Permit N CITY OF T I G A R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
Y
lf l& DEVELOPMENT H BMENT Tigard. SERVICES 639 -4171 DATE ISSUED: 3 -00063
- 13125 ED: 2(26/03
SITE ADDRESS: 13775 SW 124TH AVE PARCEL: 2S103CC -06300
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 010 JURISDICTION: TIG
Project Description: Alarm Installation /Low voltage
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: X AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: X BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: X CLOCK: MEDICAL:
HVAC: X DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: X FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: ALL ENCOMP : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
DON MORISSETTE HOMES BRINKS HOME SECURITY
4230 GALEWOOD ST 8080 SW CIRRUS DR
STE 100 BEAVERTON, OR 97008
LAKE OSWEGO, OR 97035
Phone: 503- 387 -7538 Phone: 503- 387 -7538
Reg #: MET-6410M01924
SIR- 0574274LEA
LIC 44421
FEES ELE ROSiiianspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 2/26/03 $75.00 Elect'I Final
[TAX] 8% State Tax 2/26/03 $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 r -/ ( (;( )( 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
• Electrical Permit Application OFFICE USE ONLY
Date received:: -Q') Permit no j / p 3 —(29eL 3
`i'P City of Tigard Pro ect/a 1 no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 - 4171
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
7/..1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition /alteration /replacement 0 Other: ❑ Partial
JOB SITE INFOIZNI VI ION
Job address: /II r)3 ,j) la,(..4-i-k. 11 1)e.-- Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name: I Description and location of work on premises: Lo uD R A- t, -54 ik--i;
Estimated date of completion/inspection: `
CON'I RACTOR : 1PI'LICATION FEE SCHEDULE
Job no: J (0 Fee Max
`r ( Description Qty. (ea.) Total no. insp
Business name: in ��j yn� s�l�t New residential - single or multi - family per
Address: , g0 go .51Z h l , ;, •rr S ...Dr • dwellingunit . Include s attached garage.
City: j t oq jt I Statenk I ZIP: gvipflg Serviceincluded:
Phone `/ r d , , , Fax., ,.. a,,,, E -mail: 1000 sq. ft. or less 4
CCB no.: A _ Elec. bu s. lic. no: y - Each additional 500 sq, ft. or portion thereof
it fry "�' //�� Limited energy, residential 1 15 15 2
C /metro lic. no.: _ P ) in_ -0 Limited energy, non - residential 2
c=:?;:25- Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date ,, . .0s ► Service and/or feeder 2
Sup. elect. name (print - ,,, d JL„ tu t- .W License no: .� Services or feeders— installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
Mailing address: 401 amps to 600 amps 2
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 services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E -mail: of service or feeder fee, first branch circuit: 2
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service orfeedernotincluded):
❑ 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 more 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 structures or RV park Each additional inspection over the allowable in any of the above:
0 Egress/lighting plan 0 Other: Per inspection I 1
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ 5• t7C)
0 Visa 0 MasterCard expires if a permit is not obtained Plan review (at %) $
Credit card number: I / within 180 days after it has been State surcharge (8 %) $ (o.00
Expires accepted as complete. TOTAL $ Si' I • AD
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6/00 /COM)