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Permit ELECTRICAL C ITY OF TIGARD RESTRICTED ENERGY ar,14 13125 , I 4 ' DEVELOPMENT H PMENa Tigard, (503) 639 -4171 DATE ISSUED: 4% R 2004 SITE ADDRESS: 11491 SW 90TH AVE PARCEL: 1 S135DB 12900 SUBDIVISION: HOFFMAN PART /MLP2003 -00015 ZONING: R -4.5 BLOCK: LOT: 002 JURISDICTION: TIG Project Description: Low voltage: All encompassing. 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: ALL ENCOMP : X HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: TOTAL # OF SYSTEMS: Owner: Contractor: HOFFMAN, MICHAEL J PHILLIPS ELECTRONICS 1223 NW 24TH #5 (DBA FOR MASTER ALARM L.L.C.) PORTLAND, OR 97210 1110 NW FLANDERS PORTLAND, OR 97209 Phone: Phone: (ROBERT) Reg #: L/C2- 508325364 ELE 26- 213CLE FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 4/21 /2004 $75.00 Elect'I Final [TAX] 8% State Surcharl 4/21/2004 $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 through OAR 952 -'11 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699. Issued by ' 410 Permittee Signature wAr , i / _ 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 Y Electrical Permit Application Date received: 4, pi/ , j Permit no. i.' is -Dbio A ' x 14 1' City of Tigard �: Y b Project /appl. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date.issued: B Phone: (503) 639 -4171 By: • Receipt no.: Fax: (503) 598 -1960 Case file no.: Payment type: - - Land use approval: ' . - 1'1 TYPE OF PERMIT • p 1 & 2 family dwelling or accessory 0 Commercial/industrial ❑ Multi - family ❑ Tenant improvement ❑ New construction 0 Addition/alteration /replacement 0 Other: ❑ Partial JOB SITE INFORMATION Job address: 1 /491 c ( 901± i - Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: I Block: I Subdivision: Project name: w t6v I Description and location of work on premises: Scj ,kpy A( %r t Jim wG.� ( 44 Estimated_ date of completion/inspection: . .._ . _,CO, 1TR AJCIOR.AP...PLLCATLON,._..._., . -- - . FEE S,(✓(I 41IILE Job no: • Fee Max Business name:/4 Gf r�v ,,, Description Qty. (ea.) Total no. insp - 4 r ,/ New residential - single or multi - family per Address: 00 /V' (I, ni F- dwelling unit. Includes attacliel garage. City cpy I State: 6,, I ZIP:' 7 .or Serviceincluded: Phone: �2S I Fax:22.'P c9•7-z_ I E -mail: 1000 sq. ft. or less • 4 Each additional 500 sq. ft. or portion thereof CCB no.: /.s of I Elec. bus. lic. no: _26 - 2(2 - C i✓ f Limited energy, residential 2 City /metro lic. n•.: 3003 Limited energy, non - residential 2 ile - / , Zip • AI/ 1(./124 Each manufactured home or modular dwelling Si:tf to I- if supervising electrician (required) Date Service and/or feeder 2 elect. name (print): Services or feeders — installation, . Sup. (p ) J e-cc S" cp-t-� L icense no: v 3`•� �{ 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: I State: I ZIP: Over 1000 amps or volts 2 Phone: I Fax: I E -mail: Reconnect only t 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, or relocation: ORS 447, 455, 479, 670, 701. 200 amps or less 2 201 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: I State: I ZIP: B. Fee for branch circuits without purchase - of service or feeder fee, first branch circuit: 2 Phone: Fax: E Each additional branch circuit: PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included): ❑ Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2 ❑ Service over 320 amps- rating of 1&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* ' 7S 7 2 ❑ Building over three stories ❑ Feeders, 400 amps or more *Description: ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above: ❑ Egress/lighting plan 0 Other: Per inspection Submit sets of plans with any of the above. . Investigation fee ' — - The above are not applicable to temporary construction service. Other Permit fee $ 7S `"" _ Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application 0 Visa ❑ MasterCard expires if a permit is not obtained Plan review (at %) $ Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ 6 oo Expires accepted as complete. TOTAL $ / . Name of cardholder as shown on credit card.. $ Cardholder signature Amount 440 -4615 (6/00 /COM) • Electrical Permit Fees: Limited Energy Fees: . Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY p Restricted Energy Fee $75.00 Number of Inspections per permit allowed (FOR ALL SYSTEMS) Service included: Items Cost Total 1 Check Type of Work Involved: Residential - per unit 1000 sq. ft. or less $145.15 4 n 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 n Garage Door Opener* Dwelling Service or Feeder $90.90 2 Services or Feeders . Heating, Ventilation and Air Conditioning System* Installation, alteration, or r 200 amps or less $80.30 2 El , 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 ❑ Audio and Stereo Systems New, alteration or extension per panel a) The fee for branch circuits in 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 n HVAC Miscellaneous (Service or feeder not included) n Instrumentation Each pump or irrigation circle $53.40 Each sign or outline lighting • $53.40 - • Signal circuit(s) or a limited energy ❑ Intercom and Paging Systems panel, alteration or extension $75.00 Minor Labels (10) $125.00 I Landscape Irrigation Control Each additional inspection over n Medical the allowable in any of the above Per inspection $62.50 Per hour - ' • • • _ - $62.50 _ L I Nurse Calls In Plant $73.75 n Outdoor Landscape Lighting* . Fees; n Protective Signaling Enter total of above fees $ n Other 8% State Surcharge $ 25% Plan Review Fee Number of Systems See "Plan Review" section on $ front of application. * No licenses are required. Licenses are required for all other installations • Total Balance Due $ Fees: 0 Trust Account # Enter total of above fees $ 8% State Surcharge $ • Total Balance Due $ • • is \dsts \forms \elc- fees.doc 10/09/00