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Permit .,.., A CITYOFTIGARD ELECTRICAL PERMIT - ENERGY RESTRICTED ENERGY - " ��� , DEVELOPMENT SERVICES PERMIT #: ELR2001 -00057 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/7/01 SITE ADDRESS: 13535 SW 72ND AVE PARCEL: 2S101DC -00300 SUBDIVISION: 72ND AVE OFFICE BUILDING ZONING: C -P BLOCK: LOT: JURISDICTION: TIG Project Description: Installation of limited energy for HVAC system. Job No. 72N -2012. A. RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: DATA/TELE COMM: NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: : HVAC: X • PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: . TOTAL # OF SYSTEMS: 1 Owner: Contractor: PACIFIC NW PROPERTIES HIBBARD CONTROL WIRING LLC 9965 SW ALLEN BLVD 10749 OAK ST, SUITE 1 SUITE 115 DONALD, OR 97020 BEAVERTON, OR 97005 Phone: Phone: 503 - 678 -5900 Reg #: LIC 134202 ELE 3-456C FEES Required Inspections Type By Date Amount Receipt Ceiling Cover PRMT CTR 3/7/01 $75.00 2720010000 Wall Cover 5PCT CTR 3/7/01 $6.00 2720010000 Elect Final 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 require o o rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 95g.. 01 -0010 throug OAR 95 - 001 -0080. You may obtain copies of these rul or direct questions to OUNC at (503) 246 -1987. J Is e by k - (-1�5� P ermittee Signatur 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 , , Datereceived: 7 0/ Permitno.: ea S' .,1 �! City of Tigard Project/appl. no.: Expire 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 Case file no.: Payment type: Land use approval: 61,4 P —DG?Q? TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement . New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial JOB SITE 11FOR19ATION Job address: ia220 Sub j2fd Ave) /355 Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: (Block: 'Subdivision: . Project name: - 72I4,0 A11fi ormiveati o''- J Description and location of work on premises: that) tOb3Ttipi, 1 4- 71tt-1LA71 flij Estimated date of completion/inspection: CON'T'RACTOR APPLICATION FEE SCHEDULE Job no: 1i1 - 2.o 12 Fee Max Business name: 1 ►10-p (,oNTeaL Id W g tr Description Qty. (ea.) Total no. insp New residential - single or multi - family per Address: Po . 4101 dwelling tmit . Includes attached garage. City: Do NI M;D I State: pit,' ZIP: °f 102,Q Service included: Phone: ( 6q Do I Fax: ti10sj 761 E -mail: 1000 sq. ft. or less 4 CCB no.: 1a4-2.02„. ' Elec. bus. lic. no: 3 -46 (, C/ Each additional 500 sq. ft or portion thereof Limited energy, residential 2 City/metro lic. no.: 3 -9 ? -oI /D' 1 O/ Limited energy, non- residential I 'IS 7 2 Each manufactured home or modular dwelling Signature of supervising electrician (required) Date Service and/or feeder 2 Sup. elect. name (print): License no: Services or feeders - installation, alteration or relocation: PROPERTY OWNER 200 amps or less 2 Name (print): 201 amps to 400 amps 2 401 amps to 600 amps 2 Mailing address: 601 amps to 1000 amps 2 City: !State: 'ZIP: Over 1000 amps or volts 2 Phone: I Fax: 1 E -mail: Reconnect only 1 Owner installation: The installation is being made on property I own Temporary services or feeders - insta which is not intended for sale, lease, rent, or exchange according to lladO°+ alteration, °rrelocation: 200 amps or less 2 ORS 447, 455, 479, 670, 701. 