Permit CITY OF T ELECTRICAL PERMIT
RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT #: ELR2003 -00270
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/3/03
SITE ADDRESS: 12511 SW 68TH AVE PARCEL: 2S101AA -08700
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 029 JURISDICTION: TIG
Project Description: Installation of low voltage for data telecommunications system.
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: 1
Owner: Contractor:
EDWARD HEINTZBERGER MATRIX COMMUNICATIONS
1600 SW 4TH AVE., STE 960 4243 SE INTERNATIONAL WY
PORTLAND, OR 97201 STE C
PORTLAND, OR 97214
Phone: 503- 228 -6390 Phone: 654 -3000
Reg #: LIC 74332
ELE 26- 694CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 9/3/03 $75.00 Elect'I Final
[TAX] 8% State Tax 9/3/03 $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 f low adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 throuc
Iss d by j� , U1 � - Permittee Signature
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
08/21/2003 06:07 513 -9352 MATRIX PAGE 02
D7/10/2002 11:45 FAX 5035981060 CITY OP TIGARD la 002
•
ElectricalPermitApplilcation OFFICE USE ONLY
Date received; i UM j . Permit no.: i_1•,. Ago3 -DOS r a
- `'�l,l C Xty of Tigard _�W.4 ExpI'date:
o , o fm r d Address: 13125 SW Hall Blvd, Tigard. OR 97223 Duo' tasv� By Receipt no.:
phone: (503) 639 -4171
Fax: (503) 598-1960 Case tllo Ito,: Payment typo:
• Land use approval: _ - .
TYPE PE Or PERMIT
O 1 & 2 family dwelling or accessory • • - • mmercial/indust ial 0 Multi -f n ily ❑ Tenant improvement
0 New construction 0 Addition /alteration/replacement 0 Other 0 Partial
.10E S111.1NirOR:1IATION
Job address:' , a . �i i1 X1M . Bldg. no.: Suite nq.: Tax map /tux lot/account no.:
Lot: Block Subdivi 'On:
Project name: Irif it :1 Description and location of work on premises:
Estimated date of complecion/insp ctiou:
CONTRACTOR APPLICATION FEE SCHEDULE
Job xa: • Dan • ' on Ltt3
/ /: :�� l� // // 1 /�i
�� wtlsl
Newrodd- stogieermnld4wmn7per
� �� /r7 s /L /lta�ii/�" dweniegnnit.IaeWderottnehed wee.
1 t :i7"1m, F3 via ZIP: 'W getvlaeb,du�dlt
y7 E -� . 1000 • ft. or las 4
P)lone #.P /_r -1 EIec. � . Each adthao al 100 9q- tor or , •i $an theme II= Elec, bus. lie, twof �' Iced : ns
\� City /metro ale. • ... `rililrttttttttttttt■ Llm;tod anode, aam�esido�+� � 2
IN `� ` t ai Ruh ma"ulkntred hone or modular dwelling 1111111- '
,gnwOZro of in electrician ee4uirod) Date
Service and/os feeder _ 2
El = J ' , L _ I FL7 S, Meer or feelers —ire austiao,
�S3,.�.�� intradoQor roloeottoe:
ED
PROPERTY OWNER 200 amps or lass
Name (price): ED w A ( l'1 k f t..) _ 6 t R - ! 201 amps to 400 amps
401 • to 600 rw_ 2
Mailin: address: VII a . - , .d sot snaps to 1000 woos MEM MINIM 2
City; IMM11110111111.1 State: 6 Q._ I ZIP: 973.4: / ova 100o amps or volt: MM. 2
Phone: Fax E -mail; MMIN 1
Owner installation: The installation is being made on property 1 own Taa vaTerrsorrieaortecale a-
which is not intended for sate, lease, Tent, or exchange according to 200 woos at tan •
- ORS 447, 455, 479, 670. 701. 201 amp to 400 cane _ 2
Owner's signature: _ Date: 401 to 600 rdttes EMI 2
ENGINEER • ranch circuits - Dew, alteration,
ot ntteasle° ',upsilon
Name: A. Fos fa baaeb eiuWita tvab purchase of INN'
Adds Ceti: sacvies at mode faa. each branch eirosh
8. Fe: for branch *haft yea= puscberx
City: State: of sorvko or feeder fee fiat blanch circuit: Milli 2
Phone: Fax: , E -mail: .,..,
PLAN REVIEW (Please check all that apply) INAREIgiliallill
Q Service over l:t Hedtlrcaze facility
O Serviec over 320 smps<ada6 e I &2 0 N.Ledeua loado0 Each sign outlaw tighdeg
family
bmadly
do/dingo 0 Building over 10.000 aquas fat four a
or t _ .. _..,. .. Y. ����
_
Q System ova 600 volts nominal now sesidsodel tauter in one s+avcwrw
0 0 b2dia6 over date stories 0 Fowders. 400 amps or man t: •Desai . m it. _�� ��m1 �It6�/ �!!� �a
O Occupant load ova 99 paws 0 Maattber Eructoat or RV pads Leh additio •i • aloft aver the attotrald -' a+7' of the abate:
0 ArestAightin Son • 0 Other. Par innpacooe
Subunit _ seta of plans with any ache above. Ime+d • • • - • fan
The above are not applicable to totpo*ery construction 'atria. Odor
Permit fee S
• 'lanai Wiens Rom eel& any, plows call letlsdaalm for saw i n t 6m,1doe. Notice: Nls p eIMt ap acs:itto Pl re view at r- � ° /a) 5 _
O vin 0 MasterCard =Fires if a permit Is not obtained
/ / . w itt* taco ear Ass it hos been State surcharge (8 %) .....5 �1� / . —
Credit old aumeet• Winno adapted as complete. TOTAL S
— faun of esolac: er as shown en audit out •5
Cvaasidar lrjwWN A,aa 4Ae -edt5 (. — C+•-•)
.4 1 IL)Cr