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Permit - C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT ift4ope i DEVELOPMENT SERVICES PERMIT #: ELR2005 -00428 „AA '�I �! 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11/29/2005 PARCEL: 2S 102AA -00906 SITE ADDRESS: 12080 SW MAIN ST ZONING: CBD SUBDIVISION: PAYLESS SHOPPING CENTER LOT: 002 JURISDICTION: TIG Project Description: Limited energy for fire alarm panel. 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: X OUTDOOR LANDSC LITE: OTHER: : HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: TOTAL # OF SYSTEMS: 1 Owner: Contractor: MONTCO ASSOCIATES DIVERSIFIED ELECTRONICS INC BY THRIFTY /PAYLESS INC #5354 875 WILSON ST UNIT C PO BOX 8431 EUGENE, OR 97402 HARRISBURG, PA 17105 Phone: Phone: 541 484 - 9078 Reg #: LIC 144685 ELE 20- 377CLE FEES Description Date Amount REQUIRED ITEMS AND REPORTS [ELPRMT] ELR Permit 11/29/200f. $75.00 [TAX] 8% State Surchari 11/29/200: $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 wit in days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to ollow rules : • opted • the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 thro gh OA' 952 -00 -: You ma obtain copies of these rules or direct que., o r s to OUNC,, 503 1 6 -6699. Iss d By: L Permittee Signature ., //j s Log 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 am required on the job site at the time of each inspection. / Ek urical Permit Application FOR OFFICE USE ONLY nom/ .r Received /1 01, €� /W M C +i �n_.,5'�Q 2 C Of Tigard Dann Permit No.: �dyC100 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 w /ii'l D DateBy: Other Permit: Inspection Line: 503.639.4175 ,„„,43.,111.- ea,, Date Ready /By: J ® See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: f la 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 ['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 ❑ Multi family ❑Master builder ❑ Other: ['Building over three stories ['Feeders, 400 amps or more ['Occupant load over 99 persons ['Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park Job no.: Job site address: I a 9O W IrnoA.#. 5 t ❑Health -care facility ['Other: Submit 2 sets of plans with any of the above. City /State /ZIP: ra i tool og , O R q i as 3 The above arc not applicable to temporary construction service. Suite /bldg. /apt. no.: Project name: FEE* SCHEDULE Description I Qty. I Fee. I Total I •• 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'l 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 dwelling, service and /or feeder 90.90 2 Services or feeders installation, alteration, and/or relocation 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: .:ct 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 ' r - Reconnect only 66.85 2 City /State /ZIP: /.,CJ- � !4 , , P/9- Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) 111 " "" ��' ��I 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 B. Fee for branch circuits Contact name: without service or feeder fee, Address: each branch circuit 46.85 2 Each add'l branch circuit 6.65 2 City /State /ZIP: Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 2 Phone: ( ) Fax:: ( ) Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited - CONTRACTOR energy panel, alteration, or extension. Describe: / Page 2 2 Business name: 'Div-cc-5 U �61.6/.. E. ce...E, r o v -a 1.9""e_ � M t-A-4- Address: $ IS u ilS1� S•t, �.vt.:jk.. �+ Each a inspection over allowable in any of the above Per inspection 62.50 City /State /ZIP: EL " „ n d ct'1({0 a Investigation per hour (t hr min) 62.50 �/ Industrial plant per hour 73.75 Phone: ($l(( )4.8/4 _q0-7 a Fax: (Stf,( ) 301_9(.4,1 ELECTRICAL PERMIT FEES* CCB Lic.: 1�4�J44$5 Electrical Lic.Z„p.377 ," Suprv. Lic Subtotal • ?5 Suprv. Elec`tirlc�aVsigti required: Q/1/2 7// ( Plan review (25% of permit fee) tau — State surcharge (8% of permit fee) 9 • 0 v Print name: a., K E. WOOStgAr Date: tt4 ?_3/7 Of)S TOTAL PERMIT FEE $'i. D U Authorized aa,/ This permit application expires if a permit is not obtained within 180 +����- ��`{(' days after it has been accepted as complete Print name: aactiA i)UOS . Date: a / • Fee methodology set by Tri- County Building Industry Service Board ( melt) S •• Number of inspections per permit allowed. i:\ Building \Permits \ELC- PermitApp.doc 12/03 440- 4615T(10 /02/COM/WEB CITY OF TIGARD - i' l! d BUILDING DIVISION PERMIT #: DO 5-- d T Zo 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 Hamm 0, I ,t\ Inspection Requests (24 Hrs.): (503) 639 -4175 IL INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: /oZ 0 0 "' -s` CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: 3 - - 7- O co Pour Time: Code # Inspection Desqpiption . nfirm # Contact # Message �/ 0'5 `� Corrections /Comments/ Instructions: iii NAY) /4) 7S Z 'SoL I IAETs -1 1 - ZQ 6L. , v .`i1.., `Ts ` ftkP 16 i vi - z' ON (IF 1 4 F--? f1 1 I RA ! 1 Pr 11 IA N A - 11 - tigmAN\, -1 E:Lt. r cp&I--- c,(1 . C �-�9L,vr Rte \- -o N VII c FA PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL / CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: , 11 Date: 117 6 6 Phone #: (503) 718 - Z1