Permit i CITY OF TIGARD
DEVELOPMENT SERVICES ELECTRICAL RESTRICTED ENERGY PERMIT
PERMIT #: ELR2006 -10003
� I
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171 DATE ISSUED: 3/1/2006
PARCEL: 2S 112AC -01801
SITE ADDRESS: 14965 SW 72ND AVE ZONING: I -L
SUBDIVISION: FANNO CREEK ACRE TRACTS LOT: 047 JURISDICTION: TIG
Project Description: Voice /Data.
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:
• RBJ INVESTMENTS, LLC NETVERSANT CASCADES INC
PO BOX 23175 9740 SW NIMBUS
TIGARD, OR 97281 BEAVERTON, OR 97008
Phone: Contact #: PRI 503- 646 -0533
FAX 503 - 641 -6613
FEES Reg #: ELE 34- 589CLE
LIC 150328
Description Date Amount SUP 2903LEA
[ELPRMT] ELR Permit 3/31/2006 $75.00
[TAX] 8% State Surcha 3/31/2006 $6.00 REQUIRED ITEMS AND REPORTS
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: Permittee Signature: tz,? e ps.
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 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
.
. .
CITY OF TIGARD RECEIPT
DEVELOPMENT SERVICES RECEIPT DATE: - j - 0_6
g4ii 13125 SW Hall Blvd., Tigard, OR 97223 JURISDICTION.: 1-1 .0
-- 503- 639 -4171 www.tigard- or.gov CASHIER DATE:
CASHIER RECEIPT #: --------------
LINE ITEMS:
Case No. I Fee Description I Revenue Acct. No. I Amount Due
G ' .' ?t —/ UDC i •\ ''
t 1
1
4 '
1
i I '
i
i
I
i i
1
i i i
Total Due: $ 3 , oo
❑ SEE ATTACHED FEE SCHEDULE.
PAYMENTS:
Payer: I
Method 1 Initials ti Check No. j Confirm No. Amount Paid
G ds.. C i _ - : - - _ -- - --- _T....._.... - -- ...- -= - - ) ._._.._.
I
Total Paid: $ ', i ,c
I:\ Buildin Forms\ ManualPermitForms \ManualReceipt.doc 03/01/063/1/2006
RESTRICTED ENERGY
ENERGY
4111, CITY;O' TIGARD ELECTRICAL PERMIT
BUILDING SERVICES DIVISION
°`
NJ' 13125 SW Hall Blvd., Tigard, OR 97223 n�
503- 639 -4171 www.ci.tigard.or.us PERMIT #:6a4240 - /CIO 03
DATE ISSUED: 3-1-0
SITE ADDRESS: / 4-/q6:5 S L� c 2 ? U -) PARCEL #:
BLDG /STE #: ZONING:
SUBDIVISION: Q��enn �� - mac . LOT: JURISDICTION:
This is an interim permit issued during computer system maintenance.
Construction work and inspections may proceed under this permit number.
The actual permit will be issued and mailed to the applicant within one week of the date issued above.
• ` PROJECT DESCRIPTION: \f n '� , & /— — 3off - 1c:1 O0' -sYO
i 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 LAND LIGHT:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: I
E OWNER FEES
Name: Permit Fee $ 1 a a
Address: Plan Review Fee $
City/State/Zip: State Surcharge (8 %) $ ( .
Phone: Other Fee: $
Other Fee: $
CONTRACTOR Total Fees: $ t a 0
Name: 'C\&V2Y.1 C - AS c A ,s ICJ
Address: 91 y d , � l J Y� ��- .�;5 A v
City/State /Zip: �3 � e ��- u � - • C`�- 4 Z On
Phone: _S is y(, - 0 33
Fax: 3 6 %' 1 - 6 6 /3
CCB Lic #: /5
Elect. Lic. # _may= c��,�,i✓
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 -0080. You may obtain copies
of these rules or direct questions to OUNC by calling 503 - 246-1987 or 1- 800 - 332 -2344.
Issued By:L , ,C,{) 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. ELECTRICIAN: DATE:
LICENSE NO.:
Call 503439 -4175 by 7:00 AM for an inspection that business day.
Note: If you cannot schedule an inspection while the system is down, please call 503 -718 -2433 for assistance.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
I:\ Building\ Forms\ ManualPermitForms \ManualELRpeamitdoc 12/05/05
CITY OF TIGARD RESTRICTED ENERGY
ELECTRICAL PERMIT
„ BUILDING SERVICES DIVISION
9 'Li JIIi 13125 SW Hall Blvd., Tigard, OR 97223 •
PERMIT #
503- 639 -4171 www.ci.tigard.or.us •
DATE ISSUED: _ 45_ C) _ SITE ADDRESS: / `1 (� j 3 1.2 `-- Q -- PARCEL #:
BLDG /STE #: ZONING:
SUBDIVISION: - ._.. � ,cyn , _._.. — . - -- -------- __....--- - - - - -- -------- - - -___
(�r,z , LOT: JURISDICTION:
This is an interim permit issued during computer system maintenance.
