Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 -00423
■ DATE ISSUED: 11/23/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S109DA -11800
SITE ADDRESS: 12933 SW BLACK WALNUT ST ZONING: R -7
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT: 107 JURISDICTION: TIG
Project Description: Low voltage.
•
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: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
DON MORISSETTE COMMUNITIES, LLC QUADRANT SECURITY INC
4230 GALEWOOD ST # 100 PO BOX 14833
LAKE OSWEGO, OR 97035 PORTLAND, OR 97293
Phone: 503- 387 -7538 Phone: 503- 234 -5558
Reg #: LIC 96806
ELE 26- 565CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 11/23/200`, $75.00
[TAX] 8% State Surcha 11/23/200E $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 through OAR 952 -001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: �� Permittee Signature: j .e, ('t \f‘
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 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.
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Electrical Permit Application colt ()h J ,I,, 0,N1,1
City of Tigard
- e1 Received 4 Permit No,;
•
13125 SW Hall Blvd., Tigard, OR. 97223 P �'^ Plan Review
/ `, y
Phone: 503.639,4171 Fax: 503.59R314b0�4� " ^ " t4t'jil' ( � gpir/g other Permit;
Inspection Liner 503.639,4175 ®o. ; , !i _,,,,, Date R
Ieady/By; kotl J Sec Page 2 for
Internet: www ci,tigard.or.us �1 `� J
Notified/ Method: f/ ( f Supplemental Information
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ra ew construction ` . enl Please check all that apply:
,,•. „ a.. �. ;. �:, ;:�,�
Q Addition/al alferati /roplecem
❑ Demolition [] p;1 ��LD�N ❑Service over 225 amps, comm 'I ❑Hazardous location
d "" w t `'' r �; �� a r ; : ;:,::: ❑Service over 320 amps - rating ❑Buildn over 10,000 s ft.,
:':: w std.::” ', ' try 'Sa;a::' 'Iiar� ";:i:''i ±; i +lrrti ?a' of i• and 2-family dwellings Y 8 4 or more new residential
I - and 2- family dwelling LI Commercial /industrial 0 Accessory building ❑ System over 600 volts nominal units in one structure
❑ Multi- family [] Master builder Other:
ID over three stories ❑ Feeders, 400 amps or more
.: ; „a lq w ",, , Ma ,et, Yt e - t; , : r , y y r , ;.;.;,:. v ❑Occupant load over 99 persons ❑Manufactured structures or
4.r. ^ d a a y Y i M . ,� , . F : , t a 4. A gfili u�i tii lti O N 1 t} i k0,1i �
~ ' 1.• rM> i yx! ❑Egteaa /lighting plan RV park
Job no.: Job site address: 1 2835 SW B/a Wain u,* ❑Flealth -care facility CI Other:
Submit iacts of plans with any of the above.
City/State/ZIP: i p oe The above are not applicable to temporary construction service.
Su itc/bldg. /apt, no.: Pm
Project n to " -" ' 9 i Ep ! Iii, „'u< ', :•,.
name; ,1y AkOnSSeNe i sac :,, 0 1 > - -t G
�=: r -;.:: ;r ...
imp! IJpoHptlon , Q t y, , Be 1 Total 1 .*
Cross street/directions to job site: i New residential single or multi - family dwelling unit.
