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Permit CITY OF T ELECTRICAL PERMIT - RESTRICTED ENERGY 11 DEVELOPMENT SERVICES PERMIT #: ELR2004 -00319 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/18/2004 SITE ADDRESS: 14100 SW 72ND AVE PARCEL: 2S112AA -01000 SUBDIVISION: PP1992 -007 ZONING: I -H BLOCK: LOT: 001 JURISDICTION: TIG Project Description: Limited energy for data cabling. 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: WILLIAMS CONTROLS INDUSTRIES INC MATRIX COMMUNICATIONS 14100 SW 72ND AVE 4243 SE INTERNATIONAL WY TIGARD, OR 97224 STE C PORTLAND, OR 97214 Phone: 503- 684 -8600 Phone: 503- 513 -9152 Reg #: L503-5137i ELE 26- 694CLE FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 10/18/2004 $75.00 Elect'l Final [TAX] 8% State Surchart 10/18/2004 $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 throug • • • - 001 -0100 You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699. Issu • d by y „i ;i ' i // Permittee Signatu 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 09/12/2004 02:40 513 -9352 MATRIX PAGE 03 10/15/2004 15:17 F&1 5088081980 �`, • CITY' OF TIGARD ►4J 003 l eC tr I C al Permit �I► v Lon u1TlC1. 1,Si (.0.1_] City of Tigard ,� R ewi !O ff�L � remit r10 • 0 317 13123 sac tell Blvd., Tigard, OR 97223 t�� Pion a..iew other garnet pttoae: 501639.41n Pon 503.598.1960' _ ` f LW 1 I' Bate 1 u err• i..,. B! flwPaae2tor inspection Line: 303.639.4175 r : NalecdlMtshod t supptm+watal laformatioa Interact www.ctdgsrd.or.us \I i ^ ,, ° 4 . ; `C)r � i'. ".p R . ❑ New eonstrectio Et '"_r ; oa/elter4notheplacement Please cheat all that apply: • 4 o OServiee over Demolition ❑ Other: 225 arses, cann 011armdous tonelion ❑ DQS ..rating © Buildng over 10,000 sq. it, , • rvlee over 320 am of l al • .. .. :..1.. of la eu0.1'1bit: • .. . _ _ . • . ,Frei • .::, : '.' � ;, • '. � • � � • - and bfaml7y dwelliII6g n more bath residential I D and 2- family dwelling Coma lal/induatrial ❑ Accessory building L7sy over 600 volts nominal vies in one structure ['Building ovenbtee stories ❑rerdet0, MX one° or mono ❑ Multi - family 0 Mast builder ❑ Outer: ❑O nt load over 99 persons ❑A4anufactuted sanctums or • ' ; • :. `JO &,'SITE fNPOR TIOP)';AND ;IAGA"PLiIN; • >. ': . • ' • ❑Elena 8bO°S plan RV park Job d�,` ZWIA !�I 7 ❑l;kolth c sets facility ooc>t� no.: • • � Submit � sets eFphrsw with any of the above. City/State/21P: I The above av not applicable to temporary consultation service. Suite/bldg./apt. no.: l i , / .. ' Al '1 o r m d v das ' • . _` $ 1 • °I,B sae. � - Tam • i . N Cross etreer/directions to job sits ' New residential sinks or multi-family dwelling unit. Itteludaa attached garage. 1,000 sq. IL or Boa 145.15 4 Subdivision Lot no.: 18 add'i 500 act. ft or potion 33.40 - 1 r Limited enemy, residential 75.00 2 Tax Map/parcel10.: Limited energy, non rmidenael 75.00 2 • + "•' : '1 • • D.)g9ERl T1OR OF `W ' i ' . , Each masLfncwrod or modular /TOWN dwelling. service and/or fouler 90.90 , 2 / L ; / �, j � - `� Services or feeders Iawl.Aatiive, aheratton, and/or relocation aia other 8030 2 - ,•• ZO1 amps to arms . • • .. '❑ ' PR�P&FCTY• t)�'1'x ' ... "i1LN1 T 401 neaps to 600 Amps 160.60 2 Name: LLBt LL t R 06 I tJTQI Le- 601 amen to 1.000 arm 240.60 2 Address: P a u L j3 U t/ 2 l>.'et1000 amps or voila 454.65 2 Reoumeot only 66.85 2 City/State/VP: Temporary cervices or feeders lestauation, alteration. and/or nee: (5[ VI — ( 6 (CO0 I Fax: ( ) reloeatton 100 amps es less 66.85 _ 1 Owner Installation: This installation Ls being made on property that I own which i9 ant 201 amts co 400 amps 10030 2 intended for sale, lases, amt, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 60 ___ _ 0 amps - 133.75 , 2 Owner signature! Emelt drafts— new, abandon. or artsnsien, panel . : AFee forbtancfi cneuits with • �` ;r�!hLI PlT : • i ❑ CO1V 1!y►C'1 T Rl4QN ' service or fbeder fee, each 6.65 2 Business mane: branch circuit 1), Fee for branch circuits Contact name: widows service or feeder fee. 46.85 2 each tont& circuit Adder' _ Each add'l branch davit 1 6.65 1 2 City /State/ZIP: Miscellaneous (service er feeder not inn1, ded) • Pomp orirrigation circle 53.40 2 Phone. ( ) I Fax:: ( ) Silo or outline lighting 53.40 2 fi.mail: Signal circuit() or limited- f • . " .• o r ; , Croft ' : ` .. . • -:.. • energy peel. alteration. or ✓ cribe: Page 2 •2 BuSiaese name: ' �I r� ,0` _ 1 _lit 1 . // 1 / _ �i . , - J�'� /�/j Each additional inspection over allowable to an of the above Address: J..tti ��L� � - - !� / - .- -- '± w Per inspection 62.50 OW/State/MO: i i`I ' I t ; ±�. itfil/ *" Invest! ,•- .. o . - hoer (1 to rata) I 62.50 - rip. - !Mr. ' '2— j I JI ladua t etal Plampahaut 73.75 CCB Lie.: .-1- -S w gfril Electrical Li •t " ,,dl Subtotal TS A Suprv. Electrician sigeatlae, - • • • - _ .�! - ; ‹," / Plan review (25% oipe:mlt fee) Date: /9--6-Pe— sursha>fe (895 of permit the) Print name: _ f .�. u rAL PERMIT FEE • Authorized signature: — This pennttappuanon metro Ira ps'te not obtain wtmein 100 days after tt ear been accepted as onaetate print name:. Dare: • Tee metsodederran t- CoucYBaliana hndaucre ySviceBaud . — .. x.mber of inwaatimu pet aertn t allowro. iosaadbtetr*mlrulLrocar idea 1 2N7 44 0.46131(I JCwtnvs.