Permit r
C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
����� DEVELOPMENT SERVICES PERMIT #: ELR2005 - 00116
_`''� `�'I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 5/17/2005
PARCEL: 2S 101 AB -01501
SITE ADDRESS: 07555 SW HERMOSO WAY 120 ZONING: MUE
SUBDIVISION: HERMOSO PARK LOT: 021 JURISDICTION: TIG
Project Description: Data.
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:
JOENS, JOHN D MARJORIE A COLUMBIA TELEPHONE CO. INC.
7545 SW HERMOSO WAY 9860 SE EMPIRE CT
TIGARD, OR 97223 CLACKAMAS, OR 97015
Phone: Phone: 503- 230 -8899
Reg #: LIC 99500
ELE 26- 940CLE
FEES SUP 1812LEB
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 5/17/2005 $75.00
[TAX] 8% State Surcha 5/17/2005 $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: �L Permittee Signature: _ 23
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.
05/16/20 09:54 5032395516 COLUMBIA TELEPHONE PAGE 03
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_ ..._klectricii Pczniit Applin Fro; El V E D
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City of Tigard Received .....^—/ , O
. : : L• riZeirdklav i - - a)// 00
13125 SW liall Blvd., Tigard. OR 97223 MAY 1 6 2005^ PI:cline
Other Permit;
Phone: 503.639.4171 Fax: 503.598.1960 o.011;';' Date/b
Inspection Lim 503.639.4175 ..i.i.. .0!..911. - '' i ' Dem Ready/Sy: FM 121' Sea rage z
Internet: - er
rnet: www.ci.tigartiorns CI OF TIGA; - - --- Notified/tvlethod: Sapplemeatal leformauoo
.... .....
TY . " Z ' . ■• . - a '. - . •
..;''.. .'••• . ' ••■ ::1•:•: .• ., -:..... •:. • • • :., '• • ilip ... .. N it ) . , • :. ...1 ,.: • • .• , ... • . • , '.-'''.''' •:: .,- : •'' ; ';' : A. , ::.''''': ' - ' - :•a;;!,...:!, '01: ' : - :'•••••/:.: ' ': ' '.'. '
0 New construction 0 Addition/alterationfrephicement Please check aliicat apply:
t IDServiee over 225 amps, coattail Offazardous location
Ill Dem011iuti 0 011igt:
. . „ . . ..„ .. „ OService over 320 amps -rating CifluilcIng over 10,000 set, ft,,
' • l' ' ':'?:.: ... ' :.: ...::' '''' : :-
• ''''''• :. • ' ie-ikiliolii r' ;(4 -. 4C661 ; riti.i.C . 11(iii . ' '• . . ''' • .. ' ''' • '..• • '': of I - arid 2-flunily dwellings 4 or wore new re.sideutial
D i- and 2-family dwelling 0 couguemiayindustrik El Accessory building El System over 600 volts nominal units in, one structure
°Building over three stories OFeeders, 400 amps or more
El Multi-family D Master builder D Other:
Doeenpaut load over 99 persona Olvberafaoturec1 Btructureg or
RV psuic.
..,: .`:. ,.,•: .. ; ..:':''..::.'...: , •..,.. : 73011: SI(r$:.09170/0110 p4p411.4?/4 :.., ,,.:::..:,:-.: °Egress/lighting plan
ollealth-care facility DOtlirz:
Job no.: Job sie addressz .- 1 1 i v\ o s a_ i ' 0 submit 2 sets of plans with any of the above.
City/State/ZAP; 11 6 p,p_b C ‘e c't 1 2-2-I The above are nol applicable to temporary construction service.
_ ,'::. Y , 'i.;','''' - . ‘, :t ''.. , ':::' , 1 4 tgi t. ' ',' ScitE0t.itt .:: "::':' i' : ' ''-::'::.
Suite/bldg./Vt. nO.: Project name: ef(Es % t,z ix-L. tv \ oR-TA 6 .. ..... . . . ." . • " . • .
Dennance r r
Cross street/directions to job site: New raidential Sinee or multi dwelling unit
Xfieirtdem set-tacked gaper.
