Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY •
DEVELOPMENT SERVICES PERMIT #: ELR2004 - 00027
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/9/04
1 ADDRESS: 12350 SW KELLY LN PARCEL: 2S103CC 08200
SUBDIVISION: WHISTLER'S WALK ZONING: R - 4.5
BLOCK: LOT: 029 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 #: SE14- 55521211JLE
LIC 96806
ELE 26- 565CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 2/9/04 $75.00 NIA L. _► N vi
[TAX] 8% State 2/9/04 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699.
Issued by a. ;L41 t1/, f , ti Permittee Signature c1Yt, � p fr) 0�0_0, t 6 •
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE:__ __ _
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
6/2004 15:19 5032362322 QUADRANT SYSTEMS PAGE 02
Perm / FOR QFF'.CE USE ONLY
; rical Perlt A �XCa�AOri Date/9c4 -9 -07 ZA __ Permit No. L P ( "/ — ac ) . -
,ity of 7f Igard PlanninLApproval Sign
�fatclB Permit No.:
, 1 3125 SW Hall Blvd.
0 Plan Review other
',i igard, Oregon 97223 Date/By: Permit No.:
?hone: 503 - 639 -4171 -59$ �� __ .
Post-Review Land Use
v . - L'.I. iN Date/By, Case No -:
>, Internet: www.cx.tigard.o .us •. t 1 ' "el I
►.�
�P _� f.' .,u Contact lures -' See Page 2 for
24 -hour Jnspeetien Request: 50( y 01�� ' Namc/Mcthod: Supplemental Information. • CJ ' `�
' : al ,',' • .I:,i d:;l" iiri' _.�. ' f';c 4 t. k n +Y' f' s -Try(' y. n - ,j' li r L� ' 'r i ' .. . ,
'�t r � _ r e G' 1 A i' r �
Q New construction • Demolition ■ Service over 225 amps- • Health-care facility •
commercial ❑ Hazardous location
Addition/alteration/r- . iacement 0 Other: ❑ Service over 320 amps - rating of C) Building over 10,000 square feet,
+ Mbrilia ► a t' elf F t t, e mi ;Ad,...� i d �li ,.;1%, i'-'4' 1 & 2 family dwellings four or more residential units in
a 1 & 2- Famii. dwellin • I■ Commercial/Industrial ❑ System over 600 volts nominal one structure
-'- 0 Building over three stories ❑ Feeders, 400 amps or more
Accessory Building • Multi- Family , ❑ Occupant load over 99 persons D Manufactured structures or RV park ,
Master Builder • Other: ❑ Egress/lighting plan ❑ Other:
h, aiiii' ? '! 114 t -75r. M A' , . • Z I—A 21ff A E1=16,,tt Submit sets of plates with any of the above.
The above are not a .licable to tcm.orar construction service.
Job site address: I So I -'. i~ >:," s ,' 7 �,4 ., » ,ia (III < ��:ii i.1` , E �;;
�� � � � dt l..e✓ ;: i �"i! l'u1.Y 17...3. �,'^�1 li I�I�Ii'lIMl4 •�w {a i } '.Ir�l`'a , o-� r ; �
9 , §��c:,.l .�» ,...;;�,. :,�,;,� � »..,,.��u. taJ�:.:�v,,,��,r „wF1:.5'M�, rS,� +:d
Suite #: I Bl #. » Number of ins • ections • er • ermit allowed
Project Name; gYb tom{ Descri . flan Qty Fee (ea,) Total p
Cross street/Directions to job site: New residential- single or multi- family per
J dwelling unit. Includes attached garage.
��e a-hL,C Service Included:
1000 s•. it or lass 145.15 4
Each additional 500 s.- ft. or .. ion thereof 33.40 I
Subdivision: L.L� -i 5` -IVs w � -4& . Limited cncr non I Lot #: aq Limited en _f residential U 75,00 2
� residential 75,00 1111.1.1 2
Tax ma. /. arcel #: Each manufactured home or modular dwelling III
' � I , a y' - -- -- d/or feeder 90.00 _ 2
tau VIVN NEf's'91!F-"At .1 .. ih �i Vil.Vt1 .4-...::11.7 s' 1 service an
. l;' a :
Services or feeders - installation,
f,- sr so I l ,, yl p r( F t ��� alteration or relocation:
200 am.s or less . 80,30 III 2
Ow. 41.9 - • 201 arms to 400 am.s NM 106,85 2
401 am.s to 600 am -s 160.60 - 2
.1E ,, ��...1 Q 'oIN Ri"�d §Jbs . y� ,�.
� � ,
...... ,., ..�..... 60tam.eto1000 240,60 1
6 u 1 lFi »+x��w�1fihl.l�.�. f.,ul�:aE;IE:'t!, „•,,�;. ;
Name: n �1'• .C/1'4' `tt '' II � ' ' Over Reconnect onl or volts 454.65 2
z)
�dr^r�t S Reconnect tint ME 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State/Zip: 200 a .s or less 66.85 1
Phone: Sc. 3 - Fax: 201 am .s to 400 am .s MI 100.30 2
� .. n ap's ^.t'.'. r' T I i - - !- .. •y., 401 to 600 am s 133.75 2
!• . �- ,- „��}�y�,�,��1d;: i.,�'liaGtiy.'a r: + - �!'�'�'y Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee each branch circuit II 6.65 2
City /State /Zip.: B, Fee for branch circuits without purchase of
service or feeder fee first branch circuit . 2
Phone: I Fax: Each additional branch circuit NM 6 -65 2
E -mail: Misc.(Service or feeder not included):
tt r rr' m , fY „ :,i1' .y' r:;: -rL: , - E .um. or irri lion circle II. 53.40 2
,a l.f � C T'r ! 1 1 ` I,7;•! T I . , i { G,�6j�1,45Ja .aFt ri •. , ^�' ,' m *�.'i !: ,.' .. . I' :`.` „e . ''ti 2
ns , {, ti , , i I)! !U' '. •' i e. • Laoh s• r n or outline li • ti - 53.40
Job No: 3 3,---R Signal circuits) ar a limited energy panel,
- alteration Or extension . 2
Business Namie: -fin t c -l•,r r Description! 1111 _
Address: -o eSo- it 4 33
y Each additional ins ection over the allowable In an of the above:
Cit (State /Zi.:
n� ( 9 Z”' per in .,. ction . rhour min, 1 boor 111= 62.50
Phone: - 3. - Fax: 3..- ,)_-%..,- e _ investi'.•tion fee: N
other �
CCR Lic. #: C1'Ld'tRi Lic. #: .3,1,- S3a5� C$—L, � a ,..,;,: • __ ,;:�•::., - T ,r ,, -
Oiul' u'.- .�. � u: _ �tv? 1 .�xa�s��i�.I3���1�11ib_��i "i'�I �,• � r,�;��y :'' .�� V c ¢.?�
Supervising electrician/7 1 _. Subtotal $ '76.W
signature required: /GI LA Plan Review 25% of Permit Fcc $
Pri Naix k ' Lic. #: ( �i � ( / � State Surchar :e 5% of Permit Fee $ - - -X)
-- TOTAL PERMIT FEE $ • h .63
Authorised Notice: This permit application expires if a permit is not obtained within
Signature: `� Date: " 1 4 180 days after it has been accepted as complete.
*Fee methodology set.by Tri- County Building Industry Service Board.
(Please print name)
i:\Dsts\Pcrmit Forms \ElePermitApp.doc 01/03