Permit CITY OF TIGARD ELECTRICAL PERMIT
RESTRICTED ENERGY
h k DEVELOPMENT SERVICES PERMIT #: ELR2003 -00314 •
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/10/03
SITE ADDRESS: 15230 SW SEQUOIA PKWY 190 PARCEL: 2S112DA -00300
SUBDIVISION: ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of limited energy for audio /stereo system. Job No. 11472
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: X 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: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: - Contractor:
PACIFIC REALTY ASSOCIATES COMWERX
15350 SW SEQUOIA PKWY #300 -WMI 12808 NE 95TH ST
PORTLAND, OR 97224 VANCOUVER, WA 98682 -
Phone: Phone: 1 - 888 266 - 9379
• Reg #: SUP 1645LEA
LIC 117471
ELE 37- 780CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 10/10/03 $75.00 Elect'I Final
[TAX] 8% State Tax 10/10/03 • $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 withini.80 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you ollow rules de.ted by the Oregon Utility Notification Center. Those.rules are set forth in OAR 952 - 001 -0010 throuc
Issued by LJ4O n i / I Permittee Signature �� . L /.1/.a
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 -
ti?- .. 4 •
• Electrical Permit Application OFFICE USE (SN I .V' •
Date received: /� /Q ,d 3 Permit no.: �• 3 _ ea" t ^ .� J i{ Ci of Tigard Pr oject/appl. no.: Expire date: •
City ofTigard Address: 13125 SW Hall Blvd Tigard, OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171 .
Fax: (503) 59 &1960 - Case file no.: . Payment type:
. Land use approval: .
Tl'PI. :OF PERMIT
❑ 1 & 2 family dwelling or accessory Commercial /industrial r ❑ Multi: family -❑ Tenant improvement
❑ New construction - ❑ Addition/alteration /replacement ❑ Other: ❑ Partial ,
Job address: /45 v ' S', ,,/.r/. S 1,01' —P/ Bldg. no.: Suite no.: /90 Tax map /tax lot/account no.: •
Lot: I Block: I Subdivi ion: J
Project name:�f f t Pjb�I�� I Description and location of work on premises: �p v rid Sv , 5 1'e4,1 .
Estimated date of completion/inspection:. o I,, j d3 /"
CONTRACTOR APPLICATION lEE. SCHEDULE
. Job no: ' _,tt._- — _ —_ _ -----= = / /V7 Fee Max •
Business name: �A iW/P�1'•X ^ Description Qty. (ea.) Total no. insp
tJ F ' ` "�� ' Newresidential- single ormulti- family per
�
Address: j8ert' dJ•L 1 � c� s dweWnguoit .Includesattachedgarage.
City: Vdl.i'l C CIA Vt- I State: IUM ZIP: Q gr Z__ Servicehtcluded:
Phone:3'j0896 9953 Fax: I E -mail: 10o0 sq. ft. or less 4 .
CCB no.: Elec. bus. IIC. no: Each additional 500 sq. ft. or portion thereof .
I - Limited energy, residential 2
City/metro lie. no •-•,,,..,.' Limited energy, non - residential 2
/ / - / Each manufactured home or modular dwelling
Signatu ' supervising electrician (required) Date - Service and/or feeder 2
Sup. elect. name (print):' (0,1 0?..... IlA)( U. License no:3 3 -it R Services or feeders— installation,
alteration or relocation:
200 amps or less 2
Name (print): 201 amps to 400 amps 2
•
Mailing address: 401 amps 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 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:
ORS 447, 455, 479, 670, 701. 200 amps or less . 2
201 amps to 400 amps 2
•
Owner's signature: Date: 401 to 600 amps 2
ENG I N EE R Branch circuits - new, alteration,, -
Name: or extension per panel:
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 '
Phone: Fax: E -mail: of service or feeder fee, first branch circuit: 2
Each additional branch circuit:
PLAN Rf:VIE: V (Please check all that apply) Mlsc . (Service or feeder not included):
❑ Service over 225 amps-commercial ❑ Health-care facility Each pump or irrigation circle 2
❑ Service over 320 amps- rating of 1&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,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* I 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description: 14 tJle
/, Dl u,/ 4 T'zQ 0 ) '
ed
- ❑ Occupant load over 99 persons ' ❑ Manufactured structures or RV park Each additional on over allowable In any of the above:
❑ Egress/lighting plan ' ❑ 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 O
• Permit fee ' $ X 7.7' °
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This pent application
Plan review (at _ %) $
ID Visa ❑ MasterCard expires if a permit is not obtained
Credit card number: / / within 180 days after it has been State surcharge (8 %) $' .�
Expires accepted as complete. TOTAL $ I IOC'
. Name of cardholder as shown on credit card
S ,
Cardholder signature Amount , . 440 -4615 (6/00 /COM)