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Permit CITY OF TIGARD ELECTRICAL PERMIT - RESTRICTED ENERGY �'ll� DEVELOPMENT H BMENT r S o ERV SERVICES 639 -4171 DATE ISSUED: 3% 7/2004 SITE ADDRESS: 07320 SW HUNZIKER ST 101 PARCEL: 2S101 DB 00100 SUBDIVISION: ZONING: C -P BLOCK: LOT: JURISDICTION: TIG Project Description: Install data /telecommunications system. 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: ROBINSON DEVELOPMENT COMPUTER TELEPHONY COMMUNICATIONS PO BOX 91305 PO BOX 879 PORTLAND, OR 97291 NEWBERG, OR 97132 Phone: Phone: 503 - 554 - 9232 Reg #: LIC 158001 ELE 36- 118CLE FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 3/17/2004 $75.00 Elect'I Final [TAX] 8% State Surchari 3/17/2004 $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 4- i Permittee Signature Ot ,9'/JG /C' 77OA 9. 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 Ei ctriical Permit ARGORIVED ,. FOR OFFICE USE ONLY ' Received City of Tigard Date /By 97714,-. Permit N a4 , 2n`J ' aZj ®/ 1/ 1 q 13125 SW Hall Blvd., Tigard, OR 97223 MAR 1 7 2004 n a P Review 7 y � Phone: 503.639.4171 Fax: 503.598.1960 ' Date /By Other Permit: Inspection Line: 503.639.4175 CITY OF TIGARD DateReady /By: inns El See Page 2for Internet: www.ci.tigard.or.us BUILDING DI • . Notified /Method. Supplemental Information 1 .. .,.,, :. <. ,,..,.,, r .. ... .. <...:. ate;:" :_ .. x R^ PL AN RE .IEW E: RIiz =' ° TXP:E..O WO � z � .. , ; •n . ; - ms s, ;, ; �i' a. ,., ��. � -� ' j am' . , ,, .. ' ,rte. ,t`� ... �... ✓.. '" ��. ? ., n , � "�i. �✓ R'/- ❑ New construction 0 Addition /alteration /replacement Please check all that apply: UService over 225 amps, comm'l 0 Hazardous location ❑ Demolition ❑ Other: ❑Service over 320 amps rating ❑ Buildng over 10,000 sq. ft., r ` , ,. €.. ., °! , �,.,• <; ,,- a:,;,,,; g ION ' i. ' dwellings residential -,, ., .: ;,,: -.. " . a - ". CATEG(JRY OF�CO � \ %� ""„ ,, f <., :; � o I- 2-family dwell'ngs 4 or more new residenal t ,NSTR)�CT..,...., ,.. ' � ,, ❑ 1- and 2- family dwelling 15 Commercial /industrial ['Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi family El Master builder ❑ Other: ['Building over three stories ['Feeders, 400 amps or more ' 5'1''' ,,,,; ., .: „ ,:. &s:- ,:, ,. t red structures or _ ❑Occupant load over 99 persons Manufactu r , 7 ' "' ;JOI3°. SIT E ` *TION' , AND'I,OCATION ❑ Egress /lighting plan RV park e: ; _ ° '.tea, ...'- :,• ;.. -; •. . ,� ...�•, V Job no.: ['Health-care facility ❑Other. A ( 2'� Job s ite addres �13 © 5 w wt�Z i t �2 " � � Submit 2 sets of plans with any of the above. A City/State /ZIP: 'Ti e. 0 _, ,A 0 2 — The above are not applicable to temporary construction service. """_ • : "- `'„ 4"FEE* SCH • x f i , �sA �'; Suite/bldg./apt. / a Project name: T " "° �` "` ;* no.: V tLt� 4 C ,,\ C Description I Qty. Fee. Total Cross street/directions to job site: New residential single - or multi - family dwelling unit. t k, Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: Lot no: Ea. add] 500 sq. ft. or portion 33.40 I Limited energy, residential 75.00 2 Tax map /parcel no.: energy, non-residential , .••:,,.;.. „� : :- ', x f Each manufactured or modular dwelling, service and /or feeder 90.90 2 Limited nergy, non dential 75 00 2 l � x DESCRIi'T[ON .OF;. WORT :”! % i " '" l �;;�'' °.;':;' " ".,. , .,. <. .. .fit ,,,, „ . A.+ .... . ,. 7, ,.. ."r.., >, >..,a- . �, .- ` 1 x �J 0' c.- ' 1 . .' ' A Q.. t d (/L a Services or feeders installation, alteration, and /or relocation 200 amps or less 80.30 2 -,' " t.: •;'`ra 201 amps to 400 amps 106.85 2 x ;'I1 -I ',`PRQPEIRTY QW , , , 1 t, ' T E NAI V I - ,1' ._ „ . , _.. 'F • ' 'w - -- 401 amps to 600 amps 160.60 2 N Name: .--re.;--k- �t.t v..