Permit CITY OF TIGARD ELECTRICAL -
RESTRICTED
jJi� l DEVELOPMENT SERVICES PERMIT #: ELR2001 -00046
`
-- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 02/22/2001
SITE ADDRESS: 12323 SW 66TH AVE PARCEL: 2S101AA -06400
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: C -G
BLOCK: LOT: 024 JURISDICTION: TIG
Proiect Description: Installation of data telecommunication. Job #79638
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:
TING, ELON + SYLVIA ELECTRICAL CONSTRUCTION CO
BY WILLIAM R SOUTHARD PO BOX 10286
603 SE VICTORY AVE STE 100 PORTLAND, OR 97296
VANCOUVER, WA 98661
Phone: Phone: 224 -3511
Reg #: LIC 049737
SUP 2986S
ELE 26-45C
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 02/22/2001 $75.00 2720010000 Elect'I Final
5PCT CTR 02/22/2001 $6.00 2720010000
Total $81.00 EXPIRED
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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
Issued by di, _ _ ,f _, , ,.� � 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
02/20/2001 13:08 15032953012 E C COMPANY PAGE 01
..
I•
Electrical Permit Application
. Date reecivedQ Z O b I Permit no.: " p 6pl ,_.oto 1 /
�„ j; . �� 1 City of Tigard Project/appl. no.: Expire date:
CityofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receipt no.:
Phonc: (503) 639 -4171 - •
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
rat: OF PERMIT
(] 1 & 2 family dwelling or accessory lommercial/industrial 0 Multi - family 0 Tenant improvement
CI Ncw construction 0 Addition/alteration/replacement ❑ Other: 0 Partial
JOB SITE INFORMATION
Job address: 23 $ W ( • " V ' Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot: Block: Subdivision:
Project name: i a g_• le _ • Description and location of work on premises: 1/0 V . - - a a_ / � 4 Y,
Estimated date of com .leuon/ins • tion: 1' ' j i
. C ON TRA('TO 1 i 1' 'I,jl ION .. -:, - '; + .- • - / : .... x ..... t 5 ( :11LUULl;. ..1- .. .. • •
,Yob no: 79 4 ! . F Mox
Business name: ) . / At Description Qty. (ea.) Total no. leap
Nonresidential its idential - single or multi - family per
Address: �Q Q X ) f S dweUingunlL Indodes attached garage.
City: ji r -Jo4i4 1 State: (9it 1 ZIP :17gq (p serriceinduded:
Phone: t�j 6 4 •j Fax:2 5... E-mail: 1000 sq. ft. or Iesa 4
CCB no.: ' 937- Elec. bus. lic. no: 2 ( _ 4 5 Each additional 500 •. h or Donlon thereof
Limited energy, residential 2
City /me L. • no.: t/1r!i, fi r Limited energy. non-residential 2
'&7 9..h Z- ap .0 / Each manufactured home or modular dwelling
Signature o supervteing electr 'an (require • Date Service and/or feeder 2
Sup. elem. name (print): 15fe ' . r /w ' f , - .. . Licease00o: l 1 srs 51cneeaorfeedens- Installation,
alteration or relocation:
PROPERTY OWNER 200 amps orless • 2
' VL
rq d0 y- , _. 201 amps to 400 amps 2
�- 401 snips to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: 'State: [ZIP: Over 1000 -reps o•volts 2
Phone: 44 .-- 101p Fax: 1E-mail: Reconnect only 1
Owner .installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, tent. or exchange according to IsAtailatl °o + alteration, orrelocation:
20 amps or
ORS 447, 455, 479, 670, 701. • 2
201 1 amps a 400 amps 2
Owner's si : : , - : Date: 401 to 600 am • s 2
ENGINEER Branch dreUG$ - new, alteration,
or extension per panel;
Name: _ A. Fee for branch circuits with purchase of
Address: service or feeder fee. each branch circuit 2
City: 1 State: - 1 ZIP: B. Fee for branch circuits without purcbase
of service or feeder fee, first branch circuit: 2
Phone: Fax: Email: Each additional branch circuit;
PLAN IZLvii:tti' (Please check all that apply) . Misc. (Serrlceorfeeder not Included):
O Service over225 amps - commercial - O Healtbcarefacility Each pump or irrigation circle 2
O Service over 320 ampa- rating of 1 &2 0 Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 equate feet four or Signal circuits) or a tinuted energy panel. �� 2
O System over 600 volts nominal more residential units in one attucture alteration, or extension* ,
O Building over three stories 0 Feeders, 400 amps or more 'Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable In any of the above:
0 Egress/lightingplan Cl Other. Per inspection 1 1 1 1
Submit _ sets of plans with any of the above. Investigation fee ■
The above are not applicable to temporary construction service. Other �t/1
Nes n
all accept crorSt cards, please call Jurisdiction for mac Information. Notice: This permit application Permit fee $ V�L
o visa 0 MasterCard expires if a permit is not obtained Plan review (at — %) $
crow card num b: 1 1 within 180 days after it has been State surcharge (8%) .... $ (a r Oa
Expires accepted as completes TOTAL $ S1.00
Name of cardholder as shown an ctedlt card
EXPIRED
cardholder signature Amount 440_46I5 (6/Om/COM)