201 amps to 400 amps 2 Owner's signature: Date: 401 to 600 am s 2 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: J 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: PI.AN REVIEW (Please check all that apply) Misc. (Service or feeder not included): O Service over 225 amps - commercial 0 Health- carefacility Each pump or irrigation circle 2 O Service over 320 amps -rating of 1&2 0 Hazardous location Each sign or outline lighting 2 family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited nergy panel, O System over 600 volts nominal more residential units in one structure alteration, or extensio 2 0 Building over three stories 0 Feeders, 400 amps or more *Description: O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above: O Egress/lightingplan 0 Other. Per inspection 1 1 1 1 Submit sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ 75 h0 O Visa 0 MasterCard expires if a permit is not obtained' Plan review (at _ %) $ Credit card number: / 1 within 180 days after it has been State surcharge (8 %) .... $ („,.00 Expires accepted as complete. TOTAL $ 931 Name of cardholder as shown on credit card $ Cardholder signature Amount 440-4615 (6A0/COM) Electrical Permit Fees: Limited Energy Fees: Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY l� 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 1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems Each additional 500 sq. ft. or portion thereof $33.40. 1 ❑ Burglar Alarm Limited Energy $75.00 Each Manufd Home or Modular ❑ Garage Door Opener Dwelling Service or Feeder $90.90 2 Services or Feeders ❑ Heating, Ventilation and Air Conditioning System* Installation, alteration, or relocation 200 amps or less $80.30 2 ❑ Vacuum Systems 201 amps to 400 amps $106.85 2 401 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 Fee for each system $75.00 200 amps or less $66.85 2 (SEE OAR 918 -260 -260) 201 amps to 400 amps . $100.30 2 401 amps to 600 amps $133.75 2 Check Type of Work Involved: Over 600 amps to 1000 volts, see "b" above. ❑ Audio and Stereo Systems Branch Circuits n Boiler Controls New, alteration or extension per panel a) The fee for branch circuits with purchase of service or ❑ Clock Systems feeder fee. Each branch circuit $6.65 2 ❑ Data Telecommunication Installation b) The fee for branch circuits without purchase of service ❑ Fire Alarm Installation or feeder fee. First branch circuit $46.85 Each additional branch circuit $6.65 HVAC • Miscellaneous ❑ Instrumentation (Service or feeder not included) • Each pump or irrigation circle $53.40 ❑ Intercom and Paging Systems Each sign or outline lighting $53.40 Signal circuit(s) or a limited energy panel, alteration or extension $75.00 ❑ Landscape Irrigation Control Minor Labels (10) $125.00 Each additional inspection over ❑ Medical the allowable in any of the above ❑ Per inspection $62.50 Nurse Calls Per hour $62.50 In Plant $73.75 ❑ Outdoor Landscape Lighting* Fees: ❑ Protective Signaling Enter total of above fees $ El Other 8% State Surcharge $ Number of Systems 25% Plan Review Fee See "Plan Review" section on $ * No licenses are required. Licenses are required for all other installations front of application. Fees: • Total Balance Due $ Enter total of above fees $ 1 6 • 00 ❑ Trust Account # 8% State Surcharge $ b • 00 • Total Balance Due $ 13 1 • J 0 i:\dsts \forms\elc - fees.doc 10/09/00 ✓ 111 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 • Business Line: 63 ' 171 .. BUP Date Requested 1 -/' Z y AM PM BLD i :s Location /3130 5 Suite MEC +[J Contact Person Ph cg) Z � 7f' P Contractor /7/ t Il Ph gel? LaG WR BUILDING - Tenant/Owner LC Retaining Wall • LR Footing Access: grrOF/ Foundation F• Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT q.(r Post & Beam Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall. Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final Pg 1 l C PASS PART FAIL PLUMBING Post & Beam ' / Under Slab !/ /g- c - Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL t/ ` - O a ---06 A Post & Beam Rough In / oo i " 00 Gas Une Smoke Dampers Final 1-k1//?-C. PASS PART FAIL � ` v Arm) a a d �ECj$r�` ► Service ei / vI CI / ca e �� , h - Gr.le /ls 0% Rough In "- UG/Slab Low Voltage Fire Alarm . PASS RT FAIL . Backfill/Grading Sanitary Sewer Storm Drain [ 1 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access Fire Supply Une ADA - '4/ Approach/Sidewalk Date Inspector Ext Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.