Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
DEVELOPMENT H Hall Tigard, E � 639 -4171 DATE ISSUED: 6/17/03
3 -00171
SITE ADDRESS: 13235 SW KINGSTON PL PARCEL: 2S104DA 20000
SUBDIVISION: QUAIL HOLLOW - SOUTH ZONING: R -4.5
BLOCK: LOT: 026 JURISDICTION: TIG
Project Description: All encompassing low voltage.
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:
BROWNSTONE QUAIL HOLLOW LLC AZIMUTH COMMUNICATIONS INC
12670 SW 68TH PKWY STE 200 P.O. BOX 508
PORTLAND, OR 97223 WILSONVILLE, OR 97070
Phone: 503 -598 -7565 Phone: 503- 639 -01 10
Reg #: ELE 36 -94CLE
SUP 2312LEA
LIC 145828
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 6/17/03 $75.00 Elect'l Final
[TAX] 8% State Tax 6/17/03 $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 a'j a L Permittee Signature 77
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
Electrical Permit Application . . • :.
Date received( . - ,0, Permit no 5 /
a. p Yt,..)i rl' City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
_
. TYPE OF ER
❑ I & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi- family ❑ Tenant improvement
a New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
. JOB SITE INFORMATION ' '''''''.::., , -,.' n''....--.• : ' ..` .. . :, y.' .: .o,<",:',' :.: ", < :,,ii °�r
Job address: / .235 5 4). k(,065 pi L. Bldg. no.: 3 Suite no.: Tax map /tax lot/account no.:
Lot: c p.( Q Block: Subdivision: QLI'{ L. Sc.t.Crl
Project name: at,;_q i t_ s I Description and location of work on premises: its? Ie L kJ, j) C e
Estimated date of completion/inspection:
CONTRACTOR APPLICATION �`_ '. j'' ; �. q , , . } � ,. q : SCHEDI ,E .�a . .,, 1 , .�..,
Job no: N Fee Max
Description Qty. (ea.) Total no. insp
Business name:
21 01 ttii 0 14 M t~ w ' L T-10,05. New residential - single or multi - family per
Address: ,kS _3cjS .S. .ii. 1 I2 P_c) iiD dwelling unit. Includes attached garage.
City: IX t Lgt,',,'J i- ( C- I State:C)a_ I ZIP: G 7 07 G ' Service included:
Phone: 5 (, j ri 6 1is I Fax: 6,5cj -v:1 000 sq. ft. or less 4 I E-mail: E mail:
Each additional 500 sq. ft. or portion thereof
CCB no.: ( ►{5 s 2._% I Elec. bus. lic. no: 3 �( ('t
� �j Limited energy, residential / 2 1
City /metro lie. no.: • 0000, $ (ci Limited energy, non residential 2
6 J / o ( 0 3 Each manufactured home or modular dwelling
Signature o supervising electrician required) Date
Service and/or feeder 2
� L� License no: Services or feeders — installation,
�
Sup. elect. name (print): p i_ L �� 23 i Z alteration or relocation:
PROPERTY OWNER 2 00 amps or less 2
201 amps to 400 amps 2
Name (print): .0IJ � j�l L- 2
401 amps to 600 amps _
Mailing address: 601 amps to 1000 amps 2
City: I State: ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation:
200 amps or less
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps I 2 1
Owner's signature: Date: 401 to 600 amps 2
ENGINEER •... Branch circuits - new alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E Each additional branch circuit.
.• PLAN .REVIEW (Please check all that apply) Misc. (Service or feeder not included):
um
O Service over 225 amps- commercial O Health -care facility Each pump or irrigation circle 2
i
Each s
❑ Service over 320 amps- rating of I &2 ❑Hazardous location Eac sign or outline lighting 2
family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other: Per inspection I I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $ — 75
Not all jurisdictions accept credit cards, please can jurisdiction for more information. Notice: This permit application $
O Visa ❑ MasterCard _ expires if a permit is not obtained Plan review (at %)
Credit card number:
/ / within 180 days after it has been - State surcharge (8%)
Expires accepted as complete. TOTAL $ `g 1
Name of cardholder as shown on credit card
$
Cardholder signature Amount .40 -4615 t /CO..\tt