��� 4 0, S SvC . / a r A-N 601 amps to 1,000 amps 240.60 2 Address: `7 3(va st,j Over 1,000 amps or volts 454.65 2 k_____ � Reconnect only 66.85 2 City /State /ZIP: '-` `1 t> 2 ,, 2_--2._ 3 Temporary services or feeders installation, alteration, and /or relocation Phone: (93) `1(cs,_ Fax: (So3) lo 0 - it/ 5 200 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 A ' ,1 r`" ' " °" "may ' °"'• A. Fee for branch circuits with � '1'1. •- : ❑` � - i _ � ° � ; ,❑ . .CONTACT ; r`PERSON:: . < . >,..;. • °�_ ,� ` ce feeder fee, e 2 Business name: .� &_( I � Owxb + � (t a t- service or feede ach branch circuit B. Fee for branch circuits Contact name: -e L �, � without service or feeder fee, 6.65 each branch circuit 46.85 2 Address: ` q _ S kd3 Q1''b' Lck_4�`e Each add'I branch circuit 6.65 2 City/State /ZIP: I,,j .et�k _ �t--. • ( Miscellaneous (service or feeder not included) >♦ Pump or irrigation circle 53.40 2 Phone: ( ) SC ( �3 ' S 0 S ' Fax: : (5'O"S) 53 ^ S _ j /p " Sign or outline lighting 53.40 2 E -mail: tom- 00.- t's. 3 Co - CC L • CO /- Signal circuit(s) or limited- "`,= 'CON.TaRACv«TOR`- ;� :���` energy panel, alteration, or "�. ":.,:. `s;� > , "w. ,,, °,,,,.,,.., �, , . -t extension. Describe: 2 2 Business name: // Page l �vti`��( kMt,t� `k ti C ct4 l7 k S Address: (�' •� 0 Each additional inspection over allowable in any of the above ! - Per inspection 62.50 City/State /ZIP: )\_.5 e a� • I '3 Investigation per hour (1 hr min) 62.50 Phone: ( 50 3) 5p..1_ c a-3 •� i Fax: (.63 ) 53 S S Industrial plant per hour 73.75 .<: „„ , "FEES *:,:;r . CCB Lic.: ISSOO ( Electrical Lic.:3/ II BCj_C Suprv. Lic.: 32,ZL Subtotal . - 1 5 . Cr6 Suprv. Electrician signature, required: Plan review (25% of permit fee) \ State surcharge (8% of permit fee) �, , crO ` Print name: W ( i ) D 3 _ (7 _ © ci TOTAL PERMIT FEE Authorized signature: w This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: 4�� to - L 1 - ��.e_ Date: -5 7 _ 6 * Fee methodology set by Tri- County Building Industry Service Board ** Number of inspections per permit allowed i \Building \ Permits \ELC- PermitApp.doc 12/03 440 -461 ST( I O /02 /COM/WEB CITY OF TIGARD 3/23/2004 13125 SW Hall Blvd. 8:07:08AM i Tigard, Oregon 9 72 23 ,.!iJ '' (50 3) 63 9-4 17 1 Receipt #: 27200400000000001026 Date: 03/17/2004 Line Items: Case No Tran Code Description Revenue Account No Amount Paid ELR2004 -000 7 9 [ELPRMT] ELR Permit 220 - 0000 - 431510 75.00 ELR2004- 000)(,7 7y [TAX] 8% State Surcharge 100- 0000 - 207020 6.00 Line Item Total: $81.00 Payments: Method Payer User ID Acct. /Check Approval No. How Received Amount Paid Check COM -TEL COMMUNICATIONS JMT 100197 In Person 81.00 1NC Payment Total: $81.00 • r Page 1 of 1 cReceipt.rpt • Listing 12/3/2004 Case Activity 11:54:27AM TIDEMARK Case #: ELR2004 -00074 COMPUTER SYSTEMS, INC. ,., ^ ,y .. „ �.� x .. ,,.yrru'� ., �. >. >...,.. Y r?3;° :: c:.; >srifYS';rr ✓:. °: / /.;yaYS,r., :< `�:�•Ea .,�,sr'.t' .. �..:� rwi _,„��,;,, ., ....�, a.�a i � „<,.,�, >a4r, ±£ %'sa v >- .� / f.� ;,,,'1� ;.,, �.,r, � : �- ,y,.,. �. , .i, �� k..., <.a�.. ;Fa.,,.., a3 °a,,.. r . , .:,El.,;.. �.�1.. � > > aka•: r . �, � .; x erg .`d;,.,. r 3,2, +> _w- ,m_.:. .7.: - ,...,..:., y e. ,.,.,..,,.,,. -. v,"r, „w, ,r%.,E, , ; %girie�`� '1 > ,.... Q D plc, ,� ;:..; a�@ iTpi., JR� y, 11 ` ......; =,..: te ELRC001 Ap plication Received 3/17/2004 None RECD JMT 3/23/ DLH ELRC003 Permit Created 3/17/2004 None DONE JMT 3/23/2004 DLH ELRC725 Low Voltage 3/30/2004 None FAIL GN 3/30/2004 Inspection RLB ELRC799 Elect'1 Final 3/31/2004 None PASS GN 3/31/2004 RLB ELRC500 (F) Issue permit 3/17/2004 None DONE JMT 3/23/2004 DLH ELRC800 Case Finaled 10/18/2004 None DONE RB 10/18/2004 RB Page 1 of 1 CaseActivity..rpt