Permit •
CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
" ° , COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00102
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/20/2007
PARCEL: 2S 109AC -03600
SITE ADDRESS: 14687 SW ANGUS PL ZONING: R -7
SUBDIVISION: WILSON RIDGE LOT: 010 JURISDICTION: TIG
PROJECT: WILSON RIDGE
Project Description: Low voltage
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: X AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: X BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: X CLOCK: MEDICAL:
HVAC: X DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: X FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: ALL ENCOM : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
DON MORISSETTE HOMES, INC. ALL WEATHERIZATION
4230 SW GALEWOOD ST #100 3030 SE 59TH
LAKE OSWEGO, OR 97035 HILLSBORO, OR 97123
Phone: 503- 387 -7538 Contact #: PRI 503- 649 -6542
FAX 503- 649 -2680
FEES Reg #: LIC 46969
Description Date Amount
[ELPRMT] ELR Permit 4/20/2007 $75.00
[TAX] 8% State Surcha 4/20/2007 $6.00 REQUIRED ITEMS AND REPORTS
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 through OAR 952 - 090100. You may obtain copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344. / f
Issued By: �. % Mat I � Permittee Signature: J(
OWNER INSTALLATION ONL
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 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
1
. El trical Permit lication �, FOR OFFICE USE ONLY
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City of Tigard i 1 E �
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DateByived : Permit No`�` /' ` ', ....COD //
13125 SW Hall Blvd., Tigard,0 97223 • „ , Plan Review •
Phone: 503.639.4171 'Fax: 503 598.1960 a - ,J u` ''441 ' Date/By: Other Permit:
Inspection Line: 503.639.4175 RFl 4 20 a l ,�„ � Date Ready/By: luris: 0 See Page 2 for
Internet: www.ci.tigardior.u Notified/Method: Supplemental Information
fi I 0 TIGARD
cx�s ,,,,N . io '' k $ sue`
Q New construction;! ❑ Addition /alter: tion /replacement Please check all that apply:
❑ Demolition ❑ Other: ['Service over 225 amps, comm'l ❑Hazardous location
. Demolition ['Service over 320 amps — rating g sq.
,) � " � r rt;a I , # �� .. � p g ❑Buildn over 10,000 s ft.,
:. of I- and 2- family dwellings 4 or more new residential
EW 1- and 2- family dwelling ❑ Commercial /i dustrial ^ ❑ Accesso'y building OSystem over 600 volts nominal units in one structure
❑Multi - family j ❑Master builde ❑Other: ❑Building over three stories ['Feeders, 400 amps or more
{ , �.. 1 _h er o ['Occupant load over 99 persons ❑RV ufktured structures or
' � , � , RV plan P
Job no.: 3 c ( ;' Job . he address: 1(,, Ai ' 4 V c � i nf.
❑Health -care facility ❑Other:
J 7 ,� Submit 2 sets of plans with any of the above.
City /State /ZIP: T1 4',c, lk 0 R f The above are not applicable to temporary construction service.
f I
Suite /bldg. /apt. no.: Project name: IOM
F_. T.
D escr i p ti on Qty. r Fee. Total .,
Cross street/directions to job site: 1 0, ( New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: W .ISory g, e . I Hot no.: /d Ea. add] 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential / 75.00 7s 2
r t Limited energy, non - residential 75.00 2
t , .' Each manufactured or modular
11 ' dwelling, service and/or feeder _ 90.90 2
�-C n r 4 t^''
'.I 'i: V C-- Ud \ - I. u S f q tr.' r Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
. 1 � ' � " `® f a t , %. , �, "< ,. '. _ z 201 a to 400 amps 106.85 2 Mt, r ` '' i ° t ' 401 amps to 600 amps 160.60 2
A.
Name: f)8 Nk.D , 1 RS -e - 11-e tivewle.c - 1 601 amps to 1,000 amps 240.60 2
Address: L' 2 30 i-, ' e l,tJ • • a S d- .� Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: Kt_ dS W y 7� S Temporary services or feeders installation, alteration, and /or
Phone: lJ l f relocation
(�06 ) � 3 F ` x ' ( Sd3 ) �7 k,?ti I 200 amps or less 1 66.85 1
Owner installation: This installation is being m. de on property that I o'n which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, o exchange, accor• ing to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
1.
Owner signature: Date: `. Branch circuits — new, alteration, or extension, per panel
t , ,ut V A , w g n t . A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: Am_ t✓c..A4-14 E I . +tam z 0A t` ft) C • branch circuit
• Contact name:
j B. Fee for branch circuits
t i N 0 n G 14 1-p I. without service or feeder fee, 46.85 2
Address: C �,ri J 4 first branch circuit
3 5 �u I Each add'I branch circuit 6.65 2
City/State /ZIP: (i' 6 U O • q 1/ZS I Miscellaneous (service or feeder not included)
4 1 Pump or irrigation circle 53.40 2
Phone:
(5b3) 6,5-(4 2 I F; q ( ) at 7 r 2,6�6 Sign or outline lighting 53.40 2
E -mail. Signal circuit(s) or limited-
ril ' ; M8` - � 1, a R p A�E ,, W t. energy panel, alteration, or
I , / extension. Describe: Page 2 2
Business name: ,Q-n tv .. e, /, tact : 0 coq i_ TiuL. ,
Address: . Each additional inspection over allowable in any of the above
16 . 1 ; : 6 9,1 f� ,, Per inspection 62.50
City/State /ZIP: //S• 601eo tie 771 Investigation per hour (1 hr min) 62.50
,i, 1 Industrial lant per hour 73.75
Phone: ( ) P P
CCB Lie.: 6 I lectrical Lic.: Suprv. Li .: r
� �q•1 . Subtotal J
Suprv. Electrician signature, re I Plan review (25% of permit fee)
Print name: 1 State surcharge (8% of permit fee) C 4, °
f /.�J / Llti
, lil►1J
r/ / Date: �j`,
1
i 6 -
TOTAL PERMIT FEE 0
Authorized signature: :I. 1, This permit application expires if a permit is not obtaine within 180
days after it has been accepted as complete
Print name: Date: 1 + Fee methodology set by Tri- County Building Industry Service Board
•♦ Number of inspections per permit allowed.
is UiuildingWermits \ELC- PermitApp'doc 12/03 44 4615T(lo /o2/COM /WEB
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