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Permit CITY OF TIGARD ELECTRICAL PERMIT - RESTRICTED ENERGY 4 DEVELOPMENT H BMENT Tigard. � 639 -4171 DATE ISSUED: 004 -00061 - 13125 ED: 3/9 04 SITE ADDRESS: 09802 SW SHADY LN PARCEL: 1S135BD -01200 SUBDIVISION: ZONING: C -G BLOCK: LOT: JURISDICTION: TIG Project Description: Audio /Stereo wiring A. RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: X 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: FORBES, DONALD CAROLYN MUZAK LLC BURDICK, DONALD LINDA 12449 NE MARX 434 RIDGEWAY RD PORTLAND, OR 97230 LAKE OSWEGO, OR 97034 Phone: Phone: 254 - 7400 Reg #: LIC 142760 ELE 26- 1055CLE MET 00006434 FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 3/9/04 $75.00 Elect'I Final [TAX] 8% State Surchar€ 3/9/04 $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 . • . i s of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you • follow rules ado. -d by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 throuc Is- ed by Permittee Signature �r l 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 Electrical Permit Application FOR OFFICE USE ONLY City of Tigard A D ate /B : /© ��/ PermitNo.:i� — (� � 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 i Date/ Other Permit: Inspection Line: 503.639.4175 e '' ∎• Date Ready/By: Jug: ® See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information TYPE OF WORK : - PLAN REVIEW ,- ❑ New construction ['' ddition/alteration/replacement Please check all that apply: El Demolition ❑Other: ['Service over 225 amps, comm'l ['Hazardous location ['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft., • CATEGO Y 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 ❑Health -care facility ['Other: Job no.: Job site address: 9g- ®Z S ‘,./ tJ I7 Submit 2 sets of plans with any of the above. City/State /ZIP: r j�,/el Q,e 9 7 3- 3 The above are not applicable to temporary construction service. FEE* SCHEDULE Suite/bldg. /apt. no.: Project name: / 0y L 5 tey35 Description I Qty Fee. I Total Cross street/directions to job site: 4'ree' b , 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'I 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 Tax map /parcel no.: . Limited energy, non - residential 75.00 2 DESCRIP-TION OF WORK Each manufactured or modular Q welling, service and /or feeder 90.90 2 5 :L /�i� gf 4 5p eerie S 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: 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/State/ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) 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, each branch circuit 46.85 2 Address: Each add'l branch circuit 6.65 2 City /State /ZIP: Miscellaneous (service or feeder not included) Phone: ( ) Fax: : ( ) Pump or irrigation circle 53.40 2 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: Address: _ Each additional inspection over allowable in any of the above ld� �y 9 � � �� S i Per inspection 62.50 City/State /ZIP: R r . f`� 0/ e 9' 7 Investigation per hour (1 hr min) 62.50 - Phone: (Sb3) ,2S,./.,_ 7 cfpe2 Fax: ( 3 3) a Sy_ 9 9,5-6 _ Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* . ,' . CCB Lic.: f&fl.76, 0 Electrical Lic.: /p Suprv. Lic.: 3V0&4671 Subtotal Suprv. Electrician signature, required: Plan review (25% of permit fee) Date: 3 q py State surcharge (8% of permit fee) Print name: " '-& / ' �`' �P / / TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board •• Number of inspections per permit allowed. • i:\ Building \PemtitsEP.LC- PermitApp.doc 12/03 440.4615T(10 /02/COMM'EB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COD/IlVIERCIAL WORK ONLY: -- Fee for each commercial system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems • ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation • HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations is\ Building \Pemtits\ELC- PermitApp.doc 04/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST INSPECTION DIVISION Business Line: (503) 639 -4171 BUP 97 r Received ,p / l ` � 9 Date R uested 3 fe 0 AM PM BUP WO Location v Z eel Suite MEC Contact Person 41 .-it Ph (P) 5 2-2 -O c2 7 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner 9 - (cowl M• a1�A. ELC Footing Foundation ELC Ftg Drain Access: DTI e). Crawl Drain Slab Inspection Notes: SIT Post & Beam Notes: a ‘'V-alt2. - Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof C Other: 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 -C ow Voltage ire • • arm Fin I Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. AS PART FAIL SITE ❑ Please call for reinspection RE: ❑ Unable to inspect - no access Fire Supply Line ADA Date I ate 3 - f (34- I ns ector 2- �8 �' Ext Approach/Sidewalk P Other: Final DO NOT REMOVE this inspection re rd from the job site. PASS PART FAIL