Permit � ELECTRICAL PERMIT -
C ITY OF TIC�ARD RESTRICTED ENERGY
�
T 1I DEVELOPMENT SERVICES PERMIT #: ELR2004 -00057
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/8/04
SITE ADDRESS: 13776 SW ALPINE VIEW PARCEL: 2S109BA -08800
SUBDIVISION: DAFFODIL HILL ZONING: R -7
BLOCK: LOT: 014 JURISDICTION: TIG
Project Description: Residential all encompassing low voltage.
Job No. 3424
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA /TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: ALL ENCOMP : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: :
TOTAL # OF SYSTEMS:
Owner: Contractor:
HEIGHTS CONSTRUCTION QUADRANT SYSTEMS
P.O. BOX 91249 PO BOX 14833
PORTLAND, OR 97291 1, {° 7,1 PORTLAND, OR 97293
Phone: 503- 291 -2550 Phone: 234 -5558
Reg #: SUP 1211JLE
LIC 96806
ELE 26- 565CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 3/8/04 $75.00 Elect'l Final
[TAX] 8% State Surchari 3/8/04 $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 rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throuc
Issued by G �,— 4 -� -`s -. `�� 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
031;112004 11:41 5032362322 QUADRANT SYSTEMS
J y • D PAGE 02
doll FOR OFFICE USE ONLY P , J `II , fit:': 11 Received Electrical
Date/B : - 4 Permit No.: _-'...,. ' 00
p Planning Ap rova Sign
City of Tigard MAR 4 204 Da rning Permit No.:
13125 SW Hall Blvd. F T1G ARp Plan Review Other " I//
Tigard, Oregon. 97223 Ga OF ON Date/By: Permit No.:W`�fxpe -Ot9 i11 A
q,['�,1 Post- Review Land Use
Phone: 503 - 639 -4171, Y�� i i�xo�ilcy 1 ai4.;�j'�� D ate/By: Case
Internet: www.ci.tigard.oz.us c• - Contact Ju :.. J Sec Page 2 for
24 -hour Inspection Request: 503 639 - 4175 Name/Method: -.I Su lemental Information.
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p t ` y��y7 1}•-,,,,pQyy ^�pyy �I .Yb °'r �, bT`; ,�., ,•, ��.• , .�;lb +�r{'..". Wr ` I° ' ^' 1;�'E
r 'irl,i r �.�.� °'jl`N ;l j ;l [51 ,5 2,. 4 0''k. r iliLUM -' , 1 ^W 1 i51;�Ni ([r 5 ,,.; -.7 r a' :,.
1 New construction 1 Demolition ■ Service over 225 amps- IN liealth -care facility
Commercial El I•Jnzardous location
I. Additioriialteration/re. iacement • Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
iJ(J :eg ntr:, ►:1':] 1,11 °, '• .y' p� '-,6 0 ,Mm. + �tl e 'f „i°`,l : Fib i:i'' I & 2 family dwellings four or more residential units in
NI 1 & 2 -Famil dwell.in • ii Commercial/Industrial
❑ System over 600 volts nominal one structure
ID Occ a over three stories El Feeders, 400 amps or more
r im Accesso Buildin: • ID Occupant load over 99 persons ❑ Manufactured structures or RV park
IN Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
f , rim.. • r , ., i; av Submit vets of plans with any of the above.
lei l : 9; T3 -' t' A.1�' h ° in) c' 1. o r '` "- The above are not a . n 6cabie to tem . ors construction service.
• . - Job site y 2 : K, t , , ; art� , j;.
