Permit s
CITY OF T I G A R D ELECTRICAL PERMIT E IT -
RESTRICTED ENERGY
; DEVE SERVICES PERMIT #: ELR2003 -00180
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/24/03
SITE ADDRESS: 06650 SW REDWOOD LN 190 PARCEL: 2S112DA -01400
SUBDIVISION: PP1996 -048 ZONING: I -P .
BLOCK: LOT: 002 JURISDICTION: TIG
Project Description: Installation of limited energy for data telecommunications system. •
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPEIIRRIGAT:
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:
PACIFIC REALTY ASSOCIATES WHITE OAKS ELECTRIC
15350 SW SEQUOIA PKWY #300 -WMI 30119 BERLIN RD
PORTLAND, OR 97224 LEBANON, OR 97358
Phone: Phone: 541 990 - 6669
Reg #: ELE 22 -140C
LIC 111550
. FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 6/24/03 $75.00 Elect'I Final
[TAX] 8% State Tax 6/24/03 $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_ru es adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throuc
sued by �• :�� l/ !i ✓ Permittee Signature pd-de .
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
0
•
ti
Electrical Permit Application USE ONLY
Date received: Permit no.: /4.i3 'sV /f t
t .. .J'Jl ' City of Tigard Project/appl. no.: Expire date:
City ojTigard 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 PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi- family (lefenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
.1011 SITE INFORMATION
Job address: 6, SD d, g.gd,
f.. .t Bldg. no.: Suite no.: / 9 p Tax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name: 2e'4, C r a ;ll1. 44,,,_ I Description and location of work on premises: I/O i C. @. ( 'jj C.,61,i I
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Fee Max
Business name: (JL' f . Q4,(c, V y . „
Description Qty. (ea) Total no. insp
t New residential - single or multi-family per
Address:. S o t/ q a 0.,...1, 4. R dwellingunit.Includesattachedgarage.
City: LoiA... s State:Oy( I ZIP: S 7 3 f lr Serviceincluded:
Phone: S'tu _490- 6e64 Fax: I E -mail: 1000 sq. ft. or less 4
4.
Limite ene Each additional 500 sq. fl. or portion thereof
CCB no.: / // rp �Elpe bus lie no: Z Z �I �v L 1 01110
/ rgy, residential 2
City /metro lic. no.: 1 d< Limited energy, non - residential 2
n/ L K _� �s t 2 — 01 Each manufactured home or modular dwelling
tgnature of supervising electrician (required) Date Se vice and/or feeder 2
Services or feeders - installation,
Sup. elect. name (print): , e ott ve, Ln) License no:4 06 3
alteration or relocation:
PROP ERTY OWNER 200 amps or less 2
■ / /�( / 201 amps to 400 amps 2
�
Name (print): C S
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: IFax: E-mail: I 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 Icss 2
20
ORS 447, 455, 479, 670, 701. 201 1 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am s 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 Each additional branch circuit:
PLAN REVIEW (Please check 'all That apply) Misc. (Service or feeder not included): .
O Service over 225 amps-commercial O Health -care facility Each pump or irrigation circle 2
O Service over 320 amps- rating of I &2 0 Hazardous location Each sign or outline lighting 2
family dwellings O 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
O Building over three stories 0 Feeders, 400 amps or more *Description: _ / /47 Q— /
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lighting plan 0 Other: Per inspection I I 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 $ --7✓ • 60
Not all jurisdictions accept credit cards, please call jurisdiction for more information. permit application
This ermit a lication
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 %) $ r ei 0
o to' 00 t
Expires accepted as complete. TOTAL $ n
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6/00 /COM)
Case Activity Listing 11/10/2004
11:53:59AM
TIDEMARK Case #: ELR2003 -00180
COMPUTER SYSTEMS, INC.
Assigned Done Updated
Activity Description Date 1 Date 2 Date 3 Hold Disp To By By Notes
ELRC001 Application Received 6/24/2003 None DONE DEB 6/24/2003
RCP
ELRC003 Permit Created 6/24/2003 None DONE DEB 6/24/2003
RCP
ELRC725 Low Voltage 6/30/2003 None PASS HFY 7/2/2003 ROUGH IN
Inspection JMT
ELRC799 Elect'! Final None 6/24/2003
RCP •
ELRC500 (F) Issue permit 6/24/2003 None DONE DEB 6/24/2003
RCP
ELRC580 Expired by limitation 10/18/2004 None DONE RB 10/18/2004
RB
ELRC800 Case Finaled 6/30/2003 None DONE HFY 10/18/2004
RB
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