Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
DEVELOPMENT H BMENa Tigard. ) 639 -4171 DATE ISSUED: 03 -00089
- 13125 ED: 3/24/03
SITE ADDRESS: 14011 SW RIDGEFIELD LN PARCEL: 2S109AA -06000
SUBDIVISION: ELK HORN RIDGE ESTATES ZONING: R -7
BLOCK: LOT: 038 JURISDICTION: TIG
Project Description: All encompassing limited energy.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: X AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: X 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:
KOZAK ENTERPRISES INC QUADRANT SYSTEMS
22830 SW NOBLE ST PO BOX 14833
BEAVERTON, OR 97007 PORTLAND, OR 97293
Phone: 503- 848 -7014 Phone: 234 -5558
Reg #: MET . 00002466
SUP 1211 JLE
LIC 96806
FEES ELE Fioctifaganspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 3/24/03 $75.00 Elect I Final
[TAX] 8% State Tax 3/24/03 $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 rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throuc
Issued by i Permittee Signature e /W
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 f/9142/D6.) erj70/\/ ON DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
03/20/2003 13:50 5032362322 QUADRANT SYSTEMS PAGE 02
.. • ., 1, /1.c -/---: v; - et? 3
Electrica Permit ..
.. C Date received: -3 via Permit no.
�.1;,Le:;:l +� City Tigard Pro ect! 'GR S d p�
j app]. no.. Expire date:
•
City of Tigard Address: 13125 SW Hall Blvd, Tigard O 72v : 13 231003 Datcissued
Phone: (503) 6394171 MAR Y S4411 Receipt no.:
Fax: (503) 598 -1960 CITY OF TIGARD Case file no.: Payment type:
Land use approval: RtilLDING DIVISION
TYPE OF PERMIT •
I & 2 family dwelling or accessory 0 Comnlemial/industri.al ❑ Multi- family 0 Tenant improvement
New construction CI Addition/alteration/replacement ❑ Other: _ ❑ Partial
JOB SITE INFORMATION
Job address: )'t-k it S ' '' d„ "::-.c. c . L G r ,,, c - i • Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot: Mock: `" ubdivision:
Project name: K; o. - i Description and location of work on premises: (au. _
Estimated date of completion/ins. - Lion: A, • INIHITME 0
CONTRACTOR APPLICATION FEL SCiIEMILI •
Job no: Fee Max
Business name :� ,d, t Demi tion ea. Total nolns
Address: e 4 3 Net► reantltd- s(n& ormulti- fatttiiyper
IIIEMaglin dweliingtudt includes attached garage.
State: zr ZIP: Servieefttcluded;
Phone: a '3°4 - 5 FaX: b i.1.3n114- E- mail:: 1000 sq. ft, or less 4
no.: •
CCB 5 �' /:, Each additional 500 sq. ft. or portion thereof
Elec. bus. lic. no: `-4`
Limited energy, residential . 1111Mila 2
City /metro tic. 11 . b a l . fit'
Limited energy, non-residential _IIIIMMI 2
IV ' / t'1f�jt� __ ........1. _DL Each manufactured home or modular dwelling I
Signature of supervising electrician (re, uired) Date Service and/or feeder _ 2
License no: \ Services or feeders- InataIIatica,
II
alteration or relocation:
PROPERTY OWNER 200 amps or Less 2
Natne (Print): ' b '<, 2- -,, -/1_7E-A /o //s ES 201. • a to 400 amps 2
Mailing address: • 40t alma to 600 amps • 2
601 amps to 1000 amps 2.
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect onl 1
-Owner installation: The installation is being made on property I ow '1'emporaq'service: or feeders ..
which is not intended for sale, lease, rent, or exchange according to installation alteration, tnrvfocatlon:
ORS 447, 455, 479, 670, 701. 200 amps micas .
201 amps to 400 ams 2
Owner's signature: _ ,Date: \ 401 to600am.a
2
TE1NG 1NI•I R Branch circuits - new, alteration, ,
or extension per panel:
Name: A. Fee for branch cirettils with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E - mail oiservieeorfecdorfec ,firstbranchcircuit: �� 2
Each additional branch circuit: ME
i'LAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
0 Service over 225 amps • 0 Health•carefacility Each pump or irrigation circle II 2
0 Service over 320 amps -rating of t&2 0 Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal cirmsit(s) or a limited energy panel,
0 System cvcr 600 volts nominal more residential units in one structure alteration, or extension 2
0 Building over three atoriee 01 Feeders, 400 amps or more •ihsetiption:
Cl Occupant bad over 99 persons 0 Manufactured structurca or RV park E additional Inspection over the 21foweble In any of the above:
0 Egreas/tightingplan 0 Other, Per inspection
Submit — sets of plans with any of the above. Investigation fee
• The above are not applicable to temporary construction service. Other
'Noe 01 jurisdictions accept credit emda, please can judsdkiion for mac Infottnatioo. Notice: This permit application Permit fee ............... ...... $ .570
CI Visa U MasterCard Plan review (at %
expires if a permit is not obtained ( � %) $
Credit card number _ I f within 180 days after it has been State surcharge (8%) .... $ CO33
Expires accepted as complete. TOTAL $ 01 06 .
Name o f cardholder as neon on credit card
• $
Cardholder signature Amount
440 -4615 (6430/COM)
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