Permit k .
CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
l DEVELOPMENT SERVICES PERMIT #: ELR2003 -00390
I
'- I- 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 - 4171 DATE ISSUED: 12/26/03
SITE ADDRESS: 13620 SW 124TH AVE PARCEL: 2S103CC -07300
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 020 JURISDICTION: TIG
Project Description: All encompassing low voltage.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: X AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: X BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: X CLOCK: MEDICAL:
HVAC: X DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: X FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: ALL ENCOMP : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
DON MORISSETTE HOMES INC QUADRANT SYSTEMS
4230 SW GALEWOOD ST 100 PO BOX 14833
LAKE OSWEGO, OR 97034 PORTLAND, OR 97293
Phone: Phone: 234 -5558
Reg #: SUP 1211JLE
LIC 96806
ELE 26- 565CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 12/26/03 $75.00 Elect'I Final
[TAX] 8% State 12/26/03 $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 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. 1
Issued by 1 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
12/26/2003 15:46 5032362322 QUADRANT SYSTEMS PAGE 02
• FOR 011-1('E USE ONLY
Pert______ A pp li ca ti on Received / Electrical
Datc/B : I Y t' Permit a lt, 1— 03 -0t3 Q
f Tigard d �' .0 i _ Planning Ap• -vat sign
E a g Date/By: Permit No.;
131 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 . Date PermitNo.1 _ __
Phone: 503 - 639 -4171 Fax: 503 -598 -1960 =, i t'.
q p Land Ilse
Date/By: : Case No-
Internet; www- ci.tigard.or..us i y Contact ,Iwis,: ® See Page 2 for ..
24 -hour Inspection Request: 503 -639 -4175 Name/Method: .
. ' I G i Supplemental Informatiod.
^:' �.,i� 9 �, , • ;pry a I;, `i 'tl�' ',' p. �'kl: }°aL;' "ia�r r ; ,,, i I''''' ' 1
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n:" r t: i F �r� .g- .I' ° „1.�:'�• ? :{ r Y!'!,?'rillttlt� �,'{ f• � . 1.'+;r�t M - - . t
a•. n ii 7 P5 I •I:! i, L'rrv]l” i '�?� 7,* ?t. ;ltJ .. _ I: '�4 1 n a .. , .. ,fir, r r �� , .'q r 1.�,. . lC �lJf ' n; - i F l: ;,
F.S. New construction ■ Demolition ❑ Service over 225 amps- b Hcalth -care facility
commercial ❑ Hazardous location
Addition /alterati • lacemenl' Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
rv111 �re:),r ?'te lL ( • �i " a el`'.t`�4i p', t d�i.l' " 6 e §I' ,F y dwellings !�, ��1. „I ,I.., ,,, ., ,, I & 2 Tamil wcllin s four or more residential units In
Itlkiamt • •* - AN Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
t i D • • • $ • ] • • ❑ MllltV am1l ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
• Master Builder • Other: ❑ Egress/lighting plan ❑ Other:
i ' :• Ii. ;.; I" OH' : • • ` t,L 4 D k g . i ° SC a, ; "_ t e Submit sets of plans with any of the above
0 ' ° The above are not a , Ileable to tem era construction service
Job site address: 20 S 12- :rte ; ? ii r VE c n
Suite #: I Bldg. /Apt - #: Number of inspections per permit allowed
Pro 'ect Name: Descriettion Qty Fee (cc) Tctml r'
New residential- single or molts- family per _1 •
Cross street/Direetions to job site: dwelling unit. Includes attached garage.
Service Included:
1000 sq. It or less _ 145.15 4
Each additional 500 sq. ft, or portion thereof 33.40 1
Subdivision: U itS+�.irS W Lot #: Z-O Limited energ residential i 75.00 _�,, - 2
�-�- Limited cncryy, :roe residential 75,00 2
Tax ma . / • creel #: � Each manufacturcd home or modular dwelling
ro 1�1: p , .'l -1`cF t i�' S"' :� w7 t ' 4 �ii�e' W .".';' l,�Lia:.:.t.7 u._. °a service and/or feeder 90.90 2
$ rvices or feeders - Installation,
1Y1i ted PAI GAY ` ' .,L, 1 CDT' 1
fl U. V 1 1(SL • 1 ration or relocation:
200 amps or less 80.30 2
2 01 amps to 400 amps 106.85 2 _
r 401 amps to 600 amps 160.60 2
Rilil;1 iliN e' I�uL <ui, EELVF .P a!F�: ;1 .•1K�t! i:t�..
.T . 73 6°1 amps to 1000 amps 2.40.60 2
Over 1000 amps or volts 454.65 2
Name: Reconnect only 66115 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
Ci / State/Zip: 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 - 2
r-• F S "'^�'' r r'f a 'lrl°,!1 to ',�',"`� na” ••.,• • �t •,� . 401 to 600 amps 133.75 133.75 2
Ei ::Ly i �iViallrliM,Er ? i� fr � � IM .Ei. a gi. I• aril Branch circuits -new, alteration, or
Namle: i , ' C,(AIL.,, -f-`� , .,� C. extension per panel:
Address: ho, Pi 3
A. Fee for branch circuits with purchase of G.65 2
service or feeder fee, each branch circuit
City /State /Zi .: Da chid 012 a - B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Plebe: 711 Z34 '2: Each additional branch circuit 6.65 2
Misc.(Service or feeder not indludcd):
+, 1<" ui.i �'. �:t.di' �' .w' vw e . 1 .1 ty' ' Si l li3a,: �. Fitt 17 ra "`'�`�2�I.:+; 7 Each pump or ligation circle 53 .40 2
Each 9i I; or Gu tie ii : t 53,40 2
Job No: Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2.
Business Name: 4 A , ,' i I. L 1'• - Description:
Address: PD • _ I .r 3 - -
Each additional inspection over the allowable in an of the above:
City /State/Zip: P 2 1L'trt OK q7 ,3q- _ _ Per inspection per hour (min 1 hour) 62.50
•
Phone: 57j3 2 3y-555 - 8 Fax: JD3 2 32_ Investigation fee.
D T 1 #: ( 0 o e. : - Other
CCB Z, (+- POi Li # /4 I i d, r S '" 4. gIc $ F I' µ j -, i Tr „ 1 , 'f wi 1';i
;1' �_:,_. •.. �._. r_:. �rc:. 't.4�.. ���.1.Ir_t, E.i.., `i,�rh �ll�l •i i ,�:i
Supervis.i.ng electrician / — Subtotal $ '35 , 00
signature required: /(4,, 4t z .- Plan Review (25% of Permit Fee) $ -- _
Print Name:1 -4i cbi ,Utr'I Le ✓ I Lie. #: / 2/ f / C/� State Surcharge (8% of Permit Fee) $ 1p 170
TOTAL PERMIT FEE $ $1 .pp
Authorized Notice: This permit application expires If a permit is not obtained within
Signature: Dote: 180 days after it has been accepted as complete.
—
"Fee methodology set-by Tri- County Building industry Service Board.
(PleaSe print name)
i : \i]sts\Permlt Forms\ElcPcrmitApp.doc 01/03