Permit CITY OF T I GA R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
00 DEVELOPMENT SERVICES PERMIT #: ELR2003 - 00014
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/23/03
SITE ADDRESS: 14617 SW 126TH AVE PARCEL: 2S109AD -10200
SUBDIVISION: MCCLINCY MLP2001 -00008 ZONING: R -7
BLOCK: LOT: 003 JURISDICTION: TIG
Project Description: Install low voltage: All encompassing.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: X AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: X BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: X CLOCK: MEDICAL:
HVAC: X DATAJTELE COMM: NURSE CALLS:
VACUUM SYSTEM: X FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: AL ENCOMP : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
MATT CRINO QUADRANT SYSTEMS
3 MONROE PKWY STE P PO BOX 14833
PMB 335 PORTLAND, OR 97293
LAKE OSWEGO, OR 97035
Phone: 503- 244 -0052 Phone: 234 -5558
Reg #: MET 00002466
SUP 1211JLE
LIC 96806
FEES ELE I46gS1C4$nspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 1/23/03 $75.00 • Elect'I Final
[TAX] 8% State Tax 1/23/03 $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.
Issued by ` !/t, Permittee Signature a 1' �� j_ 4 71
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
1 -21 -2003 12 :05PM FROM QUADRANT SYSTEMS 503 236 2322 P. 2
t G
• 1
Electrical l'ermu A lication
. E E d: / -. ..0 Permit n o.1CL ) ) ii-
�, �' {� { �` City of Tigard v ' � � Datereceive Projcct/appl.no. Expire date: � 4
City of Tigard ' Address: 13125 SW Hall Blvd, Tigar404. n23 D issued: By: f Recei ptno.: f
Phone: (503) 639 -4171 . Z0 03 --
Fax: (503) 598 -1960 CITY OF Case file no.: Payment type: : ,
Land use approval:
• B UILDING p 418A
TYPE OF 1?EltMMIT
1 & 2 family dwelling or accessory Q Commercial/industrial Cl Multi- family 0 Tenant improvement
-s in New construction 0 Addition/alteration/replacement 0 Other: ❑ Partial
JOB SITE INFORMATION
Job address: j A, ii- . .., i 1(444- ( � • , q rk, . Bldg. no.: Suite no.: T ax m lot/account no,:
Lot: • Block: Subdivision:
i
Project name: t ea„ Description and location of work on premise � (',;n
(4- -E( - * ,\
Aer . t ,
Estimated date of completion/inspection:. ' , .td SR. 6. s • �u s. t ( d 4: _ d i , .
( :ONTRACTOIt APPLICATION FEE SCIH?DULE •
Job no: Fee *lax
r`� lrh� �K - Description Qty. (ea.) Total n4. ins
4 ty
Business name: S New residattkl- single ormuhi- family per
Address: - PP e, t i. . dwelling unit Fnciudesatfachedgarage. .
City: .. f ~ 'o4,,L- E, —i ]State:0. -' I ZIP: T Serrioeincladedi
Phone: .13 i} AsSe J l ?a -. )J.J E-mail: 1000 sq. ft- or less _ ail
/ Flac. bus. �� S
Each additional sq. ft. or portion thereof F., CCB tsar: lie. no: zc. Limited enerrgy, residential +14
City /metro lice n Oc . of I( 66 Limited energy, non y
- Bach manufactured home or modular dwelling
i
Signature of supervising electrician (required) Date Service and/or feeder i 2 .L
• Sup. elect. name (print); — Kt ty‘ ( Ea, License no921 t Services or feeders—Installation,
alteration or relocation:
200 amps or less 12
Name (print): 201 .s to 400 amps 2
iVla address: 401. anlps to 600 amps • 12 i
601 amps to 1000 amps 2
City: ' I State: Z1P: Over 1000 amps or volts 2 1
Phone: W lFax: I E -mail: Reconnectonly .___ { i i
Owner installation: The installation is being made on property I own Temporary cervices or feeders - ' ; ._
which is not intended for sale, lease, rent, or exchange according to itpRattatlon,adtcratton, ortelocstI n.
ORS 447, 455, 479, 670, 701. a lei z
20I cr to to 400 amps 1 . � ,
Owners signature: • ate: 401 to 600 amps
Brautchcirctdts - new, alteration, 1
Name: or extension per panel: •
A. Rotor branch circuits with purchase of
Address: service or feeder fee, each branch circuit , 2
City: I State: I ZIP: )3. Pee for branch circuits without purchase ' '
Phone: Fax: Is of service or feeder fee, firs branch circuit_ ,,I 2
Each additional branch circuit: L
Misc. (Service or feeder not included):
Cl Service over 225 amps - commercial - Q Hlltr
es-care facility . ' Bach pump or irrigation circle ' • 2 4L
Q Service over 320 amps - rating of Ida O Hazardous location • Each sign or outline lighting - 2
family dwellings ❑ Building over 10,000 square fact four or Signal circuit(s) or a limited energy panel, — ti ; it
Cl System over600 volts nominal more residential units in one structure alteration, or extension's _ - 2
o Building over three stories D Feeders, 400 amps or more +Descridi on: a
0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional Inspection over the allowable in any of the above: 1
O Egressflighting plan O Other. Puinspection '-
Subtnit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other 1k
Not all jurisdictions accept credit cards. please call Jurisdiction far more information. Notice: This perm app li ca ti
,j on Pertn fee $
0 Visa ' U MasterCard expires if a permit is not obtained Plan review (at __._ %) $ . '� 11
Credit card number: _ I / within 180 days after it has been State surcharge (8%) $
exp accepted as complete. TOTAL $
Name of cardholder as shows on credit card .69 • •
Cardholder signature S Amount ( / / 1 / 7 440-4615 (61W/C M)