Permit IN .. CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00103
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/20/2007
PARCEL: 1 S134DB -11600
SITE ADDRESS: 11053 SW BRENDEN LN ZONING: R - 4.5
SUBDIVISION: DAKOTA GLEN LOT: 018 JURISDICTION: TIG
PROJECT: DAKOTA GLEN
Project Description: 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: LL ENCOMP : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: :
TOTAL # OF SYSTEMS:
Owner: Contractor:
DON MORISSETTE HOMES, INC ALL WEATHERIZATION
4230 GALEWOOD ST., STE 100 3030 SE 59TH
LAKE OSWEGO, OR 97035 HILLSBORO, OR 97123
Phone: 503- 387 -7538 Contact #: PRI 503- 649 -6542
FAX 503- 649 -2680
Reg #: L1C 46969
FEES
Description Date Amount
[ELPRMT] ELR Permit 4/20/2007 $75.00
[TAX] 8% State Surcha 4/20/2007 $6.00 REQUIRED ITEMS AND REPORTS
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 .0 to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -00 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: �C.t�t - Permittee Signature: 1
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.
:
CEWE
Electrical Permit Applicatio IOiz. OFFICE USE ONLY
City of Tigard � APR ! 't:);
13125 SW Hall Blvd,, Tigard, OR 97223 r Permit 51 �1 2 1 ' t ?
Phone: 503.639.4171 Fax: 503 CITY '4n 4'; * O Date/By: eW ' v✓
Inspection Line: 503,639.4175 A � �� Other Permit:
Internet: www cl tlgard or us BUIL r � J„
- Date Ready /By: ' P Juris: g
111ottfied S See Page 2 for
Ig Supplemental 1,17f77,671—.
�, uc/S + end*' �����..; S�,FtF �c��S�L v, ,. *' ,£ ra /Method y..
>�28 -• •`� f �,Y�,��' .�I�4 a'? ,...r...aa 7i ��t 1 '. (i l �'S � . E xr. . f , ; `F,� ii c�' � { 1 �fi � • � . x ' . (" : ° gy m n te: " upples .
r „.a .. ,a::� I,....v.x,i a ?.- .x.+,`1'„� :tau sh:F kr'i i ,!r'164 t „c � .?• t•.d4.. 5`” `.iz i ,, ti i:� a.-��77 ' ... ` T, , ?;+. `� "'�V!: :a tb ';' .� }: y .,
:..,rx.. '�.�R:'fi..s ". �..,d�,.u.:,i. ..t.s: x�� X��,ynz.a��,.; , �75 '#.,, % r :Y:aK. d��"':���'�'wt }�'.,6 X51 �r' �kR'?S�E��`.;';�`�s�nF,4�'�
(I New construction` ❑ Addition / alteration /replacement Please check all that apply:
OService over 225 amps, comm'l ❑Hazardous location
❑ Demolition di' ❑Other:
i
sy'' nr (r t i�+ �`i fr t3S r a t ik i i t i.. - z'd `" S'� a:.
{p q �i � aili t � � ❑Service over amps rating ❑r more over 10,000
"` "'" ��p'` "= tis `�� °� � sb� =;��t,�� `��� .� ..1.3.1. �..�� ��,?r ���"�t�€�� r���;�,� �r���+ of 1- and 2-family dwellings 4 or 4 or more new residential
al l
J 1 - and 2- family dwelling ❑ Commercial /i dustrial ❑ Accesso building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑ Master builde ❑ Other ['Building over three stories ❑Feeders, 400 amps or more
' 'it t I r� � fi ❑Occu ant load over 99 persons Manufactured structures or
` r� y m t<Sr i ri , :' 1l
31' a$,>??,a,, `, i Ii�tiS`t..k'i >�t y ∎ 1,t . Z xI # t` , DEgress/lighting plan p ORVpark
a �, f�',''�tF �x�s._ ux�, ,+�a�, i ...�.,..a,� F sr�...d � 2�$'i. i
� �� �.� . �.,.a..,:,a v
Job no.: . i514 - „, Job .ite address: 1 i , I ❑Health -care facility ❑Other:
t. ff/h�+n. Submit 2 sets of plans with any of the above.
City/State/ZIP: /1::, T he above are not licable to temporary �� � app p ary consWdton service.
