Permit CITY OF TI GARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT #: ELR2003 -00167
�' 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/17/03
SITE ADDRESS: 13275 SW KINGSTON PL PARCEL: 2S104DA-19600
SUBDIVISION: QUAIL HOLLOW - SOUTH ZONING: R -4.5
BLOCK: LOT: 022 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 -0110
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'I 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 ,„_. Permittee Signature a ( }yv
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
•
v
Electrical Permit Application
Date received: _/ _ Permit no., ..,;, , .? 7
A nil, City of Tigard Project/appl. no.: Expire date:
Ciryq(Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: i Receipt no..
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: T/ c .
.. •,, TYPE OF PERMIT / `� , .
❑ 1 & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi- family ❑ Tenant improvement
aNew construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
“YF 4 -. . JOBSITEINFORMATION ,,, +`' , y. r,ia.T "'_ ``
Job address: 13,27 5 S`. U _ k s Aj 6SrDJ 0 L Bldg. no.: 3 Suite no.: Tax map /tax lot/account no.:
Lot: 62- Block: Subdivision: (A Ay 4L Sc_CTH
Project name: a 4, L S -r Description and location of work on premises: 00 iC' LI= v , j) <C% .
Estimated date of completion/inspection:
CONTRACTOR APPLICATION'''. r .-
'` `,' r ° :"FEE - . SCHED1UCE . ; ° c''''''"*
Job no: Fee Max
Description Qty. (ea.) Total no. insp
Business name: 21, com(1 i tt_ltjs
(3 11 ,� /� e New residential - single or multi - family per
Address: ,A39:5 '. is)- 7i.l (3 t6 a_G f-c)('D dwelling unit. Includes attached garage.
City: (,i L s , %, ;.1 i.1i l r f- 1 State:o g_ I ZIP: e 7 07 Li Service included:
Phone:S; G � dliU I Fax:6,5 °j -ct(3— 1 000 s IE mail: d' ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: l t{S b'?`s'� I Elec. bus. lic. no: "/c, -ci (r Lirnitedenergy, residential i 2
City /metro lie. no.: 0e)OO ( S ( 9 Limited energy, non - residential 2
6 // U 1 0 3 • Each manufactured home, or modular dwelling
Signature of supervising electrici, (required) Date Service and /or feeder 2
Sup. elect. name (prinQ: ! r LPL L g_[; License no: 2.3 l Z LEA
Services or feeders - installation,
alteration or relocation:
",.:' PROPERTY OWNER . ' - 200 amps or less
Name (print):
n Q.L)AJ J7-6,t%+`= 201 amps to 400 amps
401 amps to 600 amps -,
Mailing address: 601 amps to 1000 amps 2
City: State: ZIP: Over 1000 amps or volts 2
Phone: Fax: E - mail: Reconnect only I
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 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
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 orfeeder fee, first branch circuit: 2
Phone: Fax: E Each additional branch circuit:
. : REVIEW (Please check all that. apply) . Misc. (Service or feeder not included):
O Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2
O Service over 320 amps - rating of I &2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over three stories ❑ Feeders, 400 amps or more *Descnption:
Q Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lightingplan O Other: Per inspection j I j
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $ 7S
Not all junsdictions accept credit cards, please call 'jurisdiction for more information. Notice: This permit application
❑ 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 %) .... $ 6 r
Expires accepted as complete. TOTAL $ /
Name of cardholder as shown on credit card
$
Cardholder signature Amount i-t0 -.1615 (6/00 /CONI t
CITY OF TIGARD 24 -Hour
B I.ILDING Inspection Line: (503) 639 -4175 MST v ' /
INSPECTION DIVISION Business Line: (503) 639 -4171 .
BUP
Received Date Requested 1. 2- L • AM " PM BUP
Location \ 3 -b S W t NQ .a, , w) • L • Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access: •
Ftg Drain
ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm '' •
Susp'd Ceiling - •
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
R ater S
-- Water Service
Sanitary Sewer V
Rain brains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
- MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL /r/c) / o L�%7, r4
Service
Rough -In
. UG /Slab
LowLVol ge - �� �� d 3 - G G // 7 k0 R, , (
ire Alarm
Fi al C' Reinspection fee of $ required before next inspection. Pay at City Hall, 1 Hall Blvd.
P , PART FAIL
SITE \ El Please call for reinspection RE: .Unable to inspect — no access
Fire Supply Line
ADA Date � - �� inspector L N Ext
Approach /Sidewalk •
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL