Permit CITY OF TIGARD ELECTRICALPERMIT -
RESTRICTED ENERGY
Azdve 1 DEVELOPMENT SERVICES PERMIT #: ELR2003 -00029
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/4/03
SITE ADDRESS: 13058 SW PRINCETON LN PARCEL: 2S104DA -20400
SUBDIVISION: QUAIL HOLLOW - SOUTH ZONING: R -4.5
BLOCK: LOT: 030 JURISDICTION: TIG
Project Description: I
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: 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 Wall Cover
[ELPRMT] ELR Permit 2/4/03 $75.00 Elect'I Final
[TAX] 8% State Tax 2/4/03 $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 �e � , !,(0, ' � . �,`_ _ _�� Permittee Signature poulut
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
. ' - yElectrical Permit Application
MO Date received:„ - 0 P e r m i t no.: i• . , 0 t -, 40 ,9
"ff`1-' City of Tigard PP • P
;.' I i hr g r Project/appl. I no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: f j Receiptno.:
Phone: (503) 639 - 4171
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
gNew construction 0 Addition/alteration /replacement 0 Other. 0 Partial
JOB SITE INFORMATION
Job address: /3 6 5g S,r:J • / LA) Bldg. no.: _ Suite no.: Tax map /tax lot/account no.:
Lot: 330 I Block: I Subdivision: f ua i iI dLUY( -i)
Project name: au. 41 L 1401_1_4 'Description and location of work on premises: V Q I C.67 „111)- .
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCI IEDLIE
Job no: Fee Max
Business name: ?jrm,f,cl COmAk 4lN 164T2 c) JS - Description Qty. (ea) Total no. insp
New residential - single or multi- family per
Address: c2$34SS4), gdIE4 e) dwelling ttnit .Includes attached garage.
City: Lot LS' o,JUlLte I State: o, j j ZIP: e7 7 z . ) - 2 (.3 ' Service included:
Phone: 5 6,3e; olio I Fax:5 639oksi E-mail: _
1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: / Lt Sy 24' 1 Elec. bus. lic. no: 36 ••9 lE CAP Limited energy, residential 1 2
City /metro lic. no.: CO 00 &VI Limited energy, non- residential 2
2 _ ?/ . Each manufactured home or modular dwelling
Signature of supervising titian (required) Date Service and/or feeder 2
Sup. elect. name (print): ` � «3)tc License no: /L Leo Services noreders - hutallatioa,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
(print) R , L) S7 - J E c 201 amps to 400 amps 2
Name tint : ��lJ 401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: 'ZIP: Over 1000 amps or volts 2
Phone: I Fax: 1E-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, orrelocation:
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
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-mail: Each additional branch circuit:
PLAN REVIE1V (Please check all that apply) Misc. (Service or feeder not lncluded):
O Service over 225 amps - commercial ❑ Health - care facility Each pump or irrigation circle 2
O Service over 320 amps - rating of 1&2 0 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,
0 System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories 0 Feeders, 400 amps or more *Description:
O Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan O Other. Per inspection I I I 1
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application $
0 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 %) .... $
Ex accepted as complete. TOTAL • $ •
Name of cardholder as shown on credit card
S
Cardholder signature Amount 440-4615 (6/00/COM)