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Permit A s CITYOF TIGARD RESTRICTED ER .1i( DEVELOPMENT SERVICES PERMIT #: ELR2004 -00207 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 7/15/2004 SITE ADDRESS: 13333 SW 68TH PKWY 1ST F PARCEL: 2S101 DA -00104 SUBDIVISION: FARMERS INSURANCE ZONING: MUE BLOCK: LOT: JURISDICTION: TIG Project Description: Installation of voice /data on 1st floor. 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: FARMERS INSURANCE GROUP AZIMUTH COMMUNICATIONS INC 13333 SW 68TH PKWY P.O. BOX 508 TIGARD, OR 97223 WILSONVILLE, OR 97070 Phone: Phone: 503 639 - 0110 Reg #: ELE 36 -94CLE SUP 2312LEA LIC 145828 FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 7/15/2004 $75.00 Elect'I Final [TAX] 8% State Surchart 7/15/2004 $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 thro : 0 A 95 -i= -0100. Y : bt.'n copies of these rules or direct questions to OUNC at (503) 246 -6699. Is- ed by k , "Jj //M, � /! /I 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 FOR OFFICE USE ONLY City of Tiga d a Da 1 /S 0171 �� , I �� 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review 00,2a Phone: 503.639.4171 Fax: 503.598.1960 G, 'p,"041ji- Date/B : Other Permit: Inspection Line: 503.639.4175 :AM f' Date Ready/By: ®See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: f , Supplemental Information TYPE OF WORK , . PLAN REVIEW, ❑ New construction IJgAddition /alteration/replacement Please check all that apply: ❑ Demolition ❑Other: ['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 gtommercialfindustrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi - family ❑Master builder ❑Other: ['Building over three stories ['Feeders, 400 amps or more ['Occupant load over 99 persons ['Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress/lighting RV park Job no.: Job site address: 13333 s,Wi 6stt pkwy ❑Health -care facility ['Other: Submit 2 sets of plans with any of the above. City/State/ZIP: TI o12 ci.7-22.3 Cg e0 The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: or-2., , (Project name: FA rL0u1etg C�zeo rt VIJIfNv FEE* SCHEDULE p Description I Qty. I Fee. I Total I •* Cross street/directions to job site: LOOSE 9. ©F I- S ,4 21 '- 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 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 /�( o , 1 ' dwelling, service and /or feeder 90.90 2 V / T . 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: 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 : - E APPLICANT 1 ❑ CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each 6.65 2 Business name: -7( a.l.yf -4 co itAit,( UkIt C T(olr l S branch circuit B. Fee ou service circuits Contact name: )-r ul.11i T� without service or feeder fee, 46.85 2 q N each branch circuit Address: / s S � l �n �0 , Each add'l branch circuit 6.65 2 City/State/ZIP: `TL ,k- _ f l tJ t o re._ '?7--0 z- Miscellaneous (service or feeder not included) ( �5) 3 ij / / 0 (9) ) q Sump or irrigation tl i ne ti g L 53.40 2 Phone: Fax: '� 6 3 � l t Sign or outline lighting 53.40 2 E - mail: s bortett cer.I "tvtkC0MW(1)/1 .Cao-1 Signal circuits)orlimited- CONTRACTOR - - - energy panel, alteration, or ' extension. Describe: + Page 2 2 Business name: t4z t om ' l CO ylh.Sl UN ( L 0145 J Address: / p Lk.) l U f N ^. »..i � �`� Each additional inspection over allowable in any ofxhe above Per inspection 62.50 City/State /ZIP: TUR—( j r OK_ »Q6 2- Investigation per hour (1 hr min) 62.50 Phone: ( 9 3 6 39---c, 6, Fax: ( 3) c 39 —0 / / c Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* ` CCB Lic.: 11-1-5- g Electrical Lic.: 36 ZCSuu Lic.: 23 f�1`� Subtotal Suprv. Electrician signature, required: � .�J�/ Plan review (25% of permit fee) Print name: `� g -E. "� Date: 1451,9 State surcharge (8% of permit fee) r 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:\ Building \Permits\ELC- PermitApp.doc 12103 440- 4615T(10 /02/C0M/WEB Electrical Permit Application - City of Tigard Page 2.- Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENIAL 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: 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 ❑ Clock Systems t4 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: I *No licenses are required. Licenses are required for all other installations i:\ Building \Pemtits\ELC- PetnitApp.doc 04/03