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Permit ''h`' CITY OF T I G A R D ELECTRICAL PERMIT - RESTRICTED ENERGY W DEVELOPMENT SERVICES PERMIT #: ELR2004 -00123 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/11/2004 SITE ADDRESS: 07125 SW HAMPTON ST PARCEL: 2S101AC 01400 SUBDIVISION: BEVELAND NO. 2 ZONING: MUE BLOCK: LOT: 020 JURISDICTION: TIG Project Description: Low voltage: security. 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: X INSTRUMENTATION: OTHER: TOTAL # OF SYSTEMS: 1 Owner: Contractor: SPECIAL DISTRICTS ASSOCIATION OF OR SONITROL (AKA SOUND SECURITY) 727 CENTER STREET, NE #208 20 8220 N. INTERSTATE AVE. SALEM, OR 97301 PORTLAND, OR 97217 Phone: 503- 371 -8667 Phone: 503- 223 -5822 Reg #: LIC 53535 ELE 26- 370CLE SUP 1812LEA FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 5/11/2004 $75.00 Elect'I Final [TAX] 8% State Surcharl 5/11/2004 $6.00 Total $81.00 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -0 1 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699. Issued by Permittee Signature id& OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N DATE: LICENSE NO: Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day ,- , ; : {FO OFFICE USE ONLY ' . , .. Electrical Permit A s.. , ,i Rece ve // QI/ ® Electrical 3 6 Permit No a vvi� City of Tigard A I u ,,104 Planning A prov Sign pr Date/By: Permit No.: 13125 SW Ha11 Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: C TY OF IGA' I Post- Review Land Use Phone: 503- 639 -4171 Fax: 503 - 598 w.�tri, e, DIN / � Date/By: Case No.: w Internet: ww.ci.tigard.or.us . . e . ��,Y, ,,. Contact 1 ® s.: See Page 2 for 24 -hour Inspection Request: 503 -639 -4175 J 4 Y'_•* • Name /Method: Supplemental Information. • LA - 3 (3 .. " .. t3.. 'vt .$:4'.,i y; i".i.�,:C :p`� -: ! ,Y +s'3.:4: "».%.#. r. ::�.. ��f. • , ..�.m = �'. =°� REVIEW; � .lease. clieck�all= t}iata . ` =`• ,., °.�� .,:�' _ •:TYPE;OWORIC�' f� ��,::= :��z'�.:�s�,�, .. PLAN,. ..,._ � •.. PP Y) ❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility commercial ❑ Hazardous location ❑ Addition/alteration/replacement ® Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet, tiri . four or more residential. units in (<�F�= �:;����i,��,: � CAT, EGORY „;QFCQNSTRUCTION; °' ~��,.E =:.��R._ =: I & 2 family dwellings ❑ 1 & 2- Family dwelling ® Commercial/Industrial ❑ System over 600 volts nominal one structure ❑ Building over three stories ❑ Feeders, 400 amps or more ❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park ❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other: t M;.. e.*s r JOB SITE rINF ,OR1VIt1T =IONgandLO . »- GATION M Submit _ sets of plans with any of the above. ,,. �-s... �{ M- The above are not applicable to temporary construction service. Job site address: ti \ �.5 � oua , i l..- k y, � . ;�1 '' - .'�:4 : o- E' SCHEDULE`,µ 'Et 'iw� --: Suite #: Bldg. /Apt. #: Number of inspections per permit allowed Project Name: SQ4Li0- tJ■ eicsoc . Description Qty Fee (ea.) Total New residential- single or multi - family per j Cross street/Directions to job site: dwelling unit. Includes attached garage. ' Service included: • 1000 sq. ft. or less 145.15 4 Each additional 500 sq. ft. or portion thereof 33.40 1 Limited energy, residential 75.00 2 Subdivision: Lot #: Limited energy, non residential 75.00 2 Tax map /parcel #: Each manufactured home or modular dwelling ., , ,�..:_. „,,, .._ �,. and/or feeder 90.90 2 � G19 5 � \ TIONfO i;, ',: >: : _ service door feed r " - � Services or feeders - installation, alteration or relocation: 200 amps or less 80.30 2 ' 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 e- .