Permit �:, � • r '� ELECTRICAL PERMIT -
CITY TIGARD RESTRICTED ENERGY
,1; f'' DEVELOPMENT SERVICES PERMIT #: ELR2002 -00262
r f I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/4/02
SITE ADDRESS: 13570 SW SANDRIDGE DR PARCEL: 2S105DD -04500
SUBDIVISION ? PACIFIC CREST ZONING: R -7
BLOCK: LOT: 021 JURISDICTION: TIG
Project Description: Low Voltage: all encompassing.
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:
D R HORTON HOMES AZIMUTH COMMUNICATIONS INC
5125 SW MACADAM AVE STE 145 P.O. BOX 508
PORTLAND, OR 97201 WILSONVILLE, OR 97070
Phone: 503- 222 -4151 Phone: 503- 639 -0110
Reg #: ELE 36 -94CLE
SUP 2312LEA
• LIC 145828
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 12/4/02 $75.00 Elea! Final
[TAX] 8% State Tax 12/4/02 $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 lib _ t Permittee Signature d a2/2.6 Q I / ,
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: 4V ( DATE:
LICENSE NO: I +6 1
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
- s q- ado a -ate N 0-5
• - Electrical Permit Application
F 1 Date received: Permit no.•,� D49O -�
a ) l 1 Al tiJ Lv/v.2- A, �• City of Tigard G GE` V Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall 'Br/d, Tigard, OR 97 Date issued: Receipt no.:
Phone: (503) 639 - 4171 *� `' 1 20�
Fax: (503) 598 -1960 1� r Case file no.: Payment type:
Land use approval: _ CV 0 T � GA RON
. TYPE :OF. •` -.
..1 & 2 family dwelling or accessory O Commercial/industrial 0 Multi- family 0 Tenant improvement
.,New construction 0 Addition/alteration /replacement 0 Other. 0 Partial
r .. JOB SITE INFORMATION.,:',-- s ';:::c-,' _::,
Job address: 13570 - b t i — 0 Bldg. no.: Suite no.: Tax map /tax lot/account no.:
' Lot: .. Block: Subdivision: Earg'il .....
Project name: Description and location of work on premises:
Estimated date of completion/inspection:
CONTRACTOR ;APPLICATION :FEESCHEDULE .-
Job no: Fee Max
Business name: r LidiutTfl- Co U'1/11 uto -A 7 r0 &25 Description Qty. (ea.) Total no. insp
New residential - single or multi - family per
Address: a , ' " - 5 li • P -Re, ,Ep
dwelling unit. Includes attached garage.
City:10 LSDd oicAe State: og ZIP: C ? 7D ' Serriceincluded:
�° 3
Phone:�ij C31 D JIr) Fax; •,� ,� , of /s 1000 sq. ft. or less 4
CCB no.: / Elec. bus. lic. no: ?e; - -c('.{ C•t , Each additional 500 sq. ft. or portion thereof __�_
Limited energy, residential M__ 2
City /metre lic. no.: 060e) , Limited energy, non- residential NE__ 2
I , , - fir ®pZ . Each manufactured home or modular dwelling
Signature of supervising elec ian (required) Date Service and/or feeder ■■■ 2
Sup elect name (print): _AteII L{t .t License no: Z3f2LL II Services or feeders- installation,
alteration or relocation:
PROPERTY OWNER '; " ' : 200 amps or less 2 .
Name (print): i/, 4 Hand 201 amps to 400 amps __ • 2
401 amps to 600 amps ___ 2
Mailing address: • 3 U : u iv- - - • - , c� 601 amps to 1000 amps ___ 2
City: , t c 0 State: pR pacEmEm Over 1000 amps or volts ___ 2
PhoneC , -• 'EM MET, , E -mail: Reconnect only 111.111.111� i
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration,orrelocation:
200 amps or less 2
ORS 447, 455, 479, , 701.
201 amps to 400 amps ___ 2
Owner's signature: Date: % 1 401 to 600 amps ___ 2
' :; ENGINEER`; Branch circuits - new alteration,
or extension per panel:
Name: • A. Fee' for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: ZIP: B. Fee for branch circuits without purchase MIMI
Phone: Fax' E -mail: of service or feeder fee, first branch circuit: 2
Each additional branch circuit ____
: "., PLAN .REVIEW (Please ' check : all that apply) Misc. (Serviceorfeedernot Included):
0 Service over 225 amps- commercial 0 Health -care facility Each pump or irrigation circle ■■ 2
0 Service over 320 amps- rating of 1 &2 0 Hazardous location Each sign or outline lighting _M_ 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
0 System over 600 volts nominal more residential units in one structure alteration, or extension* 2
0 Building over three stories 0 Feeders, 400 amps or more *Description:
0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
0 Egress/lighting plan 0 Other. Per inspection __
Submit — sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
0 Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / I within 180 days after it has been State surcharge (8 %) .... $
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (6/00 /COM)