Permit r1 `
CITY OF TIGARD
ELECTRICAL PERMIT -
to RESTRICTED ENERGY
jl�l DEVELOPMENT SERVICES PERMIT #: ELR2001 -00217
13125 SW Hall Blvd., Tigard, OR 97223 (5031 639 -4171 DATE ISSUED: 9/4/01
SITE ADDRESS: 12325 SW KATHERINE ST PARCEL: 1S134CC -01700
SUBDIVISION: MARY WOODARD SCHOOL ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of low voltage for voice and data (portable telco room.)
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:
SCHOOL DISTRICT #23 JT XTREME COMMUNICATIONS, INC.
13137 SW PACIFIC HWY 901 W. COLUMBIS RIVER HWY.
TIGARD, OR 97223 TROUTDALE, OR 97060
Phone: Phone: 503 - 618 -8816
Reg #: ELE 3- 515 -CLE
LIC 147263
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 9/4/01 $75.00 2720010000 Elect'l Final
5PCT CTR 9/4/01 $6.00 2720010000
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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
Issued by , _/ _ /, Permittee Signature) g _ 6 (byd
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: / 14 DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Aug - 30 - 01 09 45A BTG P 0 3
,, ...
Electrical Permit Application
.
—""--- D Permi
am received: •
.,,a .. City of Tigard Ptoject/appl. on.: t oo.: Liejt. 1 —002-I
1:=111111.111111
00) Address: 13125 SW Hall Blvd. Ti o d, 97223 We issued:
Phone: (503) 639-4171 MI IM111111111
Far: (503) 598-1960 2235=111111122
Land use approval: .
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