1,000 sq, ft_ or iess 145.15 4
_
Subdivision: Lot no.: ta. arkr1 500 sq. ft. or portion 33.40 1
Limited energy. residential 75,00 2
Tax inapiparm1 no,.:
. . Limited ener5y, DO:I-residential 75,00 2
• .•'• ''!'' • :. ' .:.-.:: :'::'.. : :.: • : 1. .. ,.. : : .., ., .''.. . -:' • : • . 7 .' • i ' . • :l'-: .. ::::'.... : Essil inailUfadlIrsd Or mo&likr
dwelling, service and/or feeder 90,90 2
1)01.0kA Cejok4e1
Services or feedex's *intonation, alteranon, and/or relocatio
200 anys or less 80.30 2 201 mpato4OOampe 106.$5 2
,:••' .•,,;'.:•••'.:. :. - Orit*VIc:q*lik'''Y ' :::::. :•.- "::"'.:' :.\''..; ... ..,:; : : ..: : ' ..,;::.: ..:.. :: .. ,,
401 amps to 600 amps 160.60 2
„. ..
Name;
601 amps to 1,000 amps 240.60 2
Address! Over 1,000 amp or volts 454.65 2
Rocormect only 66.85 2
City/StaterZIP
TemPorarY services or feetlen/ InStalbation, alteration, and/or
relocation
Phone: ( ) Fax; ( )
200 amps or less 66,85 1 1
Owner installation: n
ion: This stallation is being made on property that 1 own which is not 201 amps to 400 amps 100.,i0 2
intended for sale, lease, rent, or exhange, according to ORS 447, 449, 670, and 701. • 401 amps to 600 amps 13175 2
Owner signature: Date: ' Oranch circuits - new, alteretion, or extension, per wand ,,.. •
' ' ' :;••• • •• :::'•: 0 . ...Xiti,idiiiii:, ... :.... !': .:'' ', :‘ :, •..... ....!.". -, ...cl , ictor.rAct.'kEksoiy.f.:... ..,.,.::::.. ,eL Pee for brandy circuits with
ssrvise or feeder fee. each
Business name:
brEinch circuit 6.65 2
_
- '
13. Fee for branch circuits
Conitnot name:
without service or feeder fee,
46.85 2
Address: each branch circuit
Each add'I branch circuit 6.65 2
City/SteteJZlP.
Miscellaneous (service or feeder not included)
-
Phone: ) Fax: - ( )
Pump or irrigation circle 53.40 2
.. • _ Sign or outline 14;bling 53,40 2
• E-mail: • Signal ciraait(s) or limited-
eXtenoum. Describe: Page 2 2
\ Business name: ■AS)tA 7 eq-E/>M e- t . 1-4.! ‘:_.
AddleS87 C 6 E. m . , & c — Each add iliOnal hiSPeCtloo, over allowable la any of the aim e
-- Per inspection 62.50 •
\47 CRY/StateIZIP: tillflERRIi;Erp c.- LA-C, LA PrS 6 oc-lol investigation per hour (I hr mito 62.50
. - , 4•:. F ( 993) 3.C1 — 5 1 h , , kiln_ striistylari 9, h our ,. I, '73.75
..,... ::•••:-. A •:, w;:::• • •.•:,-•.;
CCII Lie.: Ct (4 5 Do 1 Electrjeal Lk,: ato_cgo cLE Suprv. Lie.: ‘ 1 )_1._$3. si,bt,tti
..
Suprv. Electrician signature, required: .r\ Plan review (25% ofpermit fee)
...
Priut name: -
k "IX) ttiS b-7 CAA- Li Nn Date: , ) 1 9 0 N,-- State surcharge (8% of permit fee)
...
TOTAL PERMTT FEE
Authorized signature:
Thi permit sippacation aspires If a permit Is Set obtained within Vat
Print name:
•
day, after ft bat been accepted ati COMpicte
LDate: + Fee methodology sat by Tri.C.euray Building fadonty Service Board
.. Ntaater of impactions per permit allowed.
iAtuakitoswerroitien,c-PeonitApp.doe 17103
440-46151X:PIMOCIMAII:s
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: ELR2005 -00116
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/17/2005
Phone: (503) 639 -4171 J „„iiiiii l i i r Inspection Requests (24 Hrs.): (503) 639 -4175 _�
INSPECTION WORKSHEET FOR DATE: 6/14/2005 TIME: 7:10AM PAGE: 82
SITE ADDRESS: 07555 SW HERMOSO WAY 120 CLASS OF WORK:
SUBDIVISION: HERMOSO PARK LOT #: 021 TYPE OF USE:
PROJECT NAME: PRESIDENTIAL MORTGAGE
DESCRIPTION: Data.
OWNER: JOENS, JOHN D MARJORIE A, PHONE #:
CONTRACTOR: COLUMBIA TELEPHONE CO. INC. PHONE #: • 503-230-8899
Inspection Request Scheduled For: Date: 6/14/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 009126.01 503- 222 -2222 N
Corrections /Comments /Instructions:
( . •
• \‘(4\,ifl 6'1 3'6
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED •
IT Inspector: Date: � - 13 5 Phone #: (503) 718-