Permit CITY TI GARD ELECTRICAL RESTRICTED ENERGY PERMIT
''a l DEVELOPMENT SERVICES PERMIT #: ELR2005 - 00075
�.��I DATE ISSUED: 3/30/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 109DA -SR078
SITE ADDRESS: 15131 SW HAZELCREST WY ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 078 JURISDICTION: TIG
Project Description: Vac system.
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: X FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
DON MORISSETTE COMMUNITIES LLC ALL WEATHERIZATION
4230 GALEWOOD ST # 100 3030 SE 59TH
LAKE OSWEGO, OR 97035 HILLSBORO, OR 97123
Phone: 503- 387 -7538 Phone: 503 -64 -6542
Reg #: LIC 46969
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 3/30/2005 $75.00
[TAX] 8% State Surcha 3/30/2005 $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: D-74 t Permittee Signature:
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.
•
t
Electrical Permit Application FOR OFFICE USE ONLY
Ci01 Tigard A Received .--, ...,
Date/By: 6 5/7 - 0 '5 - PL./
(._ -G.-
Permit No.:L"CIZ25 0 75
13125 SW Hall Blvd., Tigard, OR 97223 , Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 . I it. Date/By: Other Permit:
Inspection Line: 503.639.4175 ,11,- f:!`_ I Date Ready/By: Juris' . 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: I' g Supplemental Information
Irt.VITIMUM:NagEKNWCAWS352N1, IT,.,igattPiIS " INWUNIFFT81.30WWAIMPEattki
gl New construction El Addition/alteration/replacement Please check all that apply:
EService over 225 amps, comml ['Hazardous location
0 Demolition 0 Other:
. „ „ „, , , , ._,,, , ,,, EService over 320 amps - rating [IBuildng over 10,000 sq. ft.,
IffillnititAtT-60 ,,. of 1- and 2-family dwellings 4 or more new residential
[g] 1 - and 2-family dwelling 0 Commercial/industrial 111 Accessory building 0System over 600 volts nominal units in one structure
. ['Building over three stories ['Feeders, 400 amps or more
1=1 Multi-family [11 Master builder 0 Other:
o
z fj ['Occupant load over 99 persons OManufactured structures' or
JO ,--, , , „
A-- - a:, .., ,, '":,:iMi6A,M10141 I - I Egress' „ uguting plan RV park
0Health-care facility 00ther:
Job no.: Job site address: )5 1 3i fi ze i cf , 6 ,. 61 _.
Submit 1 sets of plans with any of the above.
City/State/ZIP: 'T c, \ N o The above are not adplicable to temporary construction service.
Suite/bldg./apt. no.: Project name: atilaSCRA T!IteliKii3OMNROMV:-;:MV
Description I Qty. I Fee. I Total I **
Cross street/directions to job site: &III ///1 I le 4 New residential single- or multi-family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
- ,..
Subdivision: 4 : vy% t ry \ I A. i Z 03,e, Lot no.: . Ea. add'I 500 sq. ft. or portion 33.40 I
Limited energy, residential 75.00 I 2
Tax map/parcel no.:
Limited energy, non-residential 75.00 2
11 Each manufactured or modular
1_, i, dwelling, service and/or feeder 90.90 2
( CAI +01 (. Vi, C-- ,Cit IV ti ) 014 - 1 .
Services or feeders installation, alteration, and/or relocation
Ind\ trt 200 amps or less 80.30 2
,• ,- -'& I ., - 4-ifa,ijrvbve.. , =,,;v.rm,'Row.ram,%,m,Kf;„;; , „ r =- , yt : ,,-,v;,4'nzz.:.,m 201
amp amps to 600 400 amps 106.85 2
s to amps I 60.60 2
Name: 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: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( )
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps . 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: Branch circuits - new, alteration, or extension, per panel
Aii ',tv-tilitii§o A. Fee for branch circuits with
,w, , : , b ,,w, ,
service or feeder fee, each
Business name: / 1 1,,,„44 , , i ,--„,,,„ ht .,,- co I- branch circuit 6.65 2
B. Fee for branch circuits
Contact name: - 5e, ert, /14a4 (.., (.,( kl..7 ".. without service or feeder fee,
46.85 2
Address: ?VALI - e ) . /z% - 4 1 cf- f each branch circuit
Each addl branch circuit 6.65 2
City/State/ZIP: Hit 07/2-5 Miscellaneous (service or feeder not included)
i '.--• Pump or irrigation circle 53.40 2
Phone: ( c•01 61/44 q 0 t --(A Z_ Fax: : ( V ) C, (4 fa 6 5
Sign or outline lighting 53.40 2
E-mail: ' Signal circuit(s) or limited-
, . . ..... ..,„..,_... ..-- .r.,
ralif47W energy panel n
, alteratio or
extension. Describe: Page 2 2
Business name:
Each additional inspection over allowable in any of the above
Address: ?N. -
S c, fr: G 1 cl Per inspection 62.50
City/State/ZIP: !fit I c- 1 boico De q7r Investigation per hour (I 111 Mill) 62.50
Phone: ( 1I)j) a to ( r o cl,( 2 ... Fax ( ) 6 y f .2_0?6) Industrial plant per hour 73.75
' frAV:40
CCB Lie.: i: .1 6 q 6 c Electrical Lie.: Suprv. Lie.: Subtotal 7 5
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Print name: 5 c). , ) et A Date: 7 2_1_ o s
t-wl tAk k
_1 TOTAL PERMIT FEE a/
Authorized signature: .---- 2 - dr This permit application expires if a permit is not obtained within 180
------...
Print name: Date: * Fee methodology days after it has been accepted as complete
set by Tri-County Building Industry Service Board
** Number of inspections per permit allowed.
i ABui 'ding \Permits \ELC-PermitApp doc 12/03 440-461ST(10/02/COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005.00075
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/30/2006
Phone: (503) 639 -4171 Jit l ��� l �l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/31/2005 TIME: 7 :05AM PAGE: 69
SITE ADDRESS: 15131 SW HAZELCREST WY CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 078 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Vac system.
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503-387 -7638
CONTRACTOR: ALL WEATHERIZATION PHONE #: 503.64 -6542
Inspection Request Scheduled For: Date: 3/31/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 003314 -01 503-519.6452 N
Corrections /Comments /Instructions:
6 PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL , LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / Date: -- 7 Phone #: (503) 718-
\