Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
i DEVELOPMENT SERVICES PERMIT #: ELR2005 -00135
��' II DATE ISSUED: 5/27/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 2S 112DC -00500
SITE ADDRESS: 15895 SW 72ND AVE BLDG B 100 ZONING: I -P
SUBDIVISION: FANNO CREEK ACRE TRACTS LOT: 040 JURISDICTION: TIG
Project Description: Voice & 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 NETVERSANT CASCADES INC
15350 SW SEQUOIA PKWY #300 -WMI 9740 SW NIMBUS
PORTLAND, OR 97224 BEAVERTON, OR 97008
Phone: 503- 624 -6300 Phone: 503- 646 -0533
Reg #: ELE 34- 589CLE
LIC 150328
FEES SUP 2903LEA
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 5/27/2005 $75.00
[TAX] 8% State Surcha 5/27/2005 $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 rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: . 72 44e Permittee Signature: 0
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 are required on the job site at the time of each inspection.
MAY-in-2005(TUE) 22:35 NETVERSANT CASCADES INC P. 0 0 1 / 0 0 2 '
., .
Electrical Permit Application FOR OFFICE USE ONLY •
City of Tigard RE(—ti EIV EA
Egg g WM ■ I IM E 1 Ir ..r 4
13125 SW Hall Blvd.. Tigard, OK 9743 Plan Review
nom: 503,639,4171 Fes: 503.59E1.1960 . - ' 4 `.'"%liii?' Dathf81
. .) , . Other Perna:
Inspection Line: 503,639.4175 ' .. - - „ 0._,.... Dato Reanynty: 1 1 i .... RI See l'aae 3 far
, Nnothwmcutod: a kJ Supplemental futornieda _
Internet: venrw.ci.tigard.or.us
, ',MA •i ' • :7 .!:;;Mggiitelii0,tfi t cOrMlf. : 2■E:;.??:'1.:1:;;:fi!.;1!.■.!?.
0 Now construction NAddition/alteration/replacement Please check all that apply:
1:18avice aver 225 amp. comml CI Hordvs location
0 Demolid on 0 Other:
. ...,..— ....?„!?:,,.-7t7r.r.... ...,... ...... , °Service over 320 an - . rating 013041g aver 10,000 im, ft„
!. :; .:.::.-...,....f!Ii. or 1- and 2.11unily dwellings 4 or more new residential
0 • and 2-Outlay dwelling 111 Commercial/industrial 0 Accessory building 1:1Systan over 6no volts or nominal units In one structure .
OBuilding ova time sties OFeedent, 400 umps or mote
0 Multmily —--"0 Master builder 0 Other; 1:10ccupant load ova 99 persons OMImufactured structures or
ClEssess/lighting plan ' RV park
Job nal 00,1111 9 Job site address: 15 st5 syd 97 millti ex , ',le, °Health theility 00ther:
Submit :Luis of plans with any cif the above.
City/Statc/ZIP; To g4. tq frte i r 0 R 5 1 72,2_9 —rilr/i7 The above arc not applicable to temporary construction service.
tAS'ITZdaTuiRMFZEIZOIrez • al! .••=.7,35::',Aii:101.74
Suite/bldg./11pr. no.: 161 00 Project natne: 7- yyl 01) i it
, nowilmamo I Om I he, ) MAI • 'I . ' ',
Cross street/directions to job sitm New residential single ur multi-family dwelling unit.
- Includes attached garage.
1,000 ari. II. or Imo 145.15 4
Subdivision: I Lot no,: Ea. add*, 500 • i .it. or . rtinn 33.40 I
— Limited away, maldendal 75.00 2
Tax map/parcel no.: Limited energy. non-residential 75,00 2
.....WF ant II. it!Iftl___ 141'4 - Ea d h manullictured or modular '
\!Q le e_ t hovi-A Clilluvie dWrilittit SCIVIce and/or feeder 90.90 - ..1
Serviette or fader" inetnitntion, attention. se n d/ur taloa I inn_
•
200 amps or less 80.30 2
IOUS 2
ells20:13440.4f450SAMWOYA4. : ,P ?MAIO.
i o : ., i 201 =pit to 4130 Mg . -
401 amps in 600 umpa 160.60 2
Manic : 601 amine 1400 =Ts .240.60 2
Address: . , Ova. I .000 amps or volts 454.65 2
Reconnect only 66,85 .1
.
CitylSisucIZIP: Temporary services ur faders la Ikm. alteration. and/or
Mimic ( ) I Fax: ( ) relocation
200 amps or less • I_ _ 66.05 1
Owner installadon: This installation is being made an 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 nattpa to 6001111 ' i I 133.75 1 2
Owner signature: Dam Britre ....... - new per p31111
A 4 rildPlirgt1. °" rw. I citguith wish
service or feeder fee. each
5
Businas name: Ernuach circuit 6.6 2
B. Re for branch ditS111131 •
Contact name: without service or feeder fee, 46,85 2
each branch circuit
Address: —
Each addi branch circuit _ 6,65 2
City/Stntc/ZIP: Miscellaneous biervlee or feeder not included)
Pump or Irrigation circle 53.40 2
Phone: ( ) I Fox: : ( ) Sign or oudinc liandag 53.40 2
. ,
E Signal circult(s) or limited- ,
iiZ0.11 . :Eii 4.( ....;!• 4 7-MikitYrr.VCONTRACKOrtigf!''';Erti-g"direF.14::ig t ;i:P';i...F.'::**S . ;: cliergY Wel* 411121111 °r
litISITICIS "MC: S i••--•-....-.--Ne4V2rCf-fl±:...agaPAdeL1SAJL1Sr.4■■... extension. Describer Page 2 2
_
Address: .
1 9 4 D StAi Ah vv io w 11 MI Me,- Each additional inspection aver allowable In may elite above
Per inspection j____I 62.50
City/StaterZ1P: 3 , 1 i eA -e .. 2:3_ so z ----- Investigation per hour (1 tn. mint QM . .
.....
Phony 505) L t -a 5-3 , Fax (503 ) (pg i I . - to fp / 3 Industrial plumper hour 73.75
vi,717=11«a*,
CCB Lic.: i ______ Electrical Lic39 . ; Suprv. Lic.:3 WI La . Subtotal . 0
Suprv, Electrician signature, required; 1
1 .- E
,.I / ......_,_! I ... maim-vim (25% of permit (cc)
Print name: 1 A • 011.111EM O st:..Surchrgc ( B% orpcnnit fa) ., 0 0
• ' TOTAL PERMIT PEE '' Lc) 0
Authorized signature: .
This permit application sepiree If n permit is not obtained within Ina
1:11L---.--- aye A 1 t 0 tt has WO SCCeples1 as complete
Print
' he methreiniew lest by Tri•County building Industry Service tloara
•• Mailer of inapections per permit allowed.
ainundelatonemti.c.hatiorndec 1:103 44n-4111511003,COM/WEI3
•