Permit C ITY O F T I G A R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
i . ��;� DEVELOPMENT SERVICES PERMIT #: ELR2003 - 00273
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/5/03
SITE ADDRESS: 13745 SW 124TH AVE PARCEL: 2S103CC -06200
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 009 JURISDICTION: TIG
Project Description: Install Low Voltage all encompassing.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: X AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: X BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: X CLOCK: MEDICAL:
HVAC: X DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: X FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: ALL ENCOMP : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
DON MORISSETTE HOMES QUADRANT SYSTEMS
4230 GALEWOOD ST PO BOX 14833
STE 100 PORTLAND, OR 97293
LAKE OSWEGO, OR 97035
Phone: 503- 387 -7538 Phone: 503- 387 -7538
Reg #: S2JP - 5558211JLE
LIC 96806
ELE 26- 565CEP
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 9/5/03 $75.00 Elect'I Final
[TAX] 8% State Tax 9/5/03 $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. __
Issued by CGZ -/� � �:/�L�� Permittee Signature Cf 1 G, �clt r �� , - 1
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
1 09/04/2003 12:11 5032362322 O QUADRANT SYSTEMS PAGE 02 LUIZ OFFIICE USE ONLY
•' trical Per 1, ; I!ca ou Received Eicctt
is `l�v' DatelBy_ `� ' d'J G Pcmri 03 0�,�73
City of Tigard S�\ v 1\ Planning Approval Sign /
A Date/ : Permit No.:
13125 SW Hall Blvd. F \G P � • Plan Review — Other
Tigard, Oregon 97223 GO ' O 0\ ` 1\S Date/By: Permit No.: _
Phone: 503- 639 -4171 Fax: 503 0 Post- Review Land Use
!.>.,, ,,, ,I fr : Datc/By_
Case No.:
Internet: www.ci.tigard -us . ,; 1 Contact J ¢ ' ® See page 2 for
24 -hour Inspection Request: 503- 639 -4175 — Name/Method: 7 /C7 Supplemental Information.
m III. W u g 1 I' r' a .r. +. i' i° 'tyr " -7 � 4 1 iA ' .,
0 New construction 1■ Demolition • Service over 225 amps- • Health -care facility
commercial ❑ Hazardous location
❑ Addition/alteration/rc.lacement I Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
INI (`� Est ;,°F ny11 Rijn , 1P1 i�u ` d ?r! 1 & 2 famil dwellings Mi.l.l,..,.�..� �.�,., ,.�.��1.. ��� u r,l ..;a ,.�, � bl.t�ts�z'� �� y s four or more residential units in B
0 1 & 2 -F dwellin • 'U Commercial/Industrial 0 System over 500 volts nom one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
I. Access' Buildin: • Multi- Fflrr111 ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
• Master Builder ■ Other: ❑ Egress/lighting plan ❑ Other:
.,'^iiWia7y!loth`.1 TI.Ti.�r;U]raCua^ t i;'iZ ,;i'iil(r41l 7 Submit seta of plans with any of the above.
The above are not a . .11eable to tem . ornr construction service.
Job site address: J Z 3- 1 -m - S 1. .1 f , u-, r'� ? „ r, s 1 " ;;
o., S i . I E :ltri .; , "o l. it1,l. 1 ,: 'l1,, 4 7,e7',r
Suite #: Bld_. /A•t. #: Number of inspections per permit allowed
Pro'ect Name: .. t. A ` i ;,,,.L, Description I Qty Fee (cs.) Total
Cross street/Directions to job site: ^ New residential - single or multi - family per
l dwelling unit. Includes attached garage.
Service included:
1000 sq. tt. or less 145.15 4
Each additional 500 sq. i3, or portion thereof 33.40 ,1' 1
Subdivision: Cu h', s+ Litt., Lk Lot #: s Limited canto, energy, residentd 75.00 17.S
canto, non resi 75.00 _ _ 2
Tax ma ./. arcel #: Each manufactured home or modular dwelling
+j;{.f' I , r rffT'1l�CZ f f , f . it IS W36' IC+ klQ ,' ::. ,': .',_;1 ` . I ...,, id:y. . ,. service and/or feeder - 90.90 2
/ Services or feeders - lastailat
I a.A. V I ,V • L rrt i + . Lit—t--f—.& - alteration or relocation:
t d', 200 amps or less .._ 80,30 2
k 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
P 1;1n> 1� ' ,.IT : ' k `031 j ifai
7�` a 1; } 601 amps to 1000 amps 240.60 , 2
r , 3, a' Over 1000 amps or volts 454.55 2
Name: Reconnect only _ _ 66.85 2
Address: Temporary services or feeders - installation,
Cit /State/Zl • : alteration, or relocation:
200 amps or less 66.85 I
Phone: Fax: 201 amps to 400 amps 100.30 2
r , n z 5 , i , I ,. , 401 to 600 amps 133.75 2
$,,IKEI �.:- iT t;:i:. a.lrl,li` i _. i ' '.�._ 1.7 , '. : ! �_-�.t °.: 'I , 1 Branch circuits - new, alteration, or
Name: extension per panel:
Address: A Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 6.65 2
Ci /State /Zi • • B. Fee for branch circuits without purchase of
service or feeder fee, fitat branch circuit 46.85 _ 2
Phone: Fax: Each additional branch circuit 6.65 2
E-mail: Misc.(Ser ice or feeder not included): • t� Ji :'° , ., ... "air ( 11l,'!, , fiPi -/ 1 ' - Each pump or imgationcircle 53.40 2
u . '1 .. q �+ ., f a �: •, I ,.. , . -f 1 : • ' . - Each sign or outline lighting _ 53.40 2
Job No: Signal cireuit(s) or a limited energy panel,
alteration, or extension Page 2 , 2
Business NameQ 0. .ci {,i1' , S •S' Description:
Address: ►'o . t y �3?
.. Each additional inspection over the allowable in any of the above:
Ci /State/Zi.: Cr.. . Q ll; Perin.. ction • hour min. 1 hour 62.50
Phone: d3 4- ic. #: ! 5� 5'? Fax: a 3 - at b .. a g...1).- Inv estipatien fee;
Other
CCB L tS"'!' : :- . •' 1 rl' _Ili :4.. ? It r+ii0t� 'I a � f r �l!'1� f '� }I � � , ,': ! ,�.t
Supervising electricia / �, ,_ 1 . s. ..... 1. Su b Subtotal . i
Si: ature re. aired: � j ' v 1. &-4-- ----------
- Plan Review (25% of Permit Fee) S
Print Name: • .c - ',I - 5 . IIMEMMAINSIIII State Surcharge (8% of Permit Pee) $ .n .rat)
TOTAL PERMIT FEE $ ei 'iD 3
Notice: This permit application expires if a permit is not obtained within
Signature: �L Date: (4 +4: 180 days after it has been accepted as complete.
'Fee methodology set by Trl- County Building Industry Service Board.
tb ).t 4 f
( ease print name)
i:\Dsts\Permit Fars \ElcPertnitApp.doc 01103