Permit •
C ITY OF TI GARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
4µ1ire DEVELOPMENT Tigard, 1 639 -4171 DATE SSU 2/12/03 3 -00044
- 13125
SITE ADDRESS: 10495 SW JOHNSON CT PARCEL: 2S102BB 00827
SUBDIVISION: BROOKSIDE PARK NO. 2 ZONING: R -4.5
BLOCK: LOT: 003 JURISDICTION: TIG
Project Description: N W 4.2_
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: NURSE CALL : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WINDSOR PROPERTY LTA A + E SAFE AND ALARM CO
DEAN SAFFLEY PO BOX 179
2245 NE CORNELL RD MCMINNVILLE, OR 97128
HILLSBORO, OR 97124
Phone: 503- 283 -0977 Phone: 503- 472 -6439
Reg #: ELE 36 -34CEP
LIC 65198
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 2/12/03 $75.00 Elect'I Final
[TAX] 8% State Tax 2/12/03 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throuc
Issued by , 92 Permittee Signature „ n „
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
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Sent By: ' AE SAFE AND ALARM; „ 5034723570; Feb -10 -03 12:22; Page 4/4
V.I. 11 'Jr lalrnAL +$'d NUJ.
Electrical Permit Apr iication f, 1' UR OFFICE LSE ONLY
Received Electrical CC,,t�
Jet /13Y: Permit No.:CV! 'z 3 - M O t ill
City of Tigard V E D Planning Approval Sign
e2
13125 SW Hall Blvd. �� Dace/Fay , Permit No.:
Plan Review Other
Tigard, Oregon 97223 9 Date/By: Permit No.:
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Phone; 503 - 639.4171 Fax: 503 -598 -1960 rC a 0 r I U3 Pont- Review ,Ind Uric
Internet WWW.ci.tigard.or.us r; i,
.! �l
•J5- c ' 1 ' 1! '� D Contact Case No.:
24 - hour Inspection Request 503 - 639-4175 CI Iva: ® Seri piae z for
BUILDING DIVI • • N Name/M . 1 Supptumental Information.
DI NGW cortstrtict ion II Demolition ■ Service over 225 amps- IN Health -care facility
Addition/alt4ration/re • laeemment . • Other: commercial U I location
lotion
' rv. „+ ❑ Service over 320 amps-ming Of ill Building over 10,000 square feet,
i:i.. I .f: ..rj : .0 TECvOR .3, p •: i +ttha. 1N�I
(r ,II• ±" 1Be family milt' dwclliriss four or more residential units in
• 1 & 2- Family dwellul •.,Co,:nrnerciaUIndustrial ❑ system over 000 volts nominal one structure • IN Accesso BuiIdin • lu Multi-Family _ �j &rildin ¢ over dace stories D Meader cturo amps or more
1 --�� Occupant load over 99 persons Monufaoturcd structures or 1W park
.._ aste Builder �i Other: 0 Egress/lighting plan e Other
',, '.i•'. .:•!.;.;:;:.:. WIISIEilE'II r -') • . 'Ice o f : �jidi il'', ' '' ;'' 1 ; ; i Submit sets of plans with any of the above -
�.^ ? The aApv are nut ap licable to temporary construction s ervice
Job site address: ,�r,l . .r::'lpa2 -,'� , ze . U i . -., i ...., } p er . p
+ . 't ., , . ,;, • • SWte #: I 1 L�t. is I ,' ' ,, .. . - o: ;!1:.' AA . ..4 �'.f' • :: : 1:. :.! ,.P'
Number of inspections per permit allowed
Pro'ect Name: � i ...+_, - dfi iLU' neacripao QV ITcc (ea,) Tour 1
Cross street/Directions to job site:
New tetideotiiI angle or utultl family per
dwelling rink. Includes attached garage.
Service Included:
1000 K R or less 145.15 4
jl►eh addition' 500 . o r ton thereof 33.40 1
—5:0—t � #. Limbed eeergw residential
7s 0O 2 2 mi l Subdivision:
Limited energy non residential 75,40 mm 2
Tax ma --, - t
'h� r Each manuficwrad item• or modular dwelling
l. '' , . , ,'.: L t; I IE CRT . ' . .R ',:.. :: •d;' •. "j•T 1 "1 I';! °;I`j gervice andlor leear 90.90 2
Services or feeders - Installation, '
altcratloa or nloeatwo:
200 amps or less 80.30 2
201 amps tt} 400 amps 106.85 2
0 01 amps to 600 uzvs 160.60 2
ER.' ;:.:i;; �" 601 arc t 1
' + �1 r ► � • - W1!i • i! =® l li!1 :::'. , . ,.1.!:.. , • . " .. .. i?' o 1000 amps 54 6 Z
�
. l / ! , , e vat' 1400 amp* or vo1u i
R econnect only 64.55 2
Address: / " — 1. jut?) %zt, 'e_ Temporary aanicaa or feeders - idatollation,
Ci. /StatelZl • : 2 lreradon, or relocation:
C
�i� -i / / / 200 amps or lens 6615 1
Phone: .f.i7) O 92 Fax: 201 amps to 400 amps 10030 2
fs AP " IC41�l"1!: +I''!1:''' :1 ;' f lily ,ice; ' i1��1 Gf1P1A�CT aI •:',7 : 1D: .. '? i; au t to b00 amps t39.7b 2 .
- i c - now, otsranon, or
NalD.e: extension par panel: i
ddrGSS A. Fee for branch ciieyi<a with purchase of
iervieo or feeder fee each branch circuit 6.65 2 .
Ci.t /.StatC/ • . Fee r branch e without puachage of
Service or feeder f branch rdretit, 4615 2
Phone; Fax: Each additional br.inch cireu 6.65 2 '
E -mail: Misc.(Service w feeder not ineludad):
::' . ,:� "i ` '' ,,.... '_I ? (2r! . I�Y' '�,Ti r �: i' .. ! a i;;'w . !.U' Eac p ump or irrigation circle 53,40 2
p
Erich siggnr1 or maze 11 hth1g 53.40 2
Job No: .. .��„ / t`. _ Signal Scudt(s) or a limited ra -gy panel, �]
AMU! alteration. or extension i Page 2 . / , 2
. Business Name: ,r . . . Description:
Address: it M..4 , / 7 9
Reek additional inmectlon over the allowable lit ante of the shave.:
Ci /Stat - Zi.: jj_ . /.. , ,
� � .�� c� Q., Per ineal�rtignyer hour (mfr,. 1 hour) 42,50 • Phone: :i ax....— .. - - _ Investigeoon fec:
CCB LiG_ # 4$ - - Lice `: ,3 L -4 Other. .
Supervising eleciri � ry r •�,i 1';,l i,
Subtotal ,•.S 075' S0
sianat are required: //', _� Plan Review (25% of Permit Pea) S
Print Name: — A ..., •. Lice #: ! / / yq G.) - State Surcharge (6% of Permit Pee) $ # • O'--0 U TOTAL JPERbla r FIE $ j -v-f,
Authorized / Notice: This permit application expires if a permit is not bullied within
Signature: / ,' -- _ .✓tom _ .batC:n2-2D ' O� 180 days After it has bean accepted as complete.
4 'live methodology set by Tri- Couaty ll uitainy Industry Service neard.
_ L /sbe,e,e
(Please print name)
' i:kDsts \Permit Fonru\ElcPermitApp.doe 01/03
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