Permit r ,
CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
— 13125 �I �� DEVELOPMENT r S O ERV SERVICES 639 -4171 DATE ISSUED: E1 R20 -00344
SITE ADDRESS: 07632 SW DURHAM RD 120 PARCEL: 2S1136A -00400
SUBDIVISION: SW CENTER SDR1999 -00020 ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Proiect Description: Limited energy for data cabling. Job No. C23 -335.
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 CAPITOL DATA& COMMUNICATIONS
PO BOX 4900 DEPT 302 11401 NE MARX ST.
SCOTTSDALE, AZ 85261 PORTLAND, OR 97220
Phone: Phone: 503 255 - 9488
Reg #: LIC 142457
ELE 26- 1054CLE
SUP 3132S
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 11/12/03 $75.00 Elect'I Final
[TAX] 8% State Surcharl 11/12/03 $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 t w adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throuc
ssued by Permittee Signature
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
-v
OFFICE Permit Application Date received: // p 6,5 Permit �s n ONLY .2 oo5 –on 30
Project/appl. no.: Expire date:
.61.1. �I City of Tigard I 1 E�� Date issued: By: (Receipt no.:
CITY OF TIGARD Address: 13125 SW HALL BLVD„ OR 97223 Case file no Payment type:
Phone: (503) 639 -4171 Fax (503) 598 -1960 4 0 2003
Land use approval: ',NOV A � D e 5 -00/p (p iriimmiimmi
❑ 1 & 2 family dewlling or accessory ❑ Co I ndustrial ❑ Multi- family X ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: 7630 SW DURHAM RD City: TIGARD Bldg. No.: Suite no. /,Q Tax map /tax lot/account no.:
Lot: (Block: N/A (Subdivision:
Project name: ALLSTATE (Description and location of work on premises: NETWORK CABLING
Estimated date of completion/inspection: 12/1/03
- .___.._____-V-.w,.._ CONTRACTOR. APPLICATION- -....:.__,_< _ __.._.<___,_...—..;.--- ___..__ .._-_FEE
Job no: C23 -335 Fee Max.
Business Name: CAPITOL DATA /COMMUNICATIONS Description Qty. (ea.) Total no. insp
Address: 11401 NE MARX ST. New residential - single or multi - family per
City: Portland State: OR ZIP: 97220 -1041 dwelling unit. Includes attached garage.
Phone: 503- 255 -9488 IFax: 257 -7121 IE -mail: ray @cepdx.com Service included:
CCB no.: 142457 'Elec. bus. lic.no: 26- 1054CLE 1000 sq, ft, or less $ 145.15 4
City /metro lic.no.: 4542 „ � Each additional 500 sq. ft. or portion thereof $ 33.40
. 11/7/03 Limited energy residential $ 75.00 2
Signature of supervising electrician (required) Date Limited energy, non - residential $ 45.00 2
Sup. elect. name (print): Richard Martin License no.: 2865 - Each manufactured home or modular dwelling
PROPERTY OWNER Service and/or feeder $ 90.90 2
Name (print): • • .),,S Services or feeders - installation,
Mailing address: ie P'»1 1 .1940 – ID Pr oif) alteration or relocation:
City: 1o'�g -D/j -lr4,. l State: z 'ZIP: j $ Jr' 8.4 l 200 amps or less $ 80.30 2
Phone: Fax: f E -mail: 201 amps to 400 amps $ 106.85 2
Owner installation : The installation is being made on property I own 401 amps to 600 amps $ 160.60 2
which is not intended for sale, lease, rent, or exchange according to 601 amps to 1000 amps $ 240.60 2
ORS 447, 455, 479, 670, 701. Over 1000 amps or volts $ 454.65 2
Owner's signature: Date: Reconnect only $ 66.85 I
ENGINEER Temporary services or feeders -
Name: installation, alterations, or relocation:
Address: 200 amps or less $ 66.85 2
City: State: ZIP: 201 amps to 400 amps $ 100.30 2
Phone: Fax: E -mail: 401 amps to 600 amps $ 133.75 2
PLAN REVIEW (Please check all that apply) Branch circuits - new, alteration,
❑ Service over 225 amps - commercial ❑ Health -care facility or extension per panel:
❑ Service over 320 amps- rating of 1&2 ❑ Hazardous location A. Fee for branch circuits with purchase of
family dwellings ❑ Building over 10,000 square ft. four or service or feeder fee, each branch circuit $ 6.65 2
❑ System over 600 volts nominal more residential units in one structure B. Fee for branch circuits without purchase
❑ Building over three stories ❑ Feeders, 400 amps or more of service or feeder fee, first branch circuit: $ 46.85 2
❑ Occupant load over 99 persons ❑ Manufactures structures or RV Park Each additional branch circuit: $ 6.65
❑ Egress/lighting plan ❑ Other: Misc. (Service or feeder not included):
Submit sets of plans with any of the above. Each pump or irrigation circle $ 53.40 2
The above are not applicable to temporary construction service. Each sign or outline lighting $ 53.40 2
Signal circuit(s) or a limited energy panel,
alteration, or extension* 1 $ 75.00 75.00 2
*Description:
- - — - -- ' – -- -- --.' Each additional' inspectiofrover'th allowable in any the above: -
Per inspection I I $ 62.50 I I
Investigation fee
Other
❑ Visa ❑ MasterCard Permit fee $ 75.00
Credit card number: / / Notice: this permit application Plan review ( ) $
Expires expires if a permit is not obtained State Surcharge( 8% ) $ 6.00
Name of cardholder as shown on credit card
$ withing 180 days after it has been TOTAL $ 81.00
Cardholder signature Amount accepted as complete.