Permit v CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
11011 ° ' COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00312
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/10/2007
PARCEL: 2S 109AC - 05900
SITE ADDRESS: 13168 SW NICOLE LN ZONING: R -7
SUBDIVISION: .WILSON RIDGE NO. 2 LOT: 027 JURISDICTION: TIG
PROJECT: WILSON RIDGE NO. 2
Project Description: Install central vacuum 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:
STONE BRIDGE HOMES NW LLC ALL WEATHERIZATION
16869 SW 65TH AVE #505 3030 SE 59TH
LAKE OSWEGO, OR 97035 HILLSBORO, OR 97123
Phone: 503- 387 -7577 Contact #: PRI 503- 649 -6542
•
FAX 503- 649 -2680
FEES Reg #: LIC 46969
Description Date Amount
[ELPRMT] ELR Permit 8/10/2007 $75.00
[TAX] 8% State Surcha 8/10/2007 $6.00 REQUIRED ITEMS AND REPORTS
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 que 'ons to OUNC at 503 ',•.6699 or 1.800.332.2344.
/ • ,
Issu - • = y: .;/1 // / i / LAI Permiftee Signature: /� �ijff�
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.
cc.. 'cal Permit application i.olz of i ic_1: Ilse oNI.I.
CI of Tigard Received 6 izy ; `L —60 2.
`'f g DateB : / / %�� Permit No.: - / S
13125 SW Hall Blvd., Tigard,OR 97223 n Plan Review
''
Phone: 503.639.4171 Fax: 503 598.1960 ''' 1 , Other Permit:
r , �
Inspection Line: 503.639.4175 r' f l • I Date/By: Date Ready/By: 1 El See Page 2 for
Internet: www.ci.tigard.or.us • Notified/Method: /� Supplemental Information
T YPE OF WORK PLAN - EW
011 New construction ❑ Addition/altention/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ❑Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
;k '1 GA EG ORY OF CON; TRUC'TIOPi of 1 -and 2- family dwellings 4 or more new residential
rgl 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accesso building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other: ❑Building over three stories ❑Feeders, 400 amps or more
-
JOB SITE INFORMATION AND LOCATION a ❑ load over 99 persons RV park
structures or
❑Egr Egress/li ss/lightmg plan P
❑Health -care facility - ❑Other:
Job no.: I oil LJob site address: /3/4,r A r /V Submit 2 sets of plans with any of the above.
City/ State/ZIP: (��� t37 ' The above are not ,plicable to temporary construction service.
Suite /bldg. /apt. no.: � I Project name: * '
Description I Qty. I Fee. I Total I
Cross street/directions;to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: ( j .'Sod le; O le. , I Lot no.: t Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential / 75.00 7S 2
Tax map /parcel no.- : Limited energy, non - residential 75.00 2
- 1 ESCRIPTION OF WORK
Each manufactured or modular
(. C +� dwelling, service and/or feeder _ 90.90 2
0.l V ct ud >v.. S c l„1 <. 'Pe 0 Services or feeders installation, alteration, and/or relocation
J 200 amps or less 80.30 2
. ta PROPERTY O CI , 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: a N I �S f4011 cs 1 601 amps to 1,000 amps 240.60 2
Address: L4 2, 3o i► ov / e I . ,,✓ O'C a S j _
i t Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/ State/ZIP:
1--A'. Kt- OS W e y q 70 ,5-- • Temporary services or feeders installation, alteration, and/or
Phone: ( elocation
S- ) t J �e -7 7 3 k F ( s 3 ) e7 I ! c 200 amps or less 66.85 1
Owner installation: This ins nation is being made on property that I oivn which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, o 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
APPS ICA ' 1 •' ❑ CONTAcy ERSoN , A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name:
A Ll_ V 4 - 148.,, 1 2.0,4., s ory 4 0bi F - /VC. branch circuit
B. Fee for branch circuits
Contact name: ; o , c K I l without service or feeder fee, 46.85 2
Address: - first branch circuit
o � S S4 �'`' it • Each add'I branch circuit 6.65 2
City/State /ZIP: H 4 6 v O >2 q it ZS Miscellaneous (service or feeder not included)
Phone: (503 C, Li q 6 ci a I F x :: (V ) 6 q Pump or irrigation circle 53.40 2
• � _, Gf�� Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
, , CONTACTOR , energy panel, alteration or
` extension. Describe: Page 2 2
Business name: 411 t/e,a'ft')er iza f o C•oni Ili— -
Address: S 1 $6 s - 4 ft, Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: i j. HS 6 Zo 6g f 7 / 3 Investigation per hour (t hr min) 62.50
.r Industrial plant per hour 73.75
Phone: ( 5-0";) to y 4' Li Z F ax: ( � 0 ) Cci f 660 ,ZECTRJICA�i,. P "1t119]E7` F»S''
CCB Lic.: / 6 6 : Electrical Lic.: I Suprv. Li .: Subtotal
9 � `7 3
Suprv. Electrician signature, required: ( Plan review (25% of permit fee) t ie
t . C C
L � State surcharge (8% of permit fee)
Print name: r , / 1.4 1. Date: r.../0.-07 60
....._
TOTAL PERMIT FEE Tt
Authorized signature: ; .. This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: I Date: 8 i ' -dl • Fee methodology set by Tri- County Building Industry Service Board
t 48 Number of inspections per permit allowed.
is\ Building \Permits\ELC- PermitApp.doe 12103 446- 4615TO0/02/COM/WPB