Permit ~ Y CITY OF TIGARD ELECTRICALPERMIT-
RESTRICTED ENERGY
A011 1111 4 DEVELOPMENT H B r SERVICES 639 -4171 DATE ISSUED: 3/27/01
SITE ADDRESS: 10677 SW LADY MARION DR PARCEL: 2S110DA 08100
SUBDIVISION: ERICKSON HEIGHTS ZONING: R -3.5
BLOCK: LOT: 042 JURISDICTION: TIG
Project 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 INC GREENLINE INC
1672 SW WILLAMETTE FALLS DRIVE 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 1 Permittee Signature
OWNER INSTALLATION ONLY
The installation is being m.,• •i property I own which is not intended for sale. lease, or renfzi
OWNER'S SIGNATURE: � DATE: /0
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: 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 9116 ( Permit no.t r A , p, (—'-/ �, 7
,.i if 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
ill & 2 family dwelling or accessory ❑ Commercial industrial O Multi- family ❑ Tenant improvement
ANew construction ❑ Addition/alteration /replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: `OCol 1 5 LADY MACM P' • Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: 42. 'Block: I Subdivision: EILICASON HT S
Project name: I Description and location of work on premises:
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: -a Fee Max
Business name: L LINE. Description Qty. (ea.) Total no. insp
A New residential - single or multi- family per
Address: A� /• j ; C „ ^
55 dwelling unit. Includes attached garage.
City: Tit,ARD Stater. ZIP:112.4H Service included:
Phone . 7e Fa79&' E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: , OW s3 Elec. bus. lic. no: 1,j Le. Each
energy, residential 2
City/ etro lic. no.: Limited energy, non- residential 2
Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date S /2 in 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
Name (print): ILENAlygitiNze,, emati E4 201 amps to 400 amps 2
Mailing address: 10 2. Si,) w ���/ 401 amps to 600 amps 2
�7 601 amps to 1000 amps 2
N
City: L'N S tater ZIP: atfr7a Over 1000 amps or volts 2
Phone: 6000 I Fax: ( ' 43E -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,orrelocation:
ORS 447, 455, 479, 0 7 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: . '5 , . 4 40110 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):
❑ Service over 225 amps - commercial ' ❑ Health - care facility Each pump or irrigation circle 2
❑ Service over 320 amps rating of 1 &2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other: Per inspection I I I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $ 0 IP
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
_❑Visa ❑.MasterCard — expires -if -a- permit -is- not - obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ d o
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$
Cardholder signature Amount
• 440-4615 (6/00 /COM)