Permit II.
■
`' ELECTRICAL PERMIT
CITY OF TIGARD
RESTRICTED ENERGY
�1/& DEVELOPMENT SERVICES PERMIT #: ELR2003 - 00049
�---' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/18/03
SITE ADDRESS: 13175 SW WORCHESTER PL PARCEL: 2S104DA 23600
SUBDIVISION: QUAIL HOLLOW - SOUTH ZONING: R -4.5
BLOCK: LOT: 062 JURISDICTION: TIG
Project Description: givi \ f fr (jQ Q
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 : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: •
TOTAL # OF SYSTEMS:
Owner: Contractor:
BROWNSTONE QUAIL HOLLOW LLC AZIMUTH COMMUNICATIONS INC
12670 SW 68TH PKWY P.O. BOX 508
STE 200 WILSONVILLE, OR 97070
PORTLAND, OR 97223
Phone: 503 -598 -7565 Phone: 503- 639 -0110
Reg #: ELE 36 -94CLE
SUP 2312LEA
LIC 145828
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 2/18/03 $75.00 Elea! Final
[TAX] 8% State Tax 2/18/03 $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. c ,� �r f
L
Issued by lr. � � �� Permittee Signature 2 f1 CL
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
d , ` i• Electrical Permit Application ,
iiim D ate receive dy G - /F- C :j Permi no • i -
14 ,. dil City of Tigard Project/appl. no.: Expire date:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City ofTrgard g Date issued: By Receipt no.
Phone: (503) 639 - 4171
Fax: (503) 598 - 1960 Case file no.• Payment type
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi- family ❑ Tenant improvement
2f-New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address. /1/7375',0).. cJac FES7-E-g_ PL Bldg. no.: )3 Suite no.: Tax map /tax lot/account no.:
Lot. 6Or2,_.. IBlock: ISubdivision' Ct)t,tAi L S, i -i
Project name: ( tit f }I L S(1t 1 t) I Description and location of wor on premises: t./17 i CE J lii 1_)c Ct
Estimated date of completion/inspection:
CONTRACTOR APPLICATION • FEE SCHEDULE
Job no: Fee Max
7 Description Qty. (ea.) Total no. insp
Business name:
/ �i rr t Lt rt-i L cypi i� /.1 A.. c.•q 7 /cL� S New residential - single or multi - family per
Address: - ' n
�� 3 � $' S , .�� • 3t) �� � � dwelling unit Includes attached garage.
City: jt,11L ' )ii:..l kJ- E I State: I ZIP: '- 70 - 7 6,-, Service included:
Phone/ 6 .:;e ' v i i 0 I Fax:5"03 4, -,) V I lI"E - mail: 1000 sq ft or less 4
Each additional 500 sq ft or portion thereof
CCB no.. / , + -5 I Elec. bus. Itc. no: 76 4;4 CL Limited energy, residential 1 2
City /metrr lic no.: 06004:,S7? Limited energy, non- residential 2
() j - . / / �/ if ( / Each manufactured home or modular dwelling
Lf� ti
Signature of supervising electrician quired) Date Service and/or feeder 2
n Services or feeders - installation,
Sup elect name (print). - L 71 1/ L License no:a � tr1
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
7 , � — 201 amps to 400 amps
Name (print). � /6 t - ,L it, %� LLi f= 401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: [Fax: I E -mail: Reconnect only
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, or relocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps '-
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: 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):
❑ Service over 225 amps - commercial LI Health-care facility
Each pump or irrigation circle 2
❑ Service over 320 amps - rating of I &2 ❑Hazardous location
Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one stricture alteration, or extension* 2
❑ Building over three stones ❑ Feeders, 400 amps or more *Descnpuon
O Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the abole:
Cl Egress/lighting plan ❑ Other Per inspection 1
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
N otice This permit application
Permit fee $
Not all iunsdicuons accept credit cards, please call iunsdicnon for more information Notice pp
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number. / / 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 (6v'00 /COMI