Suite #: Bld.' IA6t.
e address' I 5.,� ., ;tea +, ; ,. "n 1:'P:;tw :a$ �i� � :, ,ta o a ( �pJa��;; is 'r!'x �� ,r$ ".� � '
# Number of inspections per permit allowed
CM Description Qty. Fee (ea.) Total
Pro ect Name: S {�tY1 r • New residential - single or multi- family per j
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service Included:
---S.A.‘ 0013 C Xt C 1000 sq. ft. or less 145.15 4
Each additional 500 eq. ft, or portion thereof 33.40 'I
Limited energy, residential i 75 - 00 % 2
Subdivision: Igo, • P R Lot #: 14 Limited energy, non residential 75.00 2
Tax __ _
mfr. /•steel # : . w -,� � r ^r!K�i � °if:�;!'. .;:. .l.,':' - Each manufactured home or modular dwelling Sarviceand/orferdcr 90.9tl 2
c! f {ot r e ti m "�I FS /`;i11 rcda,,r:; } -" wJ ; ""u•
.i.' Services or feeders - installation,
` aI.S x d I 4- alteration or relocation:
' 1 200 amps or less 80.30 2
* � = 201 amps to 400 amps 106,85 2
401 am.s to GOO am.s 160.60 2
:,.�� 601 amps to 1000 amp 454.65 2
�,, ° � i �ii�`i : rti;`lu `ljtaki + ,i!!;' _: i; ;rt Over 1000 amps ar volts
Name: -
Reconnect only 66.85 _ 2
Addre Temporary services or feeders - Installation,
: 'iteration, or relocation:
200 amps or Tess 66.85 1
F 201 amp to 400 rii w5 100.30 2
Phone: 5�3_. Z,a 4.11 q y Fay: .. 401 to 600 amps - 133.75 2
1 v t ,,'tJ�T�} ' i)I +��1 E IC t) 1tJ�
. 0` !3 G'�i� , Branc circuits - new, >.. YlktlrS,:.+ i�7lJ3 :i� ?:Mk,'�fiil_�i`w��R.:4. ,...?. �..,,1i��.. .. B f alteration, or
Narne: extension per panel:
A. Fee for branch circuits with purchase of 6.65 2
Address: service or feeder fee, each branch circuit
Ci /St /Zi • : B. Fee far branch circuits without purchase of 2
service or tbeder f. first branch circuit 46.85
Phone:
Fax: Each additional branch circuit 6.65 2
E Misc.(Scrvice or feeder not included):
E irri anon circle 53.40
- ,777-117:'7"'"F17,77,,,.:.r,�; le ach uttt or
@i3 ,rrc ,y i,g isIi l
��. i lan � �f? 1 i ]tfa 1"' ' .y,� 1 c 53.40 2
II'L1A7i� +' {t ��pp� i { 1.,. 1 sT�..0 m F, :w S.,LIA.,1�,. .i:ti.,.:.a, . ,:; :;1:_ ,'t.
's i ... is1,1 ' ,: 14 , Each sign or outline lighting ,id1,��,i:C.ftivsli,��l; Li6::..�'s lea i a. h
Job No: 3 4 . , I Signal circuit(s) or a limited energy panel,
alteratio or e xtension Prigs 2 z
Business Name: 'Qr- ta.Arrrn Description;
Address : I 4.t>r3 3 Each additional inpec over the allowable In any of the ocbovc: ,
s rP Ci /State/Zi.: o � n '� 9 Z Q' Per inspection par hour (min. I hour) 62.50
Phone: o +1' 5Cr EMEMMIMMIll Investigation fcc:
CCB Lic. #: q �.,� : , � il7. � • .r.";:{ '!, ,11FI. :,; ,' g,l!, 1 �3 . ,l� :'_ill,k;l:' 11.:7:1 :: 74'�;?i+';' �t1.1:{� is !?�f'Ni,du:if�y 1
Supervising electrician 1 1 Subtotat $ - 7S.00 _
si: ature re. aired.: L -A. Plan Review 25% of Permit Fee $
Print Name: I CFI ' 1 FEIETWEINSEI State Surchar_c 8% of Permit Fee $
TOTAL PERMIT FEE $ . 1.00
Authorized `` Notice: This permit application expires if a permit is not obtained within
Signature: Date: �i e`4 180 days after It has boon etcepted as complete.
*Fee methodology set. Tri- County Building Industry Service Board.
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(Please print name) -
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