Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
,,.I,L��� DEVELOPMENT Tigard. ) 639 -4171 DATE SSU 6/29/2004
SITE ADDRESS: 09000 SW DURHAM RD PARCEL: 2S114AA -00100
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
Project Description: Voice /Data cabling.
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: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
SCHOOL DISTRICT 23J E C COMPANY
13137 SW PACIFIC HWY PO BOX 10286
TIGARD, OR 97223 PORTLAND, OR 97296
Phone: Phone: 503 - 552 - 5503
Reg #: ELE 26 -45C
LIC 49737
SUP 4040S
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 6/29/2004 $75.00 Elect'I Final
[TAX] 8% State Surchart 6/29/2004 $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 r ,/..4...ts.._ Permittee Signature 6771 45i
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
06/22/2004 02:07 5032205347 .J ) PAGE 02
2f . Electrical Permit A lication , iE•9R OFFICE USE ONLY
Dater, d / pb e ) fflectrical ��
Permit No A V., -- 00 / /
City of Tigard RE
CEW Planning App .vat Sign
13125 SW Hall Blvd. Date./By
_ PermitNp..
Plan Review Other
Tigltrd, Oregon 97223 AiN 2�� Date/By: ermit No.:
Phone: 503 - 639 -417I Fax: 503 -5.9: •960rtGP :
y Post - Review Land Use
Internet: www.ci,tigard.or.us Cs C1ir r�tn� (� , Pate/By: Case No.,
24 Inspection Request; 503c 9= 441 - "" r � Contact
tuns.. l l See Page 2 for
Name/Method: i Suppletnental Information,
T YPE OF WORK PLAN REVIEW (Please check aq that apply) _
10 New construction • Demolition • Service over 225 amps- ❑ Health -cart facility
P. Addition/alteration/rc.lacement II Other: commercial ❑ Hazardous location
'CATEGORY O)~ CONSTRUCTION ZON ❑ Service over 320 amps- rating of . ❑ Building over 10,000 square feet.
1 & 2 family dwellings four or more residential units in
• • 1 & 2 -Fami1 dwellin . 0 Commercial/Industrial ❑ System over 600 voltS nominal one structure
II Access() Buildin_ mu Multi- Farllil ❑ Building over three stories 1=1 Feeders, 400 amps or more
' ,_, ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
0 Master Builder I Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INXiORIVIATION and LOCATION Submit sets of plans with any of the above. r»
Job site address: 0 \ 0 0 0 The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
Project Naine: s t p r , t \ s ' \ e l ' Description Qty i Fee (ea.) j Total 1
New residential- single or multi - family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
!000 sq. ft. or less 145.15 4
Each additional $00 sq, h. or portion thereof 33.40 I
Subdivision: Lot #: Limited energy, residential 75.00 2
I Limited energy, non residential • \ 75.00 -Ac GO 2
Tax map /parcel #: Each manufactured home or modular dwelling
. DESCRIPTION OF WORK service and/or feeder 90,90 2
Services or feeders - Installation,
- 1J 1 1 .. b.\ \(c• +c,.,t /Q qOt q Ctk \olI - rJ alteration or relocation:
`..__ _ -_ ! te n 200 amps Or less 80 30 2
... 7__ � =- � •c 201 amps to 400 amps 106,$5 2
' -'i '`" i-\\ i([, lb E(...-- 401 amps to 600 amps 160.60 2
a PROPERTY OWNER I 0 TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: — 7, SPt-k \kA`o,N \-., Sc a ° a\ i e3 sf" 0- Reconnect only 66 85 Z
Address: Co\ Co SW S , p.,,N .,,er S \-•- Temporary services or feeders - installation,
alteration, or rel
City /State /Z p: 'T, °. Oe . °1~l 1 Zoo amps or less 66.85 I
Phone: L\3\ - '-\ 0 Fax: 201 amps to 400 amps 100,30 E 2
El A PPLICANT CONTACT Branch n h e amps 133.75 2
ACT PERSON _. Branch circuits - new. alteration, or
Name: extension per panel;
A. Fee for branch circuits with purchase of
Address: service Or feeder fee, each branch circuit 6.65 2
City /State /Zip: B, Pee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 _ 2
w
Phone: I Fax: Each additional branch circuit II 6.65 2
Misc,(Service or feeder not included):
E-mail:
Each stun. or im anon circle 53.40 2
CONTRACTOR Each st: or outline li_htin: MI 53 -40 2
Job No: '— \ \3 yq Signal circuit(s) or a limited energy panel.
alteration, or extension Page 2 2
Business Name: L- C. C 0 p'A r., 1 ,.___ pescnpnon.
Address: PO V, o'.. l U a v _ ,
Each additional inspection over the allowable in any of the above:
CAN/State/Zip: 9 \i"4 �� �� b -- ) Per ins. etton • hour min. 1 hour 62.50
Phone: - _ U ' .S3 _ Fax: aQ • S - 0 \ Z Invcsti' : tion fee:
«� Other l♦
CCB Lic. #: tA A i;�l i.�7� C , _ Electrical Permit Pees* ' • •
Supervising eleetri�1 Subtotal $ .`""\ - _ _
si_ ature re j =`\ uired: ;� `. AA - WAR Platt Review (25% of Permit Fee $
Pant Name: �e i' IMI _ • �y State Surcharge (8% of Permit Fes) $ (.1% . w
TOTAL PERMIT FEE $ % \ -(-
Authorized Notice: This permit application expires if a permit Is not obtained within
Signature: Date: 180 days after it has been accepted as complete_
'fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
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