Suite /bldg, /apt. no I Project name: F3 ¢oYRf Ilia;
Description Qty. Fee. Total
Cross street/directionsf,to job s te: L7 (Co 5,1- New residential single- or multi - family dwelling unit.
Includes attached garage. •
1,000 sq. ft. or less 145.15 4
�
�� f� (1-4,j �t , :�f of no.:
/ h
Ea. add': 500 sq, ft. or portion 33.40 1
Subdivision:
Tax map /parcel no.: • Limited energy, residential / 75.00 7S 2
tit t4r�� r > F,� + r avoy� Limited energy, non - residential 75.00 2
•t t� c an , �, .. , a < „a _a Each manufactured or modular
(`C nTA dwelling, service and/or feeder _ 90.90 2
' , �� S ervices or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
Jr�n� Y.d , r b � a�yf1 ?�re� xr '��� v , ; , x , > air � as " M gg r' s, 201 amps to 400 amps 106,85 2
gii aa's ...r,,..i..@f2�s ... +5... ,.r i�.-:�eVr�F..,r+a .'2 x ..,, §Si, �4a }'fir 4 >sf ,.`,Ur» I ,.<.. � mot' �a�d�°,�:?
401 amps to 600 amps 160.60 2
Name: ,
i4.. • t rii" l e c• 601 amps to 1,000 amps 240.60 2
Address: 4 Z 3 i - h e 4 , ,,,t,/ .. a Sd- i Over 1,000 amps or volts 454.65 2
City/State/ZIP:
Ike_ .0,.. W e y
q7° � .. Temporary Reconnect only 66,85 2
services or feeders installation, alteration, and /or
Phone: ( ^ ' � Li relocation
r i �a j ) � A� 3 F: x: (sd3 ) g.7 ��f / 200 amps or less 66.55 1
Owner installation: This installation is being m: de on property that I o; n which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, o exchange, accor• ing to ORS 447, 449, • 0, and 701.
401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
�!i � "A ;����' �, tul k #� s,���,�, e j, ,��i I r ,t�,.,�ax a . 'v fan .{sift ,� A, Fee for bra t r r Il p
� ' � & : 3 ) x ?.' ... �S r as ,:cis w s , (v Oats Il5P u t� I �) a , 0 _1 nch rcuits wu
` "' "'` " ' ""' service or feed ci er fee eac h
Business name: rL - �1/c 6.65 2
A +He i �; z'-‘0A F tvc branch circuit
Contact name: B. Fee for branch circuits
I O n G IA F t' r without service or feeder fee,
J first branch circuit 46.85 2
Address: ` i,
d , 'r 5 ` s.- t" a' I Each add'I branch circuit 6.65 2
City /State /ZIP: • �j,, I_' 6
r l ` O U o . q , � Miscellaneous (service or feeder not included)
Phone: ( ) i F Pump or irrigation circle 53.40 2
Sign or outline lighting 53,40 2
E-mail: Signal circuit(s) or limited-
I.. ,flifie - `\�t y ;:i4tta�{' y ' `fk s � (ts i t i 1 ai,:, 4 ; era3� a rf w '� , i �frtlf r r 2 rq ,. , i
,�,�„�.c�. �� �y���r.�;�«N<�,., - :..;.�,.�..,. 1
.��.,� ,. .. �s��ti ;, �s.��.�, �+��.,� �F�r�rr, r���� \, ,:�� +'�� energy panel, alteration, or
extension. Describe: Page 2 2
Business name:
,vl iv' wilici, izei , osn Ooh ti_ T 4. .
Address: S Each additional inspection over allowable in any of the above
6 54 Per inspection 62.50
City/State /ZIP: I i S 6 0 e per hour (I hr min 62,50
T � "r / 3 Investigation g P
Phone: ( 513 ) doy 41 I e I F ' : (rj -.3) 6C l f 6&0 1 d usvtal t `h ll.1 € "it „, + \ _�l� t.. 3',1 ,,,`,- „ „ , ,,„
6 611
CCB Lic.: ! lectrical Lic.: I Suprv. Li, .:
// Subtotal r15
5
Suprv. Electrician signature, re, uired: I Plan review (25% of permit fee) o re
Print name: � State surcharge (8% of permit fee) C
�C 4 // JA Ll” . IU , d i ,Date: / TOTAL PERMIT FEE 60
Authorized signature: :.' , � � " •� 1 /1
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: 1 Date: i • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
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