Permit CITY OF TIGARD ELECTRICAL -
ENER
RESTRICTED ENERGY
�jy DEVELOPMENT SERVICES PERMIT #: ELR2001 -00071
" 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/27/01
SITE ADDRESS: 10537 SW LADY MARION DR PARCEL: 2S110DA -07500
SUBDIVISION: ERICKSON HEIGHTS ZONING: R -3.5
BLOCK: LOT: 036 JURISDICTION: TIG
Proiect Description:
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: ALL ENCOMP : X ' HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
RENAISSANCE CUSTOM HOMES GREENLINE INC
1672 SW WILLAMETTE FALLS DR PO BOX 230755
WEST LINN, OR 97068 TIGARD, OR 97223
Phone: 503 - 557 -8000 Phone: 968 -1978
Reg #: LIC 103033
ELE 34 -397CL
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 3/27/01 $75.00 2720010000 Elect'I Final
5PCT CTR 3/27/01 $6.00 2720010000
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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
Issued by ( i Permittee Signature
OWNER INSTALLATION ONLY
The installation is being made r perty I own which is not intended for sale. lease, or rent.
OWNER'S SIGNATURE: DATE: 3 PA /o
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELECN: DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Electrical.Permit Application
Date received: 3) /01 Permit no.: .60/ —0a0 /
�,•, , mi City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
•
7 - 4 1 & 2 family dwelling or accessory ❑ CommerciaUindustrial ❑ Multi- family ❑ Tenant improvement
`!l New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: 1 0/ 51 SW LADY. p /4 'R4 • Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: 3(p I Block: !Subdivision: E R�!(•.se7N HT S
Project name: I Description and location of work on premises:
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Fee Max
Business name: Gi,� Line. Description Qty. (ea.) Total no. insp
�` 1 t New residential - single or multi - family per
Address: d t 7 j VJ
P V 1 I57 dwelling unit. Includes attached garage.
City: Tit Stater ZIP: 1'1 Service included:
Phone. 7‘15 Fax9(/$' f,E -mail: 1000 sq. ft. or less 4
CCB no.: I DUI s3 I Elec. bus. lic. no: 'Z L J L.E V Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
City / etro lie. no.: Limited cm energy, non-residential 2
e Each manufactured red home or modular dwelling
Signature of supervising electrician (required) Date *gin Service and/or feeder 2
Sup. elect. name (print): License no: Services or feeders — installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
(print): tb fe,' /'�A►V Q / I /�7'9�A 1La�L 201 amps to 400 amps 2 ' L
Name riot ' { "' r+ ri��"'V (rv.+ ►IfJI /1G7 401 amps to 600 amps 2
Mailing address: ! k1 Z 5W wi! F 5 601 amps to 1000 amps 2
City: W Sr LINN State", ZIP: 0 1196, Over 1000 amps or volts 2
Phone: S51 • taDDO I Fax: (fu, 3E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders - .
which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation:
ORS 447, 455, 479, 0 7 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: _ Date: 3 .1... Q1 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E - mail:
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) . Misc. (Service or feeder not included):
0 Service over 225 amps - commercial 0 Health -care facility Each pump or irrigation circle 2
O Service over 320 amps- rating of l&2 0 Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over three stories 0 Feeders, 400 amps or more *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
0 Egress/lighting plan 0 Other: Per inspection • I I I I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other �/�,
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ `�/ '�
_O Visa O.MasteiCard — expires -if -a- permit -is- not - obtained Plan review (at _ %)
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
Expires accepted as complete. TOTAL $ •••"--
Name of cardholder as shown on credit card '
$
Cardholder signature Amount 440 -4615 (6 /00 /COM)