Permit 111
C ITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
� . �i�, DEVELOPMENT SERVICES PERMIT #: ELR2003 -00318
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/14/03
SITE ADDRESS: 15230 SW SEQUOIA PKWY 190 PARCEL: 2S112DA -00300
SUBDIVISION: ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: Low voltage: voice and data wiring.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
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 ESP TECHNOLOGIES
15350 SW SEQUOIA PKWY #300 -WMI 7929 SW BURNS WAY STE. F
PORTLAND, OR 97224 WILSONVILLE, OR 97070
Phone: Phone: 503 628 - 4195
Reg #: LIC 73872
ELE 34- 269CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 10/14/03 $75.00 Elect'I Final
[TAX] 8% State Tax 10/14/03 $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
v. I
Issued by _,s�1 Permittee Signature /1 /
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
09' : uul u9: 1 r:'1.1 JUJJ`J (S1Z1bU 1.111 UY 111a U(11 `�I "`� ""•�
• • • Electrical i Pe Date received:, /d O' Permit no.: , i • 3 - 3/ 0
-.. Expire date:
Ptoject/appl nv
- `rlt1l City of Tigard � �YYd
C r Receipt no.:
City of $ Date issued:
irya Address: 13125 SW Hall Blv ar R Payment type:
F Pone: (3 503) 5 9 8- 196071 CITY OF TIGARD
Fx: (503) 58 -1960
Land use approval: BUILDING DIVISION
1 YPE• OF PERMIT - .
0 Multi - family 0 Tenant improvement
dwellin or accessory Commercial/industrial __ — Cl Partial
O. & 2 family dwelling ddition/altt tat on/replacenlent CI Other. •
O Ncw c onstruction
JOB SITE INFORMATION lot /account no.:
Job address! 152 S 1/44
- 0 i a • Bldg. no.: Suite no.: f 0 Tax map
L.ot: Block: Subdivision:
Description 1/17T9111 Description and location of work on premises: r / d
Estimated date of completion/inspection: FEE SCI)ILDlJLC
CONTRACTOR APPLICATION Fee
Job ao: li a e ; s 3 �eription Q (ea) F illigi
New residential - sitgle or mold - family per
• i l.(FJn Cu _ ( - )f Q dwellingtmitincludeaanachedgarsge-
Address: 7 �j Service included; li e Stare: Up ZIP: G' 7O • - 000 sq. ft, or less
/ _ a -� L a��.•1 - M Fvch additional 500 • - ft, or portion thereof
Phone: t1 � . •3 ( 2
Flee. bus. lie. no: 2
City /metro lie. no.: Each maufactured home or modular dwelling II;
�� ^ � � ^ � � Seirc md/or fwired) D ■ Sid of su• �Ising elriian (r t1'Iecsorfcedere- It aallation. C�censeno�j$lerrtionorreloliott:
PROPERTY OWNER 200 amps or less ��
• 201 stops m 400 a mps 2 2.
Name (print): A— �D'-�' v..12_ 401 amps to 600 uua • s MIMI Mailing address: 23 0 5 W S ' " ati0 rot. P S ( - 0 601 amps to 1000 amps 2 2
State! 012 ZIP: 9 ZZy over 1000 amps or volts =�= 1
Phone: ' Temporary services or feeders - . . _
Owner installation: The installation is being made on property I own
Installador yalteration,orrelocation: 11111 Z
which is not intended for sale, lease, rent, or exchange aceording to Za p amps or Teas 2
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps ___ 2
Date: 401 to 600 am • %
Owner's signature: Branch circuits- new, alteration, • ENGINEER emersion per panel:
A. Fee for brunch circuits with purchase of circuit feeder fee, each service or •
MilIMEMIMIMM s feed branch
si S. s ea for br fe eitcuits wl tsar ureha c 2
of service or (trd fes first b ttm it:..
Edell additional broach circuit: ■�
Mice. (Service or feeder not Included): 2
PLAN REVIEW (Please check all that apply) Each pump or irrigation circle
amps 0 Health-care facility
. ti O Service over 225 amp a
O Service ydw over 320 amps - ruling of I &2 . 0 Hazardous location Signal circuits) or a alteration, or extension' limited e nergy panel, 2
family dwellings 0 Building ovcrlO ,00 square feet Couror
❑ System over 600 volts nominal more residential units in one structure , . c--e- •� EP ��
O Feeders, 400 amps or more •Owed • tion:
O Building over r stories ion over the allowable In any of the above:
O Occupant load over persons t] Manufactured structures or RV par Each addit Inspection __�
❑ Other Per inspection plan 0 Egtess/lightin Submit sets of plans Investigation fee
S4b _ with any of the above. Other The above are not applimtble to temporary construction service. Permit fee $
o Notice: This permit application Plan review (at %) 5 ii
Not all jurisdictions accept credit arils, plaac call jurisdiction for maR infomtaoa '
expires if a permit is not obtained State surcharge (89b) •• •• $
Cr Visa ur M r -- --/------ .within 180 days after it has been TOTAL $
Credit cane numD� Expires accepted as complete.
Name of cartt�oldcr as sho.,a on t earn $
440 -4615 ( fit
Cardholder rlenutue
Amouar
•