Permit (118) •A CITY OF TIGARD ELECTRICAL PERMIT -
, RESTRICTED ENERGY
a�� DEVELOPMENT SERVICES PERMIT #: ELR2001 -00200
' I " 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 07/30/2001
SITE ADDRESS: 16200 SW PACIFIC HY Z PARCEL: 2S1156A -00100
W
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of low voltage data cable.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
IBJ SCHRODER BANK + TRUST CO DATA CABLING SERVICE INC.
BY ALBERTSONS INC #565 PO BOX 2813
ATTN: CORPORATE ACCTG DEPT BOISE, ID 83701
BOISE, ID 83726
Phone: Phone: 208 - 378 -7778
Reg #: ELE 37- 741CLE
LIC 110792
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 07/30/2001 $75.00 2720010000 Elect'l Final
5PCT CTR 07/30/2001 $6.00 2720010000
Total $81.00 EXPIRED
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 throu h OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987. ,
Issued by � ) .,,41/9/4/_) Permittee Signature i1, 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: DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
i Jul.26. 2001 10:13AM . U DATA CABLING SERVICE ., No.4442 P. 1/1
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1 7 4 1 4
N,0 6 - Electrical Permit Applic . i on orrirE i SI: ONLY
- - .
*
. WA-gW1G-111,7Y—a Date received: Permit no.t 1
_ _, 10 , -Oo200
Project/2pp]. no.: Expire date:
o Address: 135 N. 1st AV, Suite 3S0-12, HillsborcREteMID
l'e
cstE0 \ Phone: 503-843470 Fax: 503-846-390 Date issued: By: Receipt no.:
1 6 met Address: wsvw.co.washington.or.us JU 2 C 200 . cm file no.:
' - Payment typm
Land use approval:
. COMMIT DEVELOPMENT •
IIIIIIIIIIIIIIIIIIIIIIIMIIIIII M I IOTIMIMIIMIMMIIIIIIIIIIIIIIIIIIIIIIMII —
LI 1 & 2 family damning or accessory )4- Ccuranercial/indusirial 0 Multi-family El Tenant improvement
0 New construction 1:1 Addition/alteration/replacement 0 Other: 0 Partial
JOE', SITF I,\ FORNi-\TI(
•
Job address: 4140 fiv i
e • ei . City'. r : Idg. no.: Suite no.: Tax. map/tax lot/account no.:
LOT: Blocl Subdivision:
Project name: 1// in..s — . I Description and location of work on • - ■*ses: sr/a/ 4, ... a
Estimated date of completionr ., . •-•. . - - 7
• . —
(:(N; I iz_Nc' km: APPLICA I ION FEE SCF I II:Di ji.1::
Job no:
i‘s e . .
Pec Max
Buain ess qua= : _ D 4 _ 44/4,1 Seireye .c. • nescriptigo Qty. ea. Total no. bas2
Net, roadoillal-singleor mult1.41nnity per
Address: gr80 140 erieV7 e..f threlling anat. bender machad garage.
City : g.i.re istate, [ZIP: WO? Service Winded:
FbL - Allg - P8 - 77 ) f I F Perna 1 °EL 0 1.9. 1 t. °I less
i . 4or.s 125.00 4
Each additional 500 aq, ltor portion thereof 35.00 '
CCIAno.: . HO 79.4.= 1 Elec. bus, lic. no: .51,- 7,
Litaited march 1 & 2 FlartilY 35.00 - 2
City/metro Tic, no.: N/A _ - Limited energy, Muhl-Family 55.00 . 2
ks1 7-e--cv Each oterwfactured hume ur modular dwelling • •
• Sigeorsure of &droll Eloto (Required) Date Service andlor feeder 55.00 2
Sup. elect name (print) r - . Licerwc no: .k Serosees or feeders - !Retaliation,
eltereeno or relocation:
200 amps or loss 75.00 2
Name (print): Nie&F/Jiins . . 201 amps to 400 arms . , 100.00 2 '
" ' 401 amps to 600 amps 150.00 2
Mailing address: /g7,42%. 5 RocWk Al 601 snips to 1000 amps • 225.00 z
City. ''V "4 j State:40e. " I ZIP: 9 72 2 Over 1000 - • • or volts 420.00 2
Phone re - P7r.J jYac ---- Small --• Reconnect only 65.00 1
Owner ligstallatien: 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,litersuion, or related= •
ORS 447, 455, 479, 670, 701. 200 amps or Ieee 65.00 2
/ • 2oi antra 01) 4 00 alltro 90.00 2
OWner'S .. .+1 • i • : -42/ 401 to 600 amps 125.00 2
. 1 N'l 1 C. Branch circuits - new, alteration,
Name: Aft4 . t.4.,:,p, or extession pEr panel:
A. Feefor branch eimuits with purchase of
Address: service or treder fee, each branch circuit 7.00 2 •
City: : f sage; 1 ZIP: B. Fee far branch circuits without purchase
• of service or feeder the. fast branch circuit 45.00 2
phone: Fax: E-mail:
. Each additional branch circuit 7.00
PLAN I:1 I Pl:./ cl I 11 1
.3.: .3., 1,1;it ,app1:, ) Wm. (Service or feeder not included):
0 Service over 225 ampa.eterenercial 0 Ifeakh.caft facility Each pump or iffigetion circle 50.00 2
O Service over 320 reoPsrvellog of 1a2 0 Hazardous location Each sign or outline lighting 50.00 2
&truly dwelling* 0 Building aver 10,00" square fret lbw or signal circuitK of a limited energy panel, l'.-
0 System over 600 volts nominal mom maidodial win in One &Demme new, alba:dim, or extension / 50.00 0 2
0 Building over than stories 0 Plan. 400 amps or more "'Description: ‘ .
0 Occupant load aver 99 persons 0 Manufircneed structures orRY mark Kea additional Inspoition over the allowable in any Of the above:
D EaresdlighlhISPien 0 other: _ ___________________ Per Inspection ___1
Submit 2 sets of piano with any of the above. 1nvcsiOlation fee
The above are not apptleable to temporary constructlou setvice. Other
Pernxit f ' ''
- -- 4
ee 5A
', • / •:, •
-'
1 01;2 !11"11 -
. , L
Nati= Mr pasta application d.
..' no review (at 25%) / --
• .. cepityrz ir a permit a
----...---,,- within 180 days gyi _,, 7% , , egn ti surcharge (8%) $ • O 1
___ D Li
-
__--.-_ -- '14111empogr-7 — ... ' - TOTAL 60
accepter/OS complete.
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