Construction work and inspections may proceed under this permit number.
The actual permit will be issued and mailed to the applicant within one week of the date issued above.
PROJECT DESCRIPTION: 1
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 LAND LIGHT:
OTHER: - _ -_ HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
OWNER FEES
Name: Permit Fee $ 1_5 e
Address: Plan Review Fee $ -_
City /State /Zip: — _ -_- State Surcharge (8 %) $ 6 . _
Phone: Other Fee:
_.__- __.__._..- _.----- - - - - -- -- - - - - -- ---- ___- ... - - -- - _._ - - - -- - - - - - -- $ -._.----------- --
Other Fee:
CONTRACTOR Total Fees: $ 1 o
Name: ' )"VeY.S . - C
Address: c 1 y Q 5 W._� St�r , .� ts S_._ _
City/State /Zip: ri
A?✓ - `
0 c t` - �on __._..
Phone: - 5 - 0 - 3 - 6 t ;(. -. 2 = z
Fax:. -) O. 6 (_/ 1 f 3
CCB Lic #:
Elect Lic. #: c yz.5 - —G -- - --
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 -0080. You may obtain copies
of these rules or direct questions to by calling 503 - 246-1987 or 1- 800 - 332 -2344.
Issued By: , Z d Permittee Signature: 4)\N
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. ELECTRICIAN: DATE:
LICENSE NO.:
Call 503- 639 -4175 by 7:00 AM for an inspection that business day.
Note: If you cannot schedule an inspection while the system is down, please call 503 - 718 -2433 for assistance.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
1: \Building\Forms ManualPermitForms \ManualELRpermit.doc 12/05/05
FEB-28-2006(TUE) 04: 3'3 NETVERSRNT CASCADES INC P. 001/002
•
,
' . F1 ectrical 6
Permit pRi Th, it E °n
J .., i D FOR OFFICE.' USE ONLY
City of Tigard RIII:clwgil 2- - A , f Paudt No.: L. " 4 0 - a•g
tlaarAlv: ..., L. ■
13125 SW Hal1131vd., Tigard, OFt 9722$ r .... .) e 7nflR , HuRevie.
Phone: 503.639.4171 Fas: 501598.19613 Lijk" 2 ' . :111?' 1)511013r Other Penni':
lnepcetIon Upe: S03439.4175 c in iji _. TIGARD .Flo- r• Pala Itcady/13y: Jum li, See Pate : far
Internet: www.ei.tignrd.orais Supplement al information
...
, • .1., t !f17' .:.' rm
wo ..,.., ,, ,!:::.... , .y::':,, '. • .:--,..:;.: ......;i:..., .7- !.;.,,....:... r:: ....,..er:.:i...4 .i) !...11(..•:.'f ..:.,:...17...-1
' .12 ' New constru ction 1ST Addltionialtemtionkeplacemont please check till 61111
0 Demolition 0 Other: ['Service over 225 amps. comnfl 01.1o7ardons location
.... _ -. . . OService over 320 amps - rating OBulidng over 10,000 sq. ft.,
''-‘.;;;OrA'Vf.T, ;;;",<w): . 4. -. .•-•,:;'•:il'.;';,^: of 1. arid 2.family docility 4 or mare new residential
Oswalt o no 600 volts mmigni units In one structure •
IZ1 1-
and 2-family dwelling Ca ere ittWit 0 Accessory building
OBuiltling over throe stories Clrecdcrs, 400 2rnps or more
CI Multl•tarnilY Maalcr builder 0 Other: _ ClOccupunt load Wet 99 person ['
s Manufactured stmetures or
11tA4ri.ii11)..:;:rir 0054i:410..?".400. ClEgnelsaighting plan RV park
Job no,: l'1( (144SM Job site address: ILI 105 si riZai itive(644.... Di leumi-catc tbeitity [lather:
Submit 1. sets of plans with any or the abovc.
City/State/ZIP:T GK z The above= not applicable to =rotary consul:don gaol cc.
.
Soho/bldg./apt. no.: Project num= re oil SOL+
Cross strect/direcrions to job it New residential single. ur multi.fandly dwelling unit.
, Includes attached mace.
1.000 se. IL arias 145.15 4
Subdivision: 1 Lot no.: E. add'I 500 sq. 11. or portion III 33.40 =
Limited I
- - mited enemy. meld:mail 75.00 ,
.
