Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
1 DEVELOPMENT SERVICES PERMIT #: ELR2004 -00080
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/26/04
DRESS: 10022 SW 70TH PL
PARCEL: 1S136AA-08900
1 : DIVISION: VENTURA ESTATES ZONING: R -4.5
BLOCK: LOT: 011 JURISDICTION: TIG
Project Description: Security, audio and structured wiring
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: X AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: X 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:
WINGATE CORP. GENESIS HOME TECHNOLOGIES
15840 S. POPE LANE. 8219 SW CIRRUS DR. #17D
OREGON CITY, OR 97045 BEAVERTON, OR 97008
Phone: 503- 657 -3300 Phone: 503- 657 -3300
Reg #: L503- 6431 0 8
ELE 26- 989CLE
FEES Required Inspections
Description Date Amount Ceiling Cover
[ELPRMT] ELR Permit 3/26/04 $75.00 Wall Cover
Elect'I Final
[TAX] 8% State Surchart 3/26/04 $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 throuc
Issued by .-- , -/11�ry� Permittee Signature
// 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
`
/
Mar 26 04 11:OOa GENESIS HOME TECH 503 - 643 -3300 p.2
• ITN S r —' ,,s
r USONLY Electrical Permit Application OFFICE USE R EC IL' V J L Datc received: Permit no ,�ii� pt1D F'()
h � t ,. i % f C ity of Tigard v IL...._ �/ L•- Project/appl. no.: Expirc date:
City of Tigard Address: 13125 SW Hall Blvd. Tina OR .Q 3 Datc issued: By: I Receipt no.:
Phone: (503) 639 -4171 MAN (uJ
Fax: (503) 598 - 1960 Case file no.: Paymcnt type:
CITY OF TIGARD
Land use approval: BUILDING DIVISION
TYPE OF PERMIT
1 & 2 family dwelling or accessory 0 Commercial /industrial 0 Multi-family 0 Tenant improvement
0 New construction 0 Addition /alteration/replacement 0 Other: 0 Partial
JOB SITE I `'f OHAIA'1'ION
Job address: 1,7oz.•2_ SW 0.01 P(x-i — ri .r,d, Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: (Block: Subdivision: J
Project name: I Description and location of work on premises: ill - < ' i - �61t ' L� )
Estimated date of completion /inspection: 31-r re << tArtr 1 MG
CONTRACTOR APPLICATION FEE SCIIEDULE
Job no: Fee Max
Business name: Ct4494 tS ROD AL lit 1,1fraipA;.� Description Qty. (ca.) Total no.insp
15/ 1 a New residential - single or multi-family per
Address: \py �l� j'm`jL 4 • 'r4\Q 41 4 dweRinguniLlocladesattachedgange.
City: 1 ! r, \ I State: a e.I ZIP: q—I)(2 Serriceioduded:
Phone: ( 1104 I Fax: 1.1,3 - WiC# E -mail: 1000 sq. ft. or less 4
CCB no.: g .� 0q%, j Elec. bus. lic. no: a& -( C9 C/-6 Each additional 500 sq. 0. or portion thereof
Limited energy, residential 1 7S 7S 2
City /metro lic. no.: Limited energy, non - residential 2
Each manufactured home or modular dwelling
Signatu e ect ire.) Date Service and/or feeder 2
Sup. e . name (print): jr a ' + 2 License no: Servicesor inalallatioa,
alteration or relocation:
PROPERTY' OWNER 200 amps or less 2
Name (print): t 11c, 12 - �P. CI , 1 i , UIVLQ 201 amps to 400 amps 2
�. 2
Mailing ddress: 401 amps to 600 amps
g 3 ' . 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property i own Temporary servicesorfcedcn
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or Iess 2
201 amps to 400 amps 2
Owner's signature: Date: 401.to 600 am.s 2
ENGINEER Branch circuits - new, allegation,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: scrvicc or feeder fce, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E -mail' of scrvicc or feeder fee, first branch circuit 2
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Ml sc . (Service or feeder not included):
0 Service over 225 amps - commercial 0 Health-care facility Each pump or irrigation circle 2
0 Service over 320 amps- rating of 1 &2 0 Hazardous location Each sign or outline lighting • 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
0 System over 600 volts nominal mote residential units in one structure alteration, or extension* 2
0 Building over three stories 0 Feeders, 400 amps or more •Description:
0 Occupant load over 99 persons 0 Manufactured struct” or RV park Each additional inspection over the allowable in any of the above:
0 Egress/lighting plan 0 Othe -• Per inspection I I I j
Submit sets of plans ' Investigation fce
The abo ervice. Other
Not alt iu' Notice: This permit application Permit fee $ — 75% 00
visa • expires if a permit is not obtained Plan review (at _ %) $
within 180 days after it has been State surcharge (8 %) S (i
accepted as complete. TOTAL $ ?I. O 0
440 -46 15 (6/00/C0 M)