • • 'ASS .` • 'TIAL APPROVAL ❑ CANCEL ❑ NO ACCESS n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: L Date: 74 T 0S Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: — r —O Dfri 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: - 7-(2, _ Q S Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: /60 7 9 S W 7 Qt. ~ e I CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: coo kcSC c9 DESCRIPTION: OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message Corrections /Comments /Instructions: • PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: Phone #: (503) 718-