Permit CITY T I GA R D ELECTRICAL RESTRICTED ENERGY PERMIT
,4 1+� PERMIT #: ELR2005 -00242 D EVELOPMENT SERVICES
�,��I DATE ISSUED: 8/23/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S109DB 02200
SITE ADDRESS: 15026 SW BLACK WALNUT TERR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 060 JURISDICTION: UR
Project Description: Low voltage - all encompassing.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: 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: LL ENCOMP : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
DON MORISSETTE COMMUNITIES, LLC GENESIS HOME TECHNOLOGIES
4230 GALEWOOD ST #100 9450 SW GEMINI DR
LAKE OSWEGO, OR 97035 BEAVERTON, OR 97008
Phone: 503- 387 -7538 Phone: 503- 643 -1704
Reg #: LIC 128098
ELE 26- 989CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[UELPMT] ELR Permit 8/23/2005 $75.00
[UTAX] 8% State Surc 8/23/2005 $6.00
Total $81.00 •
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: `0:26 Permittee Signature: VA
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Flug 23 2005 12:06PM GENESIS HOME TECHNOLOGIES 5036433300 p.1
. t Electrical Permit Application a OR 4)I I'It'F: i •.1 t1\I.1
City of Tigard A
t kla i Recaiv /1 c,4J 0� 2&--' No,: ✓L - Ib� 7()J /
13125 S W Hall Blvd., Tigard, OR 97213 t P lan R `c
e L
law
Phone: 303.639.4171 Fax: 303.598.1960 s rr.,' ) r r ^ a w ; i ' Date/Bv: ether Permit:
Inspection Lino: 503.639.4175 J . - _�_� Date Ready/By: 114_,,,,n1 El gee Pa 2 far
Internet: www.ci,tigard.or.us NotffediMethod: (� Z Supplements! Information
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E:1 New construction ❑ Addition/alteratIon/replacement Please check all that apply:
❑ Demolition Q Other: ❑Scivtce over 225 amps, comm1 ❑Hazardous location
Ski ry r� � y, ,p,st{:g }) ; ry ;n „xax i,l'.! " iq; ti PBl'� s.A ,c' SCd °ip ;t at3a$➢n {n ^xrsa r aU,ti v:�..w ;xkY "i7, 'J " ^tlr1 ' ,. , 7+ ' t v,' v l arse rr.. , ['Service Over 320 amps — rating E, Build g over 1Q 000 . it.
4 } ftA �}y9.1 ; {dtl 15 1 a'g:i 1Ni+�'l, Lr'Fi1 a'A ,, i t s l nr 5 T 4 �kx t�¢ Y ' } 1 . :. • x Y y . o rP f r (6 i g: 1 , S W. , , IN4 " i! r , 0 { ,:ui, ""d r g
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Dry 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
D Multi -famil [] Master builder 12 Other: [Occupant load over 99 persons ther: ❑Building over three stories ['Feeders, 400 amps or more
t r : ,,.::n v •: ,a,� l , : ;;:y „- rA ,tr ❑Mimufactured structures or
c .. j d ii r ' ,ii tt i?hi ° r:, ' ' p sin mr:::0 : Vu r6rat'r'f6 asst; g ;6uuduIlii'ti';'n�t,.,.; : rr wrr' ar y ::)' ;'X ;;
t rrp¢r } } ir r ' 1 n r .. �v ::.� y if 3 iS . , •. �, k: . ;,. ;, 41 f f i r M1e 1 r• b y t ' ��iVr i swZr t : : ;. o P'i' ❑Egress /l(ghrmg plan RV park
v S, ;ff, � �1 .,�.rt,q SS 7 lYe..' hl'. v7nl.... L. �aucxutiv�aa�mwtNOx? t' qo. naptaCM? f rv'. it.., u�GS$. bri, R3, 5h' M ,f'.fS�3...1,.1 leas, tt��u�u�tn��n.t av .d�„d�.
, ❑Health -care facility ❑Other:
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Job no.: Job site address: 0,_ _ i Submit a sets of plant; with any of the above.
