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Permit CITY TI GARD ELECTRICAL RESTRICTED ENERGY PERMIT DEVELOPMENT SERVICES PERMIT #: ELR2005 -00167 �� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/28/2005 PARCEL: 1S135BA-03302 SITE ADDRESS: 10520 SW CASCADE AVE ZONING: I -P SUBDIVISION: OFFICE DEPOT LOT: JURISDICTION: TIG Project Description: 2 low voltage cabling for office and HVAC monitor system. A. RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: X 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: 2 Owner: Contractor: MARX, ERNEST L + BARBARA R BAILEY'S ELECTRIC LLC TRUST 2160 SW LEE WOOD DR 2140 VELOZ DR ALOHA, OR 97006 SANTA BARBARA, CA 93108 Phone: Phone: 503 849 - 3134 Reg #: LIC 159814 SUP 5115S FEES ELE 34 -389C Description Date Amount REQUIRED ITEMS AND REPORTS [TAX] 8% State Surchari 6/28/2005 $12.00 [ELPRMT] ELR Permit 6/28/2005 $150.00 Total $162.00 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 - 001 -0100. You y obtain copies of these rules or direct questi. s to OUNC at 503 - 246 -6699. Issued By: � c �2 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 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 Application FOR OFFICE-USE ONLY. Cit of Tigard JUN 2 Received Z U ( j OS Date/By. - t7 I Permit No ; L __ale 0 r - // t / 7 13125 SW Hall Blvd., Tigard, 012 Plan Revie Phone: 503.639.4171 Fax: S� 8 ' .1 46 i TIGgRD A. ' t /I� jl l `i Date/By Other Permit: Inspection Line: 503.639.4175 UU LD!N f ®j //��e pp�� ^• Date Ready/By: ®See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: l `, Supplemental Information TYPE OF WORK . PLAN REVIEW ❑ New construction ❑ Addition/alteration/replacement Please check all that apply: ❑ Demolition ❑ Other: ❑Service over 225 amps comm'l ❑Hazardous location 7 c----% ❑ 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 ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ['Building over three stories ❑Feeders, 400 amps or more ❑ Multi- family 0 Master builder ❑Other: ❑Occupant load over 99 persons El Manufactured structures or • JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park • Job no.: Job site address: ! D Z S � sC46/P ❑Health - care facility ❑ Other: 3 Submit 2 sets of plans with any of the above. City /State/ZIP: 7 x i_ I] O 2 7 G Z The above are not applicable to temporary construction service. f Suite/bldg. /apt. no.: Project name: �1 / p � + FEE SCHEDULE �� ✓� .t �'� Description I Qty. I Fee. I Total *" Cross street/directions to job site: 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'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 " f) / f _� 6 � r`Ny 11(/#-- j� f c dwelling, service and/or feeder 90.90 2 LQ �( (f </ TU Services or feeders installation, alteration, and /or relocation S ,sl[ f ,k 200 amps or less 80.30 2 ❑ PROPERTY OWNER ❑ 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: branch circuit Contact name: B. Fee for branch circuits without service or feeder fee, 46.85 2 Address: each branch circuit Each add'I branch circuit 6.65 2 City /State/ZIP: Miscellaneous (service or feeder not included) Phone: ( ) FaX:: ( ) Pump or irrigation circle 53.40 2 Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited - CONTRACTOR energy panel, alteration, or / t / S` extension. Describe: Page 2 2 Business name: e / ee•4 L .z__ C Address: e 2 j 1 •' Z.ze., J Each additional inspection over allowable in any of the above �2 ` Per inspection 62.50 City / State/ZIP: p a �� i , ©� 9 Z. ,73 Investigation per hour (I hr min) 62.50 Phone: (j Q ) q / 7 j ' v Fax: ( --} -- ? (' — — t Industrial plant per hour 73.75 r ELECTRICAL PERMIT FEES* CCB Lic./ Electrical Lic.: . ?-/-g?? Suprv. Lic.: S/ /S S Subtotal Suprv. Electrician signature, required: �G �.,/�irej, f r 10 — i —o 7 Plan review (25% of permit fee) Print name: ate: State surcharge (8% of permit fee) /Z TOTAL PERMIT FEE 1 &�. 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. is \ Building \Permits \ELC- PennitApp.doc 12/03 440- 4615T(t0 /02/COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: 1-RESIDENTIAL WORKDAY,: Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ • Audio and Stereo Systems* El Burglar Alarm El Garage Door Opener* • El Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COIV MERCIAL WORK ONLY i Fee for each commercial system • $75.00 (SEE OAR 918- 260 -260) • Check Type of Work Involved: ❑ Audio and Stereo Systems El Boiler Controls ❑ Clock Systems 5 1 Data Telecommunication Installation ❑ Fire Alarm Installation • ca. HVAC ❑ Instrumentation El 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- PermitApp.doc 04/03 CITY OF TIGARD BUILDING DIVISION PERMIT #: ELR2005 -00167 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/28/2005 Phone: (503) 639 -4171 /fn�juvmpdi� Inspection Requests (24 Hrs.): (503) 639 -4175 J • __.. INSPECTION WORKSHEET FOR DATE: 7/8/2005 TIME: 7:10AM PAGE: 3 SITE ADDRESS: 10520 SW CASCADE AVE CLASS OF WORK: SUBDIVISION: OFFICE DEPOT LOT #: TYPE OF USE: PROJECT NAME: OFFICE DEPOT DESCRIPTION: 2 low voltage cabling for office and HVAC monitor system. OWNER: MARX, ERNEST L + BARBARA R, PHONE #: CONTRACTOR: BAILEY'S ELECTRIC LLC PHONE #: 503 - 848 -3134 Inspection Request Scheduled For: Date: 7/8/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message Electrical final 011056 -01 503- t349.3134 N Corrections /Comments /Instructions: PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED \ Inspector: , / �/ -- Date: ? 6- 65- Phone #: (503) 718 -