Includes attached garage,
1,000 sq. ft. or less 145.15 4
Subdivision: ... i 44 :: L. , _ t°i Lot no.: , Ea, add'l 500 sq, ft, or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
;�'; ":r: ;vii': f pNf , \:?rti 'X'': "jF`ae �.. i >7:< e:.u, . >„ ;�,,, . ',;,, - .. Limited energy, non - residential 2
`aV, tii :., .',1'.(^,,. rRur >''� .fl.' .4 5 .4' k f.': f.� ,:r. � tu 75.00
O +,. r 1. :,'7lhk Gv x .., x.. , t,: s , Each m
-;:-». -. :xr, .:�..� �;L':x;. -..,. .. v anuthettmedormodular
j +�i,Jl r j � _ r dwelling, service and/or feeder 90.90 2
i Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
,,,�
Ii r;u„,r s• �A,C,;tCIJp v. a K �.. . i; ,.,, }r + �•:: rigr r: h "tit.; _
=: w C : � 4: F;> , }Ci' T�': 201 amps to 400 am
'::; ", •- . 1r'� °�'GG.y:'� .l%t r �� .,: >�� t. >sn`r}/e r �n, P PS IOG.R$ 2
k1;}I, rM tali � ;S -�: ( +ds;;,x•. ,
Name: 401 amps to 600 amps 160,60 2
601 snips to 1,000 amps 240.6 2
Address: Over 1,000 amps or. volts 454.65 2
City/State/ZIP: Reconnect only 66.85 2
Temporary services or feeders installation, alteration, and/or
Phone: ( ) Fax: ( ) relocation
Owner installation: 'Phis installation is being made on property that I own which is not 200 amps to less 00,3 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701 • 201 amps amps to 600 amps 133.75 2
to 400 amps 100.30 2
Owner Signature: 401 amps
--�� -• new, Date: Branch circuits altar ¢flea, or extension, per panel
:., � �;.�.� +;:';;cgs, �,,. n o. C s. •,;. �.Y I , ,i °< ,�,,, , +, , � _•
., f `>:,1 t � �; ?, i ,, c,' • � t . . 'IZ t ' 1,0: ' A, Fee far branch circuits with
k service or feeder foe, each
Business name: branch circuit 6.65 2
Contact name: B. Fee for branch circuits
without service or feeder foe,
Address: each branch circuit 46,85 2
Each add'I branch circuit 6.65 f 2
City/State/ZIP: _ Miscellaneous (service or feeder not Included)
Phone: ( ) Fax: : ( ) Pump or Irrigation circle 53.40 2
E -mail: Sign or outline lighting 53,40 2
�r M n < ^'oG <• „ i }� r a �:. q Signal circuits) or limited-
;�. ,:; n y.:. ri ,: i?' 't , ; r ':.if1.s :, . ,.
.a t, . i +.r, ' ” �'� i ja,. �: �;r"i.!aM�:`��5.: ;. t.; "nt, j�'ti ,., i,�_•. energy
•:1�.. : �,�, RY alteration, or
;.‘11.: , extension, Describe: ! Page 2 r },Ob 2
Address: � _. -
c / ( — C/� �' •- =� Each additional Inspection over allowable in any of the above
Per inspection 62,50
a is i _Investigation per hour (1 hr min) Ill 62,50
Phone: ( a,3 ) a • L) W 555o' Fax: (5) 5 )3' Co —0 Q Industrial plant .cr hour MI 73,75
IMMEINIMail Suprv. Lie -' r�p}
CCB Lic.: J'' w'' f:21 hsh`. i 4Jf1L : —Si,'" « ', ' ; <1 `; *t; "'::,..:.
Subtotal (75, 0 0
Suprv. Electrician signature, required: Plan review (25% of
_�. ( permit fee)
Print name: [. •1 "1 �• State urch e (8% permit (,.Q0
d�,�� , J � ) A Date: ( 2 m'g (8 /° of ermit fee )
Authorized signatu O• J TOTAL PERMIT FEE g 00
i 1 rf O✓ Title permit application expires if a permit Is not obtained within 180
Print name: RASA tr1 ,� 1? { days after It has been accepted Aa complete
. �: 1 I ME= a Pee methodology act by Tri- County Building Induatry So Board
I lnuildlnRlPomrlmlEl ,C� • • 12/07 "Numberof inapectlona par permit nflo+vd
440- 4 6I5T(10/02/('OMNVEB T1 r _ „:„I 1 _ fe--a--