Permit `o, CITY OF TIGARD ELECTRICAL -
ENER
RESTRICTED ENERGY
! ji�� DEVELOPMENT SERVICES PERMIT #: ELR2004 -01000
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/25/2004
SITE ADDRESS: 12073 SW WHISTLER'S LP PARCEL: 2S103CC -14100
SUBDIVISION: WHISTLER'S WALK NO. 2 ZONING: R -4.5
BLOCK: LOT: 088 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 ALL WEATHERIZATION
4240 GALEWOOD ST #100 3030 SE 59TH
LAKE OSWEGO, OR 97035 HILLSBORO, OR 97123
Phone: 503- 387 -7538 Phone: 503 -64 -6542
Reg #: LIC 46969
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 6/25/2004 $75.00 Elect'I Final
[TAX] 8% State Surchar€ 6/25/2004 $6.00
Total $81.00
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This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to ow rules - adeRted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
thro gh OAR 952-001-(11p0. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
ued by �iV��% Permittee Signatu �~
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
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Electrical Permit Application 1•.01; ( 1-: 1:SI.: ON ix
atrorTigard Received
Date/B : 1 . .,, , ,,1 0 Permit No.: L 1,946 -- /400(n1
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503 . 598 .1960 Nitre/ I,' '';'• Date/By: Other Permit:
Inspection Line: 503.639.4175 .t4. "'IL Date Readyisy: - • 7 I RI See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: i Ile I Supplemental Information
'IgINAT;I:.,,1,0i::,Vi',.;,,,,,;;,'''::' d i..pP;!:Ni , l'A - RRAZA c Ne;? ' ''4 1 4K144iNt' lliheiiii****ViATI,WiU`e
i 0 , ,'' .i ::!4,0 ‘;; 4; .;,s; — „ ,;-: „';■nr,a, r 7, „ , 7.,c1, ■,;„,o, ) v:' - i,, , m,-,010*,, , , 4
Okisiew construction 0 Addition/alteration/replacement Please check all that apply:
0
0Service over 225 amps, comm'I ['Hazardous location
0 . ElService over 320 amps — rating 0Buildng over 10,000 sq. ft.,
i
' ',$ , ZPV„ , ',1 , 0q,ii i ::,:q . Demolition ;!y '.' If ', ,,t Other: ,,qri' • ...,"'Ii.7 • 110*,:' • ,1' di1 ,,\ '' ,". .. .- of 1- and 2-family dwellings 4 or more new residential
. A."‘ :lie; - - - '. et, ', ' .''
li 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building 0System over 600 volts nominal units in one structure
0 Building over three stories ['Feeders, 400 amps or more
0 Multi-family 0 Master builder 0 Other:
, 0 Occupant load over 99 persons 0Manufactured structures or
4 ;,,,Oi',t'j0*.t,i*.W**r0**M*,g*;*0*,':','' ', Z:::, : ' ', Iti l q.i4".'.; 0Egress/lighting plan RV park
e tc 0Health-care facility 00ther:
Job no.: Job site address: a 0 1 7 3 s k j 14 ,1 115 . 1 .. k es '
Submit / sets of plans with any of the above.
City/State/ZIP: Trj 4, (ck (..) ie it2 ' .-3 The above are not applicable to temporary construction service.
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Suite/bldg./apt. no.: 1 Pw name: i 4/0 r/ ii)rne_s D...1,, ` u.' ' km. 1 s.... 1 To a j ..
Cross street/directions to job site: p New residential single- or multi-family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: R ,J. lin ., /1 I Lot no.: g-g , Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential I 75.00 2
Tax map/parcel no.:
Limited energy, non-residential 75.00 2
6 : , :K ,'' . : M*frollotifia0x4045JjAkkoik i g, c ft. ' iM*10 , :i5: ' Wino: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
1 £12 ii-cle_ Vekc-uk) 01•\ . t.,"... Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
amPs1° 4°° aniPs 106.85 2
401 amps to 600 amps 160.60 2
Name: Apn Ai ev ., icse /47Lyyle..„4- 601 amps to 1,000 amps 240.60 2
Address: fia , l in /4 , 00 ,), ./- Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: L ex 4 q (DR T Yo 3 5 Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( 1-0z ) - tgatp -4 N"") - 6 1 Fax: ( ) 200 amps or less 66.85 1
Owner Installation: This installation tAmng made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or 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
!!",'''.,:,,': , : , p,3fEt t . ; ,:4t '` . ar .1 iMM, 4 - i , p;, 1 : : , ..X:',i , 16t;'' A. Fee for branch circuits with
service or feeder fee, each
6.65 2
Business name: A I ',y os: Ali e r . i z C.64 +v ej._ -1—ea....‹. branch circuit
B. Fee for branch circuits
Contact name: s ylit re, e_ k 4 c-r) without service or feeder fee,
46,85 2
each branch circuit
Address: '.0 30 IF: cet ft` C+ Each add'l branch circuit 6.65 2
_
City/State/ZIP: KA Is (. a r . ) oe q. — 7 I D.1 Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: (, ) a./ et __ as q :1_ I Fax: : ( 51,3 6 Li 4 aa, k
Sign or outline lighting 5340 2
E-mail: Signal circuit(s) or limited- '
0 0slt4000 - 10:, , ,, , ;; :;:iy,, - JI" . V. ; ,.' 1 . ',..;, '':; energy panel, alteration, or
' extension. Describe: Page 2 2
Business name:
Each additional inspection over allowable in any of the above
Address: —2 r, '"?,(). 41 = ct 41 \ C.- "E Per inspection 62.50
City/State/ZIP: if ) i C b le ' / D„. Investigation per hour (1 hr min) 62.50
Industrial plant per hour 73.75
Phone: ( -5-63) "'(,,f I _ 6s—co_ Fax: (5 ) 6 t 26 el
CCB Lic.: 4 1 C 4" Electrical Lic.: Suprv. Lic.: Subtotal
Suprv. Electrician signature, required Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Print name: Date:
TOTAL PERMIT FEE i ff/
Authorized signature:
This permit application expires it • permit Is not obta within 180
days after it has been accepted as complete
Print name: --5 /4 vl c, ti .... k ".\ 1 Date: 0 - ,..)._.g —014 • Fee methodology set by Tri-County Building Industry Service Board
A
** Number of inspections Der permit allowed