Permit a
CITY F T I G A R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
1
DEVELOPMENT / I Tigard, SERVICES ) 639 -4171 DATE ISSUED: ED: E2 R60 00389
13125 SITE ADDRESS: 13705 SW HATHAWAY TERR PARCEL: 2S103CC 07900
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 026 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 QUADRANT SYSTEMS
4230 GALEWOOD ST PO BOX 14833
STE 100 PORTLAND, OR 97293
LAKE OSWEGO, OR 97035
Phone: 503- 387 -7538 Phone: 503- 387 -7538
Reg #: S2.IP - 555$211JLE
LIC 96806
ELE 26- 565CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 12/26/03 $75.00
[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 thro gh OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699.
Issued by rap' c Uve�.C'/Gc C Permittee Signature rc CGG�
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 04
. 1
' A . FOR O 'nGF LIST ONLY •
E ectrical Permit_Application Received Electrical
u u tL u V >L U DatefBy: far' Permit No.' ' 36 3 '
Planning A rov ai // Sign
City Of Tigard DEC p t c/ : Permit No.:
13125 SW Hall. Blvd. r"r,3 Plan Review Other
Cry
Tigard, Oregon 97223 Date/By: Permit No.:
Post - Review Land Use
Phone: 503- 639 -4171 Fax k5 4 ,; Datc/F3 : aseNo.:
Internet: wpvw.ci.tigard.or.usUILDING Divis err LI- final contact Ju s.: Sec Page 2for
24 -hour Tns cction Request: 503 - 639 -4175 Name /Method: Li St C,1_ informa; :h'!.
g' '?1 ; Ol 6 V1 O : ', y��y;"':I� if5 %�i .° Plj.i� `{`�f� ; V7—i -�, , y,�yy ttyl�+�r, 1-,, .Z °n. 1 L yl
s a.111 �mxl �y!!S : y, . .Ih
" j {��iil {�, ltt,:�. ,��I. {� - �,a�I. � Ih:�� "��7�"l�t'•:�= �1'���II�RR� .,s;';. �:ll�.� .�,�anC':•��.C7t „1 i �f> „ I i JCdIC >S.!�I>,�.1v�l...i ..�. t'li y�.1.,'�K,ry.����f�'
::ti,l4�..'titlp �u.a. t i.. •�•'�. �,.. ° �:. ":G• ..w -. r. r4 � �� . ,. -. .
® New construction • Demolition ❑ Service over 225 amps- ❑ Health-care facility
commercial ❑ Hazardous location
• Addition /alteration/re lacement rU Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
"°r �Alnil`‘'M i %`ii . o ' ,, O1 rot, si .,',II, j 5i ; to ` m!',iom i1j i•' 1 & 2 family dwellings four or more residential units in
1 I & 2- Family dwelling Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
n Accessory Building ri Multi- .Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
Master Builder ■ Other: ❑ Egress/lighting plan 0 Other:
r 4 d " ;;; le u' 1'l ' PS ° 1 � • ',1111 ► ..1: y l ^, " i}1;'d ,l ' O.R isi•"" ;a't9a : Submit sets of plans with Any of the above,
ixF�t�- r� .�e( °' c. • �'^ c
The abov ar no A � � iicA to temnorat• construction service.
Job site address: 13� 05 Svc! - haw)G1u,i T-e,t rag_ s-: l,r ; .l ; i r a1-a +,sM e . g , , , Ica � ig ,, ' fit rr i .
J1 /� ����rr I II yy ���yy�� gq,
�1 ;.`�?K:+.. '�MH�• "' i 9�A , r', r.�,,. ,, � 1. S�.effll @!t. t�lav: t'.l 9i��S.inh•bl;
Suite #: Bidg./Apt.#: Number of inspections er permit allowed
Project Name: _ Description _ Qty Fee (ea.) Total i
Cross street/Directions to job site: d residential-single unit. or multi-family per
dwelling Holt. ]ncludC6 attached garage.
Service included:
1000 sq• ft. or less 145.15 4
Each additional 500 sq. ft_ or portion thereof 33.40 1
.--- Limited energy, residential 1 75.00 15.i 1) 1 2
Subdivision: L t r / 1 IC Lot #: 2 to Limited energy, non residential 75.00 I 2
Tax ma . e arcel #: Ench manufactured home or modular dwelling
1t1, 1 ' Imat' I 1 ,,��,��R ' l i rr 9�1 I�'[ , 050:7 :<]r't+', , � i5;
,_ 2:;s :;�;,r . _ service and/or feeder 90.90 2
I:o: ' a s1 51{�� vp IYjy,, li.. h:` ��4. �nL.k`�Is1.d9,iE,ia':W —•
Services or seeders - installation,
alteration or relocation:
200 am .s or less 80.30 2
201 amps to 400 ajs 106 -85 2
401 amps to 600 amps _ 160.60 2
� t "' ° "': if 601 a1/19s W 1000 am s 240.60 _ 2
tf;,1�, a k PJ �s5�'l f ` � P RI ?, i�Y'rJ�:IYI ilia ,'t;r.1k- -if P 5
Over 1000 amps or volts 4.4.65 2
Name: _ _ Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100,30 2
°m i m c ... „'.,,,,, .. _ 401 to 600 flues 133.75 2
i.d �ri•s.4 C.'<! h.. ^a ,t- ti + - ' Branch circuits - new alteration, or
Name: e 4 . / . ' .. A, , ii c . extension per panel:
A. Fee for branch circuits with purchase of
Address: _014)' service or feeder fee, each branch circuit 6,65 1 2
city /State /Zip: B. Fee for branch circuits without purchase of
a service or feeder fee, first branch circuit 46.85 2
Phone: p 2,j /4';5.,8 I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
„ n a 1t l ,, .ry Each pump or irrii Atkin circle 53 -40 2
u v #, Hlt',l�iJtiE�t'�Sllli:s�+! • $t.��.4.�1 !`t''_ ty f ' !i:�r, "l;�r �id.Gu'':? Each sign or outline • lighting 53.40 2
Job No: ( Signal circuit(s) or a limited energy panel,
t alteration, or extension Pie 2 2
Business Name: zidaa 1 ri Description:
Address: 1 3 - — —
Cit /State /Z (�2 ViL�. rr�� Each additional ins. tetion over the allowabl In an o f the above:
y p' V i2 a 2)9 Per inspection per hour (min. 1 hour) II 62.50 ..
Phone: S3» 234. 555 Fax: 52.73' 2 36 232 2. Investigation fcc:
Lic. #: b Lic. #: /2 ! L/ ,4
Other;
CCB F � � _ _
:��:, � � N;� .v° + }, ,,,�v r"
. °f+'i�:.�..br,.,.,:5!i1''' ic. �t�tA�. f7�° ��' �. �. fl, l”. �'' lSi'.' �. 1P.°.. 1. �i.: �5i: ��l, �C3{lrl:s::���.'u:�a'7,:1',Rw�f ,Ft..l.� .s r�..�}
Supervising electricia l Subtotal $ ']5•b0
signature rccuired: / t ,P1, /7i r Plan Rcvicw (25% of Permit Ir $
Print Name: /24'Gl7 ,GO / (Pik Lic. #: ( / / / EA-. State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE S ELQ0
Authorized Notice: This permit application expires it' a permit is not obtained within
Signature: Date: 180 days after it has been accepted us complete.
`Fee methodology act by Tr1- County Building Industry Service Board.
(Please print name)
i : \ Dsts \Permit Forms \ElcPermirApp.doc 01/03