Permit ELECTRICAL PERMIT
C ITY OF TIGARD RESTRICTED ENERGY
I ik DEVELOPMENT SERVICES PERMIT #: ELR2004 -00171
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/22/2004
SITE ADDRESS: 12077 SW WHISTLER'S LP PARCEL: 2S103CC -13900
SUBDIVISION: WHISTLER'S WALK NO. 2 ZONING: R-4.5
BLOCK: LOT: 086 JURISDICTION: TIG
Project Description: low voltage for 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:
DON MORISSETTE HOMES ALL WEATHERIZATION
4230 GALEWOOD ST • 3030 SE 59TH
STE 100 HILLSBORO, OR 97123
LAKE OSWEGO, OR 97035
Phone: 503- 387 -7538 Phone: 503- 387 -7538
Reg #: E51B- 64- tiLSiVb9
LIC LIC. FOR VAC. SYS. NOT
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 6/22/2004 $75.00 Elect'I Final
[TAX] 8% State Surchart 6/22/2004 $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 1-0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
Issued by ■ : _ Permittee Signature i
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
Electrical Eermit Application 1.0 1; ()HI( is 1 s l 0N1.1
City of Tigard � , _ �D .s ; C=N i ■ OP • 0 0 1 71
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 "" � Other Permit:
" DatdBy
Inspection Line: 503.639.4175 ,„ -'_. , Date Ready/By: Ium ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method. 7 J G Supplemental Information
TYPE' OF WORK ' . . ' ' PLAN REVIEW • ' ' •
Q4iew construction ❑ Addition/alteration/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.,
CATEGORY OF CONSTRUCTION ' - of 1- and 2- family dwellings 4 or more new residential
eff and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
12 Multi - family 0 Master builder ❑ Other
❑Occupant load over 99 persons ❑Manufactured structures or
' „ , 'JOB SITE INFOR TION AND LOCATION , I e' ❑Egress/lightingplan RV p ark
Job no.: I Job site address: 7 ) ri h41 fs �� ❑Health -care facility ❑ �
I % T Submit Z sets of plans with any of the above.
City /State/ZIP: r O 4 ! k q 7 '- - A The above are not applicable to temporary construction service.
Suite/bldg./apt no.: J FEE" SCHEDULE nemtptne I Prof ect name: . / A �j. -� i�1 / �/ a ✓, 'it ` i t I Qty. I pea. I Total I ..
Cross street/directions to job site: / I 5 PL New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: vv / k f C 0 9 J( Lot no.: ‘,--‘ Ea. add'l 500 sq. ft or portion 33.40 1
Limited energy, residential 75.00 2
Tax map/parcel no.: Limited energy, non-residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90.90 2
/--L7 l✓ fro 1 't'G. qi Vkt L t/ V n. S5 e,-k. r ✓ - Services or feeders installation, alteration, and/or relocation
V c.J 200 amps or less 80.30 2
. . ['ROPERTY OWNER .I ' ❑' TENANT , . . 201 amps to 400 amps 106.85 2
Name: /� 401 amps to 600 amps 160.60 2
/ /p er, /1 0! f S5 e. WIC 5 601 amps to 1,000 amps 240.60 2
Address : q / rl 70 / z ( o _ .rn ,( - Over 1,000 amps or volts 454.65 2
`'1 / J ! 'I T/ C7tJ� 7YP Reconnect only 66.85 , 2
City/State/ZIP: t ie( le OS / i n 0(e q - o3 c Temporary services or feeders installation, alteration, and/or
Phone: (Q, Fax: ( ) l relocation
�j"" 200 amps or less 66.85 1
Owner inst anon: This installation is being 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
. ,11kAPPLICANT •I. ' ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: A1(14.4. 0.- Nei- i Zc. --ia n. (-64 }.•r.,. r i- Qcrc,4, branch circuit
B. Fee for branch circuits
Contact name: se r. j Mtn c. k 4 O v. without service or feeder fee,
46.85 2
each branch circuit
Address: ' 30 SE S4j te ` C+ Each add'l branch circuit 6.65 2
City/State/ZIP: M iscellaneous service or feeder not included
ry fi c� CA P �j I �3 (service
� `' Pump or irrigation circle 53.40 2
Phone:
(1 -,. ) �' / LI — ( y + l Fax:: (! 6 (-1 26 �s i) Sign or outline lighting 53.40 2
E - mail: / Signal circuit(s) or limited-
CONTRACTOR energy panel, alteration, or
' extension. Describe: Page 2 2
Business name: A 11 kn. K -1 iQt^) ?�o. +l d r. c-e)✓) + -
Address: -�t Each additional inspection over allowable in any of the above
S �- Per inspection 62.50
City /State/ZIP: 1+ Cr 2 e ",' � 3 Investigation per hour (1 hr min) 62.50
Phone. ( T63) 6(' �' - �, 2 11 Fax: (5.3) G K C 2 c n y Industrial plant per hour 73.75 . , • 7 EI:EI.`I'RICAL PERMIT FEES a
CCB Lic.: GM 6 y I Electrical Lic.: l Suprv. Lic.: Subtotal 154,6
Suprv. Electrician signature, required: / _ 4 eh Plan review (25% of permit fee) f,
State surcharge (8% of permit fee) .r, 00
Print name: Date: �� r op
PERMIT FEE
Authorized signature:
This permit application expires Ira permit is not obtained within 180
days after it bas been accepted as complete
Print name: ` m erry /YJton L g fm 'Date: 6- ,..) 2 — 04 • Fee methodology set by Tn- County Building Industry Service Board
•• Number of inspections per permit allowed.