Permit CITY OF T I G A R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
I DEVELOPMENT SERVICES • PERMIT #: ELR2003 -00090
��' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/25/03
SITE ADDRESS: 14800 SW SEQUOIA PKWY PARCEL: 2S112AD -00900
SUBDIVISION: ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: Install low voltage system for ultrapost and detacher in tool corral.
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: : HVAC: PROTECTIVE SIGNAL:
5. INSTRUMENTATION: OTHER: : X
TOTAL # OF SYSTEMS: 1
Owner: Contractor: •
HOME DEPOT USA INC BROADWAY ELECTRIC - COCHRAN INC
370 CORPORATE DRIVE 626 SE MAIN
TUKWILA, WA 98188 PORTLAND, OR 97214
Phone: 1- 206 -574 -3567 Phone: FAX - 238 -2098
Reg #: U04- 65600072942
SUP 3447S
ELE 37 -546C
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 3/25/03 $75.00 Elect'l Final
[TAX] 8% State Tax 3/25/03 $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 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699.
Issued by f' / // / . . ��� Permittee Signature ,ice C.
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: lY /,P , _ DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
•
_ Permit Application
•
- s- ;:,.., i .
RECEIVED Date received :5 ---i7 3 P ermit no.: Pa.�3 ..oto 9 0
4' : .I City of Tigard 1 Projectlappl.no.: Expire date:
City o�gard Address: 13125 SW Hall Blvd ig Q�? Date issued: B I Receipt no.:
Phone: (503) 639 -4171 //{{�� 11 [ IJ�
Fax: (503) 598 -1960 Case file no.:. Payment type:
CITY OF TIGARD •
Land use approval: BUILDING DIVISION
TYPE OF PERMIT •
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration /replacement ❑ Other. ❑ Partial
JOB SITE INFORMATION . ;. so
_ Job address: ; r r / iMr Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivisi I • .
Project name: I l"" e . b-I— I Description and location of work on premises: in ► I I U 0,,s,
Estimated date of completion/ins ction: ai 10 Oi • • 1
__ , CONTR APPLIC• TION FEE SCIIEDtLE •
Job no: r ld Liu - R �-9 Fee Max
Business name: gjr kylA eleCtylc, Description . Qty. (ea.) Total no. insp
New residential - single or multi-family per
Address: • , * , . 6_ - r dwelling unit. Includes attached garage.
City (I L j : s M - ZIP: " _ Service included:
Phone: z117L{(oi(pll Fax: f E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: '72...a/ 1.1 Z Elec. bus. lic. no: 2,'7 -54 (pc, ' L i m i ted energy, residential 2
City /me 1 .C. O.: Limited energy, non- residential 2
.. Each manufactured home or modular dwelling
Signature of supervisi g electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): . _ ■ License no: 3 "15 Services or feeders — installation,
g�N _ u
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: 'State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
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 itutallatloo , alteration, orrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am s 2
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: I State: • I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E -mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps ❑ Health - care facility Each pump or irrigation circle 2
O Service over 320 amps - rating of 1&2 0 Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, �
O System over 600 volts nominal more residential units in one structure alteration, or extensions 2
❑ Building over three stories O Feeders, 400 amps or more *Description:
O Occupant load over 99 persons O Manufactured structures or RV park Each additional Inspection over the allowable in any of the above:
O Egress/lighting plan 0 Other: Per inspection I I I I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ 7 g
❑ Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
' Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ & —
Expirca accepted as complete. TOTAL $ - 8' t---
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440.4615 (6i00/COM)