�::-- ;„- �: �a =; =:: 601 amps to 1000 amps 240.60 2 iPRQPERTCOW „° a`` ®;TENANTS,..; ".: , _ t ,RY � � " � p pp��--- ,,\ (1 Over 1000 amps or volts 454.65 2 Name: S C'i` G& t &5 V I . I-��SOC • (Y 02 Reconnect only 66.85 2 Address: ‘-( \ a5 \ L -. Temporary services or feeders - installation, ^ alteration, or relocation: � City /State /Zip: 0 Lt' J Q- , 0 1 )a3 200 amps or less 66.85 1 201 amps to 400 amps 100.30 2 Phone:56-(p�p- OloCe Fax: ao s `CONTACTR it 1to600amps 133.75 2 ►:IgAP;PLIC'ANT? ";.;, �� �`o.• , ?��� -. ? ERSON - � "��'•`- ='' =�' Branch circuits - new, alteration, or Name: ( yl^. 2 ICY / y -- 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. Fee for branch circuits without purchase of service or feeder fee, first branch circuit 46.85 2 Phone: Fax: Each additional branch circuit 6.65 2 E -mail: Misc.(Service or feeder not included): :��T �� re -- _ ,,; -:r E h p um p or irri g sign or outline lighting ation circle 53.40 2 -yw.: s'..- ::_�; +�_ - � E , >; " -3:° .;CON:TRACTQ / R : - <,.._ =. >, 4r 53.40 C Job No: -j a 4,1- \ b a. Signal circuit(s) or a limited energy panel, I =.,,l 2 alteration, or extension Page 2 . Business Name: S.p ‘ #--' \ 5 2-��v % Description: • Address: $ a s O Yv yar �/ Each additional inspection over the allowable in any of the above: City /State /Zip � k C YZ. a_nri _ R1 a, 1 in Per inspection per hour (m. 1 hour) 62.50 Phone: a a3 �s . Fax: b, r13 - ' ( Investigation fee: CCB Lic. #: 353 5 Lic. #: aCa 3 6 Cam. ;_:: ,,.. < .. ': AN. Electrical,. PermifgFeesx ,aaMK� _ s�i= '.-= �.4= -v:u Supervising electrician j/ �� ' . Subtotal $ r ■ t50 signature required: L'�' �- 2'2 y� Plan Review (25% of Permit Fee) $ Print Name: 5G071 -- [- ` -(oes- Lic. #: - - O /T State Surcharge (8% of Permit Fee) $ Lp , by TOTAL PERMIT FEE $ Isk . 6O 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) is \Dsts\Permit Forms \ElcPermitApp.doc 01/03 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information ' LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all systems $75.00 Check Type of Work Involved: n Audio and Stereo Systems n Burglar Alarm n Garage Door Opener n Heating, Ventilation and Air Conditioning System Vacuum Systems n Other COMMERCIAL WORK ONLY: Fee for each system $75.00 (SEE OAR 918- 260 -260) • Check Type of Work Involved: n Audio and Stereo Systems • n Boiler Controls n Clock Systems n Data Telecommunication Installation n Fire Alarm Installation HVAC n Instrumentation n Intercom and Paging Systems 7 Landscape Irrigation Control Medical n Nurse Calls n Outdoor Landscape Lighting Protective Signaling n Other I Number of Systems * No licenses are required. Licenses are required for all ,. other installations • 4\ ' \ 1 3 r i: \Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03 CITY OF TIGARD 24 -Hour BUILDING Inspection f ine: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Reque ted 1! I \,& ` dam AM PM BUP Location k Suite MEC Contact Person c,LA\ Ph (S 0 )5 ° IS ri PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR © L i 1 3b �7.3 Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall N Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: c_7 Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG /Slab kow Voltage Fire Alarm -ASS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. ❑ Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date °� Inspector ` I if 4 / 14111•1•0 Est Other: Final DO NOT REMOVE this Inspection record from the Job -ite. PASS PART FAIL