Permit 'CITY OF T I G A R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
l+L � 11 DEVELOPMENT H BMENT Tigard. SERVICES , 639 -4171 DATE PERMIT
4/12/04
4 -00096
SITE ADDRESS: 16150 SW UPPER BOONES FERRYRD BLDG. C PARCEL: 2S113AB -00600
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -L
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of limited energy for phone & data.
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:
PACIFIC REALTY ASSOCIATES DRAGOS CONSTRUCTION
15350 SW SEQUOIA PKWY #300 -WMI 10949 SE PARDUE
PORTLAND, OR 97224 PORTLAND, OR 97266
Phone: Phone: 503 351 - 3730
Reg #: LIC 107211
ELE 26 -1001C
SUP 4694S
FEES Required Inspections
•
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 4/12/04 $75.00 Elect'I Final
[TAX] 8% State Surchart 4/12/04 $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 within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to follow _ les adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throuc
ssued by . _ ;_i . I i �,L,/ j Permittee Signature
•
_f ! 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
L
a - Co mmunity Development ELECTRICAL PERMIT APPLICATION
A 13125 SW Hall Blvd. cc//ll mmll
Tigard, OR 97223 Permit # al e'O() `-( /
- h
��,�,�� �• Date Issued 9 / . - ail
� I I Phone (503) 639 -4171
FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development 5� g Q / Number Of• Inspections per permit allowed
6
Address / /5O 5 611 UPYOO4C5 I'p//9 12-0
/ • Service included: Items Cost(ea) Sum
City /State /Zip `rt IjC.P4' 0 R. 4a. Residential - per unit
1000 sq. ft. or less $110 00 4
Name (or name of business) 1 E t'Z T410 Each additional 500 sq. ft. or
portion thereof $25 00
Commercial n Residential ❑ Limited Energy $25.00 1
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68 00 2
2a. Contractor installation only:
4b. Services or Feeders .
Electrical Contractor DRA- os CONS F. Installation, alteration, or relocation $60 00 2
200 amps or less
Address 1071/9' 56 PA-KO EE S>~- 201 amps to 400 amps $80.00 2
City Po l- T,._fr' 1 0 State oa Zip 9726 b 401 amps to 600 amps $120 00 2
601 amps to 1000 amps
$180 00
Phone No. e''v 3) 351 - 3730 Over 1000 amps or volts $340 00 2
Job NO. Reconnect only $50 00 2
contractor's license NO. 2--(— /De / e 4c. Temporary Services or Feeders
Contractor's Board Reg. No. l 0 7, / Installation, alteration, or relocation
Signature of upr. EI c'n �i•-� 200 amps or less 2
License No. 4 44/ s Phone No. 9 S/- 4) 3 0 201 amps to 400 amps $50 00 2
401 amps to 600 amps $75 00
Over 600 amps to 1000 volts $100 00
2b. For owner installations: see "b" above
4d. Branch Circuits
Print Owner's Name New, alteration or extension per pane
Address a) The fee for branch circuits with
purchase of service or feeder fee. 2
City State Zip Each branch circuit $5.00
Phone No. b) The fee for branch circuits withou
The installation is being made on property I own which is purchase of service or feeder fee. 2
not intended for sale, lease or rent. First branch nal br $
Each 00
Eh additional branch circuit $5.00
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) • 2
3. Plan Review section (if required): Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40 00
Signal circuit(s) or a limited energy r 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension / .1.41 1436--- J • o
4 or more residential units in one structure Minor Labels (10) $100 00
Service and feeder 225 amps or more
System over 600 volts nominal 4f. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
as described in N E.C. Chapter 5 Per inspection $35 00
Per hour $55 00
In Plant $55.00
Submit 2 sets of plans with application where any of the above .
apply. Not required for temporary construction services. 5. Fees:
5a. Enter total of above fees $
NOTICE 5% Surcharge (05 X total fees) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter 25% of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. wordkomdevdec. ❑ Trust Account # • '
$
prm app .
Balance Due $