Permit CITY T I GARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 -00141
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/2/2005
PARCEL: 2 S 109 DA -S R2 119
SITE ADDRESS: 12996 SW BIRCH HILL LN ZONING: R -7
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT: 119 JURISDICTION: TIG
Project Description: 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 COMMUNITIES, LLC ALL WEATHERIZATION
4320 GALEWOOD ST #100 3030 SE 59TH
LAKE OSWEGO, OR 97035 HILLSBORO, OR 97123
Phone: Phone: 503 -64 -6542
Reg #: LIC 46969
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS ,
[ELPRMT] ELR Permit 6/2/2005 $75.00
[TAX] 8% State Surcha 6/2/2005 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: `� Permittee Signature: z$\)()
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 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
06/01/2005 14 : 51 FAX a 006/007
....._
Electrical PermitAmlication
REC . , 'VI- . •,
FOR OFF1C -... USE ONLY
City of Tigard ' -- - 6 1 -Toil_ Permit No.:61,1c2,X1- 06 /c//
13125 SW Hall Blvd., Tigard, OR 97223 JUt , or Plan Review
Other Permit
Phone: 503.639.4171 Fax: 503.598.1960 .. . 1 liii'•`,, LW Dtae/By
Inspection Line: 503.639.4175 A,W..77„..L Date ReadyiBy: Stair k i ei See Page 2 for
Internet: www.ci.tigard.or.us
CIT OF TIGARirredueth.1 .-1- i (1.- Supplemental Inforrnation
: ; • .• :: ...; : :..•.•• : . , . ., L . ,': .,', tyit:; '. ' i : ':':'.' • :. T : ,:'. : ::: ::::;::.., ' ':•... ' '..:,:.: ::.: likitii:* •;:•:.::. :. :
gNew construction 0 Addition/alteration/replacement Please check all that apply:
0Service over 225 amps, comni'l D Hazardous location
0 Demolition 0 Other:
0 Service over 320 amps-rating 0Buildng over 10,000 sq. ft.,
:•.•':::••••...:::::' .:.: ::.'..::-.:.•:.:: . :: : ', : 0.4400.WO:t.i0014401 ::::,•;:-.;.:..-•:::...::: ; .. of I- and 2-1.1unily dwellings 4 or more new residential
[gl - and 2-family dwelling 0 Commercial/industrial 0 Accessory building 0System over 600 volts nominal units in one struCture
El Building over three stories OFeeders, 400 amps or more
0 Multi-family El Master builder D Other:
0 Occupant load over 99 persons 0 Manufactured structures or
• •:.•:*.*:•:::.:: ::'.."'..:: :::::::. ..: ; ::: : 0Egress/lighting plan RV park
DHealth-care facility EiOther
Job no.: Job site address: - --- Ze.".: -, i), Hi it Submit 2 sets of plans with any of the above.
City/State/ZIP: e.,,,A 0 it!...
T-1,1 The above are not applicable to temporary construction service.
,•:•''::: : ,-:;,:::,:::„; 1. .... .
Suite/bldg./apt. no.: Project name:
Dereription r Q I F ' x '' I T°431 _I:"
Cross street/directions to job site: /: i 44 /-• New residential single- or multi-family dwelling unit.
Includes attached garage.