The above are not applicable to temporary construction service. 1
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Suite/bldg./apt. no.: Project name: a rm,,,, � u ... ,�:. , ..,t
Deaoriptton R4. Fez Total ••
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage,
1,000 sq. ft, or less 1 145,15 4
Subdivisions �� .� ` � �/, Lot no .s Ea. add'I 500 sq. ft. or portion 33,40 1
Limited energy, residential 75.00 2
Tax map/parcel no
;*..v.:1‘.'4:1 6 n� 0a4 tv ,k + �, 1' t' uy�uw �ayngrx6a�xt •ttr "YrYytr x iv�nG ,�>14C p agty y g 7t714Y. i 1 t aY „ Y : , ,.. ; Sd + r limited energy, non - residential 75.00 2
{: .G;t.„ ,a` % G At' , i +a 0 : i4G: 0 r ri r .1?:::" �:A:• :n lr_ .141^.tfilicuxax vk0:v4'414ii hilt l � 7 ma��f r 7 r r Each manufactured or modular
dwelltnR, service and/or ilteder 90.90 2
..... s • Services or feeders lnstalladon, alteration, and/or relocation
`A 200 snips or Tess 80.30 2
6 f V. i , P r a r u x r n,4 so s r i lit tv" ,16 I t T..W ,i nwa,t; y H� 0 AV t11r 1 ( \, t N 201 am s to 400 si 8
!"; ,,,5 4 f `:a a 1 } ∎ ).rl >, ;4•$4IY .w a7 , +f_ i . 41'3 ∎ W` '''illaousts�ti t ` ? 3 R: 5,44K 't 7 , r � ' +. w� 4: 1 a 6i } � ' # , p p 106.85 2
401 amps t0 600 amp 160.60 2
Name: /7JD ,!'t S'S A 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
` Reconnect only 66.85 2
City /State /ZIP: , 24 d , e, A " .0 0 Temporary Services or feeders instsailatlon, alteration, and /or
Phone; (c.r.) ) — S Fax: ( ) relocation
200 amps or less 66.85 r
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 @nips 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701 .
401 amps to 600 amps 133.75 2
Owner signature Date: M( Branch circuits— new, alteration, or extension, per panel
7- ne,:y, 1z i.^� 5� .Z 7W v` M1 ll:.:..:: t ".0; 1 % M1 ' I , 1 l' j y }YJ NI,, Ip ,;i l, S t h 'A 4';` ; 1 {1 4tM 1 '* 1 �} , ii5l i,g0iiN A. Fee for branch circuits with
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service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee fbr branoh circuits
Contact name: without service or feeder fee,
46.85 2
Address: each branch circuit
Each add'i branch circuit 6.65 2
City /State/ZIP: Miscellaneous (service Or feeder not Included)
Phone: ( ) Fax: ; ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 55.40 2
E-mail
' ,w,a7w'u, ,3nra YrlV,P4r,,r:r „. Signal circuit(s) or limited -
- • ;iia '
N . t Yvs
rl X1 ., o: �r,1�t} tih ih.;;i:iki ” { ur 7� �Y , ,f sy , }� ii y i Ii r S t , f y o gi : r7 7 ;d iii, IX �} 1 f }14'tY , i ilirr i CRC panel, alteration or
`+Zti]?jl,�0,;;Pn, ii... SlawV,Y, PSrk tn9. ...,,,t M, .. iiiy�tu fl:itlfAi.,ii R1' , , 1,1ld { V'' , S:g.151. l}i1?7,44 / ��
Business name:
extension, Describe: Page 2 7s 2 2
Address: Each additional Inspection over allowable hi any of the above
—'.. Per inspection 62.50
City. GENESIS HOME TECHNOLOGIES investigation per hour (Ihemin) 62.50 -.
Phot 9450 SW Gemini Drive Beaverton, OR 97008 Industrial plant per hour 73.75
Phn- 503 -643 -1704 Fax- 503 -643 -3300 faii ;ygr1; M•?r.,tq a d „ra .:,t %#.a•. ,.,'; .174 ,, ,.aura`s st }gihii; 't ^ s
CCf CCB 126098, CLE26 -989, Subtotal 7S to
Supt 2885 -.1 L E Plan review (25% of permit fee)
V State surcharge (8% of permit fee) O b
Date:.. — 2i- J 5
Authorized signature: TOTAL PERMIT FEE OG
8t
$ This permit application expires If a permit Is not obtained within 180
days otter It bee been accepted as complete
Print nettle: Date: • Fee methodology act by Tri- County Betiding Industry Service Board
•• Number of Inspections per permit allowed
l:lBuildbi \PerminaltLC- PeredtApp4oe 1203 4404e1ST(10/021COM/wIm
CITY OF TIGARD '`
BUILDING DIVISION PERMIT #: ELR200500242
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/23/2005
Phone: (503) 639 -4171 - .. 9 ,, i 1p�i���iiul� "i
Inspection Requests (24 Hrs.): (503) 639 -4175 i' I
INSPECTION WORKSHEET FOR DATE: 10/11/2005 TIME: 7:08AM PAGE: 68
SITE ADDRESS: 15026 SW BLACK WALNUT TERR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 060 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Low voltage - all encompassing.
OWNER: DON MORISSE.I I E COMMUNITIES, LLC, PHONE #: 503 - 387 -7538
CONTRACTOR: GENESIS HOME TECHNOLOGIES PHONE #: 503- 643 -1704
Inspection Request Scheduled For: Date: 10/11/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 017958 -01 503- 619 -6452 N
Corrections /Comments/ Instructions:
S n PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: kiLad Date: /0- ."// -- (OS_ Phone #: (503) 718 -