Tax manipareel no• : - - --. Limited energy. nonquidendul 75.00 2
ire1t12 ' Igirw i flirAl...„ ' if ci,VAW,PW-5. Each manufactured Or modular
1 •
V 0 I ei c Z ba a Ooloito
Est;
, dwelling, seiviee and/or feeder 90.00 2
Services or feeders Installation, alteration. and/or relocation
i
200 MIMS nr hats 80.30 2
- 106.85 3
- 401 ATMS to 600 ;mpg 160.60 , 2
..
Namm 601 alma to 1,000 amsa ' .240,60 2
Addrws: _ - ,
Over 1.000 amps or volts 454.65 2
sk tanncet on 66.85 2
City/State/ZIP: Temporary strokes or feedersinstallition, ulceration, end/ r
-- relocatian
rte: (-----"".""-... Fax: ( ) ..
200 amps or less 66.85 I
Owner Installation: This installation LI being made on property that 1 own which is not 201 amps to 400 amps -
100.30 2
Intended for sale, lease, rent, or exehange, according to ORS 447, 449. 670, and 701. ,
401 amps to WO arms 133.75 2
Owner signature: Dm= Brunch circuits. new, 'Mental% ur "estenzion. - per panel
ig A. Fcc for branch chaults with
service er feeder fee, each 6.65 2
Business name: - branch circuit
13. Fcc for branch circuits
Contact name: wick*: service ar feeder fee, 46' 115 2
each branch circuit
Address:
Each atidl branch circuit 1 6.65 2
City/Sono/ZIP: Miscellaneous (service ar feeder not Included) .
53.40 ..
Phone ( ) Fax: : ( ) Pump ar irrigation circle
. Sign or outline lighting 53.40 2
-
&mail:
. _ .. Signal eircuit(tt) or limited.
:iciilV2di'44.i.ii:' =TY PancLakennion• or
. extension. Describe Page: 2
Business name: Ne 4 VerScirj-- ( c? SO,acte4) 1 440
Addr '7'j o _ A614 $.20 Hwy ' w ..•... blach additional Inspection over atiowable la any or tha above
4 Per Inspection III 62.50 ,
City/State/ZIP: ge011/M enZ 49 17 d 0 F investigation per hour 0 hr miu) 62.50 IIIII
' -
Phone: (513 ) Wfu-OS L J Pi*: (9 3 ) to c i t -Ce (. P I 3 Industrial plant per hour 73.75
:lar:i`,7:::-
CCR Lic.: in ;), g Electricul tit.; _ :,„-, : Supro. Lica 5
----fte Subtotal _15_ co
Suprv. Electrician sigimture, required: t gg L1. 0 I, / . Plan ft-view (25% arpermit fee)
State surcharge (11'16 ofpormi I. fee)
Print name: 1 &ici B , .. * IC Date: , , ; 6 c
. .rarm.pERmrr pEE i 1 0 0
--A -
A u th orixctl si6mature: Ws permit applleatlun aspltas Ira penult Is nat obtained wlimu in
days Mier It los Woo accepted as complete
Print name: i Date: • foe methodalagy set by Tri•Ceunty Building Wag/ Sarvkc baud
. - - Number of Iftspeellous ;ler permit allowed.
houlldlaaltarmanlIt.e-PernliAap doe 12!O) 4411401)T11114134.-0MiwIlll
CITY OF TIGARD _ �Z I
BUILDING DIVISION PERMIT #: .. 66- /0 0 3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 //a, �'
Inspection Requests (24 Hrs.): (503) 639 -4175 'f I..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: / / 9 6 S 7 a 4 - ) pi 1\-41'.€--- CLASS OF WORK:
SUBDIVISION: l LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 - / 6 - 6 ( Pour Time:
C..-_: Inspection Description Confirm # Contact # Message
!cI &/e. 330 12-8'
ections /C. ments /Instructions:
'.-I 64-A- - 1 ■ ' an im
c .
! .... :10
A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: V + ," 013 L Date: 3 I b Phone #: (503) 718- �'~
CITY OF TIGARD 3/31/2006
' 111 13125 SW Hall Blvd. 1:00:06PM
e ' • Tigard, Oregon 97223
TIGARD (503) 639 -4171
Receipt #: 27200600000000001024
Date: 03/31/2006
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
ELR2006 - 10003 [ELPRMT] ELR Permit 220- 0000 - 431510 75.00
ELR2006 -10003 [TAX] 8% State Surcharge 100- 0000 - 207020 6.00
Line Item Total: $81.00
Payments:
Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid
CreditCard NETVERSANT - CASCADES INC DER/DLH 001684 In Person 81.00
Payment Total: $81.00
cReceipt.ipt Page 1 of 1