Permit RESTRICTEDE
•
CITY OF TIGARD ERG
RESTRICTED ENERGY
- 13125 r e
DEVELOPMENT HO BMENT Tigard. 639 -4171 DATE ISSUED: E1 R 6 20 4 0 40354
SITE ADDRESS: 07632 SW DURHAM RD 125 PARCEL: 2S113BA-00400
SUBDIVISION: SW CENTER SDR1999 -00020 ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Proiect Description: Data & Voice.
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:
OPUS REAL ESTATE OREGON IV LLC APPLIED TECHNICAL SYSTEMS INC
1000 SW BROADWAY 6024 SW JEAN RD
1130 STE E -200
PORTLAND, OR 97205 LAKE OSWEGO, OR 97035
Phone: Phone: 752 - 3548
Reg #: LIC 89511
ELE 2 -71CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 11/16/2004 $75.00 Elect'I Final
[TAX] 8% State Surchar€ 11/16/2004 $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 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
Issued by j:7 N Permittee Signature c'_e t- Qr\
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 OF I� lCE USE ONLY
R ani �4! r , —
City of Tigard �� Date/!3 : A /
13125 S W
Hall Blvd., Tigard, OR 97223 -� \ n Plan Roview (� • l O e c ( ��O D
Other Perm
Phone: 503, 639,4171 Fax: 503.598.1960 r "' "r' �V l(� i ' Basis :
u ' f 521 Sr e Page 2 for
Inspection Line! 503.639.4175 y 6 1 - ;� .. = � DA
, Ready/
�, Notificd/Molhod' Suppleinental'Information
Internet, www.ci.tigard.or,us \1V kW) {{(( t t f ' i l � i v '1 { � � j { ) + y i r} ,} � Iy ' { { j ` l 1 n y1 ) } {`y , ?y�{ {�I�� w : 1 '3' (f�� .I , , 1 1.,i f
i tt l i, llf � ni1'J ll '''.:,11 j y'Utf ilikii ' I`
l a 11F E 4J 7 L' iurwi l f ,' It{ l lS4i'i l 'SFUJ I #r � 1 ;lsi Y�6 1f.Ik9����iF S W itt l[Il �i t i '' .. I ! . .n, ht : ii
0 New construction ❑ Addition /al[erati "o
Pleas. ahecic all at apply:
V «v�� ° Q Scrvice over 225 amps, contm'l ❑I{azntdous location
t t i� � � : t .a ti 1 t.,
❑ D ❑Othe ❑Service over 320 amps - rating ❑Bulldog over 10,000 sq, f
Other:
gigill l 31 W r , W t . �� ,: riWd Y. i , 1
I: I 1 .r, it lift I 3> , :,444. r 4' 1 11111) l of I -and 2- tainlly dwellings 4 w more new residential
El 1 - and 2- family dwelling Ei Commercial /industrial ❑ Accessory building (]System over 600 volts nominal units in one structure
❑Building over three stories (]Feeders, 400 amps or more
Multi - family yy El Master builder ❑ O'thiu ❑Occupant load uveuw 99 persons ❑Munufbcturod structures or
M 1 1 , i . ;ar li° 1 ° 4 1 , .;': t ' Irterl l �a NI Y- i - , 4 , 'MI 1# b 1!f, IOW 9 t plan RV park
ray is i t 3' ', ❑ E Sr esslli ghtin 6 g
t ❑Health -cure facility °O ther:
Job n0.: Air site address: 7 ' W Ot�. .m e r. Submit „2_ sets of plans with any of tho abovo.
City /State /ZIP: Tigard / OR /CI 7).9 The above arc not , �'
{ applicable to temporary construction service.
I ; .. � It��U .£; �U�'J lt I MS fl Y5i 1 �Nd _ r - I , f i li ",i'r. =a`,. '< , .. 1 14,C'
Suite/bldg./apt. nu,: 125 Project name: Columbia Curuwupit Dank Deserlptleu [Qty. pee, I Tiiral --
Cross street/directions to job site: Durham & 72nd New residential single- or multi- family dwelling unit.
_ Includes attached enrage.
. 1,000 sq, ft, or less 145.15 4
Subdivision: i At no.: Ea add'l 500 sq. ft. or portion • 33.40
Limited energy. residential 75.00 2
Tax map /parcel no Limited energy, non - residential 7 5.00 1 2
�: ,Y ► i ,, I r .It Y ' rain". , "..: ' ii i I # � t � ,r � ,. ' ; °�: , l ., l . r 1 •
RI + , *. H N 1 �r +niw7 sr ir TEME1� Cti E ach m anufactured or modular
dwelling. service and/or feeder 90.90_„
Data & Voice Cabling _ Services or feeders installation, alteration, and/or relocation
it Iy` f 200 amps or less 80.30 2
' I ;, . � 11 ,' �a `t � n i m' i vim �it�l1 . f ° t+ dt i . .� .. ' 1 i I t1l it uI ..01 amp. to 400 amps 106.86 z
; i; i t * :; r l , a l Iu t d in 401 am 10 60 0 amps 1 60.60 2
Name: 601 amps to 1,000 amps 240.60 2
-
Address: Over 1,000 amps or volts 454.65 2
_ _ Reconnect only 66.65 2
City/State/ZIP 7 — Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) — _
Fa ( ) 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 or to 600 amps 133.75 2 _
Owner signature; _ Date: Branch circuits - pew, alteration, or extension, per panel
m j ., ∎.i ∎ 11 ' '
t p� + ' : l ;t I 11ni f V ,17 1 r i iP o t ' A f ce for branch circuits with
i( bf,, fDl,1 #i � r :' u i , 1111 �� i� " i iii . tut'ar r,ufuo�iinatira service or feeder fee, each 6 -65 2
Business name: branch circuit -
B. Fee' for branch circuits
Contact name: without service or feeder tee, 46.$5 2
each branch circuit
Address: Each add"I branch circuit 6.65 2
City /State/ZIP; _ Miscellaneous (service or teener nor Included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: ( ) Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited- .
n x a r ,,. y ; l nt energy panel, alteration, or
1 ; # i :,n * ; , l'P 1 °i ? ?,° w rt t .1( rs ` ' ;at Eli ' t i re Page 2 2
,u extension. Da vibe:
Business name: Applied Technical Systems,Inc.
Each additional inspection over allowable in any of the above
Address: 6024 SW Jean Rd, Per inspection 62.50 —
City /State /ZIP: Lake Oswego/OR/97035 Investigation per hour (1 hr mitt) 62.50
industrial plant per hour 73.75
Phone: (503) 684 - 9611 I Fax: (503) 598-0498 `' 'h', i I7, ,E YIA.' !' t. ;��. "' 1. ll`1>,r f; /, 'l,l'r! , ; .i
CCB Lie.: 89511 Electrical Lie.: 2 - 7ICLE Suprv. Lie.: 1474LEA Subtotal �'r�'��
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) —
Print nine: Date: 11/16/04
TOTAL PERMIT FEE
Authorized signature: TIY19 permit application expires it u permit is not obtained withiu t80
_ days abler it bus been accepted as complete
Print name: - 1 I I I I I I I ii i il I Dato: 11/16/04 a Fee methodology set by Tri- County Building Industry Service Board
-. •* Number of inspeettolta per permit allowed,
l;lBuildingt.Peranis\ iLC- PcriniLApp.doc 12103 440 -4 l5T(I0/02/COM/WEIS