Permit CITY OF T I G A R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
��
DEVELOPMENT r S o ERV SERVICES 639 -4171 DATE PERMIT
7/18/03 3 -00208
13125 SITE ADDRESS: 12130 SW KELLY LN PARCEL: 2S103CC -08800
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 035 JURISDICTION: TIG
Project Description: JOB NO. 3074
AUDIO SYSTEM
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: X 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: • 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 #: NPB'T- 55580002466
SUP 1211JLE
LIC 96806
FEES ELE akkiiihitnspections
Description Date Amount Elect'l Final
[ELPRMT] ELR Permit 7/18/03 $75.00
[TAX] 8% State Tax 7/18/03 $6.00
Total $81.00
This Pen 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 Permittee Signature j9)1
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 - - - - -- --
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
07/•17/20P.3 12:54 5032362322 QUADRANT SYSTEMS PAGE 02
Electrical Permit Application 1 'OR OFFICE 1.lSE ONLY Reeeivca Electrical Ci
City of Tigard RECEIVED Planning App an S�� 13125 SW Hall Blvd_ Mui R
Tigard, Oregon 97223 eview other
Phone: 50 JUL 1 2003 Plan R Date/By: Permit No.:
3- 639 -4171 Fax: 503- 598 -1960 i 7 , Post- Review hand
Internet: www.ci.tigard.or.uJITY OF TIGAR � „ j l i � Date/By:
Case No.:
tees l5t i L /ISI - Contact Juris.;
9 -” , Name/Method: Sec Page for
24 -hour inspection Re �—�`
Supplemental informnte
'2..f",'..','. 4! i&,.1 a 3,11a R' A m. i ^ rnafig'� ''Jdr� f ��;�L;' l� 1 �`'. •r• " 4 ",^„ "
�.51i�.. tsJiliEa � a,..sE:r�rd <� µ' f'^T'• � ,
New constructs Demolition � o over 2 t a mp s - � 'µ '1 l lt ] gal f " �r;'¢a'';'
� construction r . Aem ■ Service ;��' � • ,
amps- ■ Health -care facility
II Addition/alteration/r- .lacement 111 Other: commercial Q Hazardous location
Service over 320 amps-rating
t , W, i::�.:;.R "a i^``"i-)'� ;y .5: i t fhYq FG A i fir"' Ps R of [] Building over 1Q000 square feet,
Rl- u1 :o,� •'it i & 2 family dwellings
~ it Commercial/Industrial four or more residential units in
hi 1 & 2 -Famil dwellin
tit System over 600 voila nominal one structure
111 Access° Buildin • ❑ Buildin over tree storie
Ir.
�� h 0 Feeders, 400 amps or more
Master Builder
CI Occupant toad over 99 persons ❑ lvlanufhowred s
C 5 ^ I Other: ❑ E6ress/lighting plan structures or RV park
f t a'. 1.".4��" fIIl:MIR fii p'G' +�.5 {;'r,: „-m..- r,,;., ,.�- El
,�. \f,.r <w ���i+ �"': d��:°. �. �:: ���M� ,:�«t��� 1
''..�'!� Submit �¢etsof lams With rc pa
Job site address: J Z 3 0 ..C\-.-1 lee ( �� �� fhe above are n a , , licable em orany of nst uction s
to eonstr twice.
Suite #: B1d• ^ /A•t.t. <:h 4 n 1 ^17i.' „5 AD D l of I ' l l i lly 1 � t!1' ^ n r; a, r ^
Pro ect Name: _ Number of inspections per permit allowed
Description Qty Fee (os.) Tota
Cross street/Directions to job site:
Now realdcntlaasingle or multi f�nafiy per
k La-4k M
Service quit. Includes attached garage. ncluded:
1000 sq. it or less 145.15 4
Each additional S00 ag. ft. or portion thereof 33.40 qr 1
Subdivision: �a ` - ( ' t,ti • lk-. Lot #: -3 S" Limited enemy, residential 1 75.00 7S 2
Tax ma ./ we] #: �y Limited enerp, non residential _ 75.00 Each i'l ff i 1::> J11ialn!%"'1 D.W %��I�A rEFit- Iiif� f �S ` ^ 4 -T•: -,;, 8 twicmanufactured erome or modular dwelling 2
a
. � , �t: ::,.,:<:l:7;��!:'...: ,.•.:_;., • .'�a - 90.90 2
-� Y 4.0( 0 , i " " Services or feeders - Installation,
alteration or relocation:
i ♦ i 200 employ leas
80.30 2
-...- , 400 amps 106.85 �;�1;':_�?�� r ?a'; rim +; - .. �.�, i.a , .'`. . .....
401 amps _ 160.60 2
ill,: +a: 1,' �.,� iia ,lt,itt' :- ;1, „ I' 'f l ,its i',.. , r , 601 amps to 1000 amps 2
I c;, amp.
IMEtligr
O 1000 arms or volts 240.60 2
—i' Iteconncmmily _ 54,65 2
Address: Tem ora 66.85 2
p ry services or feeders - installation,
Cit /State/Zi • : alteration, or relocation:
Phone:...-.... V - t{ u- 200 amps or less 1
. .; - y F ax 66.85 20
!�I y _ 2 01 amps to 400 amps
t i!. � �? � 1 $ � ? h i l 5 ,74if'',` , �i ;`i. 7�, ¢l i,t �; r l r';f it °'i:rt :� t 4 - ' 40I to 600 amps 100.20 2
: .... D� ,.. _ - . Bra circuits 3 2
Name: "' is - new, altcratEon, or ^
extension per panel:
Address: A. Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 6.65 2
• B, Fee for blanch circuits without purchase of
Phone Phone Fax: service or feeder fee, first branch circuit 46.85 2
; Each additional branch circuit 6
�; .i?.l ",' ' t "''al i',' °;rr a r 1 . ^. — — ^ Misc.(Service or feeder not Included):
� 65 2
nine:; tY � 9rii;i,JC�e.�J,:ai,ilc7, -' 'T,r;1 ril ��I
:! li' r,'.- :,�, i Each PUmp n i i titon eirelc 53.40 2
r ,.
... ���:.,.: ._;._. F,-: � .:..:. ::.:..�.,':.. ";�a, :� ' fa _ �
Job Q: h sipp or or out Iig}itittR
53.40 2
lrnsa t Signal circuit(s) era limited energy panel,
Business Name: aiterat� aon,orextenaipn Page 2
Address: - PO .. 1 4 F 33 Description:
Cit /State/Zi.: - 1>04 .• a,+ Z. Each additional ins ection over the allowable in an of the above:
Per inspection per hour (min. 1 hour)
Phone: % - S' - S Fax: 503 - o), 3 t - ..2. 12 Investigation tee: 62.50
CCB Lic. #: 9 kb, J 4 Lic. #: 2.t• - -S CE P 001 er:
Supervising eleotrici � 4PC I. .t.: lII'N% 11 ,, . - I1 n I
':r�,SaJ'.S J r
•
sip attire re. uired: s
Subtotal Y w , ie i ndil,� 4
c $ S. ocj
Print Name:
Review (25% of Permit Fee) $
�r State Surcharge (8% of Permit Fee) $ (,ap)
Authorizes TOTAL TOTAL PERMIT FEE $ ei "iS
Signature: pate: l�' Notice: This permlt application expires if a permlt is not obtained within
- t 6' 180 days niter it has been accepted as complete.
y� a e air 'Fee methodology set by 'Fri-County Building Industry Service Board.
(Please print name) -
•
i : \Dsts\Permit Forms\ElcPclmitApp,doc 01/03