Permit CITY OF TIGARD ELECTRICAL PERMIT -
1 RESTRICTED ENERGY
r4li DEVE H BMENT r S SERVICES 639 -4171 DATE ISSUED: 4/92 004 2004-00095
SITE ADDRESS: 12068 SW WHISTLER'S LP PARCEL: 2S103CC -WW275
SUBDIVISION: WHISTLER'S WALK NO. 2 ZONING: R -4.5
BLOCK: LOT: 075 JURISDICTION: TIG
Project Description: All encompassing low voltage.
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:
DON MORISSETTE HOMES INC
4230 SW GALEWOOD ST 100
LAKE OSWEGO, OR 97034
Phone: Phone:
Reg #:
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 4/9/2004 $75.00 Elect'l Final
[TAX] 8% State Surchari 4/9/2004 $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 / ! / ._ / Permittee Signature
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, orrent.
OWNER'S SIGNATURE: DATE:
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
ti
12004 13:22 5032362322 QUADRANT SYSTEMS PAGE 02
I'OR OFFICE, 'ISE ONLY
E1iict Permit Application ,�
Permit Date/By: 0 / ,X e5 Electrical
rmit No.''G � ' c2
�� Planning • • , 1 Sign
City of Tigard �� B Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 APR 0 F 200 Date/By:
Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 ' ► Past ^Review Land Use
%� "'''!', �! 1 ,,, Date/By: Case No.:
Internet: www.ci.tigard.or.us CITY OF a h I " , 1 I C ontact - 18I See Page 2 for —
24 -hour Inspection Request: 503-639;4175D IN .. r ■ Name/Method: lr\ - Supplemental Informatlod.
:IV' 'Xe!1 r€ t.1- I:..F1 7 alu�l '1i�iT +;�NrL+tN1aj ..I.5"'lJ�i3 r',`d' q. 0.kLiir: u%' '
New construction • Demolition ■ Service over 225 amps- 1 Health-care thcility
commercial ❑ Hazardous location
• Addition/alteration /r • lacement • Other: ❑ Service over 320 amps-rating of ❑ Building over 10,000 square fcct,
- .9 t IP''? .9E-031.411,9171:053T74' E` ; ;, 4 . "I r, I & 2 family dwellings four or more residential units in
'I I & 2- Family dwelling I• Commercial/Industrial ❑ System over G00 volts nominal one structure
• Aceesso Buildin t • Multi -Fam11 ❑ Building over three stories ❑ Feeders, 400 amps ar more
❑ Occupant load over 99 persons ❑ Manufactured structures nr RV park
0 Master Builder • Other: ❑ Egress/lighting plan ❑ Other:
! i:( r-'" ylt •* .} , t , , ai a l §g7DIZMW �}'t: "'i �} G O C' 'i' 1 �lG i f Submit sets of plans with any of the above.
w n / � C - a. l - .�.. o ' - =' e. The above arc not a . • likable to tem r construction service
Job site address: /y- 7 4 1A) � hi,+ I.vS LS , r ,lrr_ J.nt JI.^l�l� "..'- },.. iip l'.11w;Y� 7,;� }�t. 20 9 , .lo
Suite #: ( BldgfApt. #: Number of inspections per permit allowed
Project Name: 4/6 f4- /-e/s" 414. / It Description Qty Foe ies.) Total
Cross street/Directions to job site: New residential- single or multi - family par i
7 dwelling unit. Includes attached garage. •
Service Included:
1000 sq. It or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Subdivision: I Lot #: limited ener v, residential 75.00 2
L energy, non res 75.00 2
Tax ma./ parcel #: Each manufactured home or modular dwelling
,t r t t�a�y ri i
: t. (%il iir1 i' t t'ilii l ' a1. 1 g ;' ',; x ;zit feeder 90.90 2
e- hl ► h ! "�sl( j� �;._� .. „_,.lv rt service and/
�
Services OT fcedtxs- Installation,
alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amts 106.85 2
40l amps to 600 amps 160.60 2
I
'i t 1!{c�t_ al'J'” Pk I r:c �'1 i J 1 1 i li 'i � 1 i1 t - 1. 'Ell ?'. , ..c._ - :, -.' . 1- 601 111134 W 1000 amps 240.60 2
;. .. ..:: ..�'i..\ +.,. ���:.. Over t000 moos or volts 454.65 2
Name: Reconnect c i f 66.85 2
Address: Temporary services ar feeders - installation,
alteration, or relocation:
City /State /Zip: 203 amps or less 66.85 I
Phone: Fax: 201 amps _ m 400 amps - 100.30 2
-yt , , F; ,i^ r 1 a r , 401 to 600 amps 133.75 2
t ��1 7 r i, ti a S T a 9 b�'F"IFJ ,C '¢PP lrlt SJCO I3,J 7435} 4r ;
1 � '•i��,�n� xl +,� ��, .-� G' � r.. r,�c - Branch circuits - new, alteration, or
Name: extension per panel:
- A. Fee for branch circuits with purchase of
Address: - _ service or feeder fee, each branch circuit 6.65 2
City /State /Zip: i B, Fee for branch circuits without purchase of
service or feeder foe, fast branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
E-mail: Misc.(Service or feeder not included):
Ji ,,m-,7 t ,,,o 1 r r , ' II ,, r t f fi ltl �' b_ n ! t 4 k •`11'''''• , , 7", Each pump or inigadDn Circle 53.40 , 2
hal t,-I�_,J a .. I L ,. II... ! 'iv, i t,.,..r� Z ..a ,r. . r. _ . rr Each sign outline lighting - 53.40 2
Job No: Signal circuit(s) ore limited energy panel,
Name: - alteration, or extension 2
Business Na
4 ed c t S ' Cc.s/ 147 F �i4C - Description:
Address: T20 r Rai /T 3 �q n / � p
p ' / t _
lea ad in over the allowable In anLof the above:
Cl /�'t3tC /ZI pi f O 14 i_ 0 E / Fcr inspectiction on per hour (min. I hour) 62.50
Phone: S'a —Z 3 SS' Fax: S " 1 ? -2.& - Z ?i.. Investigation fee:
CCB Lic. #: 4I6 : 4 6 Lic. #: - - r C L
Other:
�Yf ��qq�-- "_ l � [. �G'r ;i l� :r-.Ir f rrr r� }
tf.�'- ,.._ -- �._.... t �'�r�.'!t ..I�f �, � I�ar), t. L :.�i;l�.t! ±.- .i�.!;; :
Supervising electrician./ I I. _ Subtotal $
signature required: / 4 .-h Plan Review (25% of Permit Fee) S
- Print Name: g 1 . I le r I Lie. #: f 2/ I i _ State Surcharge (8% of Permit Fe!) S .00
'TOTAL PERMIT FEE S 8/ ,Q d
Authorized MoModem Thu permit application expires if a permit is not obtained within
� `� rl
Signature: t - Date: If y dT 180 days after It has been accepted as complete.
*Fee methodology set by Trt- County Building Industry Service Board.
err RN C. AI id. koIA'S _
-
(Please print name)
i : \Dsts\Permit Forms\ElcPermitApp.doc 01/03