1,000 sq. ft or less 145.15 ' 4
Subdivision: i....,,.. ,/y j - ,4? , ?*,._.c Lot no.: / , / CT Ea. atid 500 sq, I or portion 33.40 1
- Limited energy, residential 75.00 2
Tax in . :' .. ap/parcel no.:
Lim erter
ited gy, non-residential 75.00 2
•:-:. - .- .:- -'• :•::. : ••
'-';•-:::. : :: .• : - - . :*: 1 0P' - *OW' : :::; .f. : l'' ..,-.. -:' :': ::': : :- •.: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
C_C vi lAi' I \ ,/ :/'" : 1-,
. Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
:::, ...• ::.-: • :;. f '?..:' •:'....::,:': :;:• . :,,: 201 amps to 400 amps 106.85 _ 2
401 amps to 600 amps 160.60 2
_
Name: ,..../2 i < : HI_ 601 amps to 1,000 amps 240.60 2
Address:
Over 1,000 snips or volts 454.65 2
Reconnect only 66.25 2
City/State/LIP: 1 , k / ).e.,,,,, . " :, ii , ',; ,..e. Temporary services or feeders installation, alteration, arid/or
J relocation
Phone: ( ) 3 87 74 3 . Fax: ( )
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 runps 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 -stew, alteration, or extension, per panel
,:.:. :...-:.:.:::..:,-•:•:' ;:.,: .. .. - :' i .':; - . , : -' , ",p : : , , .:::',.." . '::' ...: 1- ; A. Fee for branch circuits with
service or feeder fee, each
-
Business na;;;:.74 64( kt 6. -1 e-•, tic,,,' 7 • branch circuit 6.65 2
13. Fee for branch circuits
Contact name: - . , „/4 )„ e:t h:).^. without service or feeder fee,
46,115 2
each branch circuit
Address: * -.' ;?)<_;' : l . Z71/ (- - Each atid'I branch circuit 6.65 2
City/State/ZIP:
fr///66i; Miscellaneous (service or feeder not included)
' Pump or irrigation circle 53.40 2 _
Phone: ( " ) 6 IA ' :, 4 Fax: : ( 5 ) ...,:' y /1 2 e 6,s,-.e.) Sign or outline lighting 53.40 • 2
-
E-mail:
Signal circuit(s) or limited-
- 77T: . :, :•-•.- i ' i .. - :::::-, 7 ., 0.10:woolt: ,. ,, .: . : .,.::,.:,.......- : ...-.-::::* ...-. .:, :. . .:. eenxteenrgsypnan Describe el
alteration or
io
Page 2 2
Business name: --/- 1
Address: 3 ' 1 C
r, t j .. r I _ Each additional inspection over allowable in any of the above
. 7) 2 -.6 7 i -
For inspection 62.50
City/State/ZIP: i OK Investigation per hour (1 hr min) 62.50
' r Industrial plant per hour 73.75
Phone. ( 13 (c) 6 '7 (.;:: sq c._ Fax: ( 1 7 , ) 6, z? -/ / 2 . .. . 6 -. ' .2. ; , ::; , .:. ,, :-..:statilicAL:putivarFasi:, - ,-- •
GCB Lie.: LA I 6, 1+ Electrical Lie.: Suprv. Lie.:
Subtotal
Suprv. Electrician signature, required: Plan review (25% of permit fee)
h
State surcharge (8% of permit fee)
Print name: Date: LY)
TOTAL PERMIT FEE 1
_---
Authorized situ
gnare I ---- -
This permit application expires if a permit Is not obtaathin 180
days after it bre; been accepted as cuts
Print name: ' - • ---‹ - > ,-,, ,, I Date: - - 7? ( -,, Fee methodology set by Tri-Couuty Building Industry Service Board
1 ". Number of insoections per permit allowed.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005 -00141
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/2/2005
Phone: (503) 639 -4171 A omiorelo p Il?A
Inspection Requests (24 Hrs.): (503) 639 -4175 I
INSPECTION WORKSHEET FOR DATE: 8/18/2005 TIME: 7 :06AM PAGE: 21
SITE ADDRESS: 12996 SW BIRCH HILL LN CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT #: 119 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE NO. 2
DESCRIPTION: Vacuum system.
OWNER: DON MORISSE I I E COMMUNITIES, LLC, PHONE #: •
CONTRACTOR: ALL WEATHERIZATION PHONE #: 503 -64 -6542
Inspection Request Scheduled For: Date: 9/16/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 013839 -01 503-209-4837 N
Corrections /Comments /Instructions:
•
irale
•
Vi PASS I/ 'TIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL v ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
v
Inspecto Date: Phone #: (503) 718-