Permit • •
CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I DEVELOPMENT SERVICES PERMIT #: ELR2005 - 00152
I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/13/2005
PARCEL: 2S 109DB -03600
SITE ADDRESS: 13018 SW HAZELCREST WY ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 074 JURISDICTION: UR
Project Description: Low voltage.
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: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: ALL ENCOM : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
DON MORISSETTE HOMES GENESIS HOME TECHNOLOGIES
4230 GALEWOOD ST 8104 SW NIMBUS AVE #4A
STE 100 BEAVERTON, OR 97008
LAKE OSWEGO, OR 97035
Phone: 503- 387 -7538 Phone: 503- 643 -1704
Reg #: LIC 128098
ELE 26- 989CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[UELPMT] ELR Permit 6/13/2005 $75.00
[UTAX] 8% State Surc 6/13/2005 $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: � � J Permittee Signature: - A c
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.
Jun 13 2005 10:05RM GENESIS HOME TECHNOLOGIES 5036433300 p.2
E1ectriea1 Permit ,App1a C l so . . I.(,IS (Irl,lc • l i�l.,'i1r.1
City of Tigard o Y 4 -J' •,l (.... J 5 o 5
No, ;
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone, 503,639.4171 Fax; 503.598.1960 J Jl\ 3 2� '7r' "Y� °ii1 }'M I �' Date/13y: other Permit:
Inspection Line; 503.639,41 75 -s. '� �� Date Ready/By: m 5d See Page 2 For
Internet: ww�v_oi.tigard,or.us . F r A a Notlfled/Method; I /� Supplameatat information
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t NeW construction ❑ A. dition arteration /replacement Please check all that apply:
❑ Servioe over225 amps, comm'l ❑Hazardous location
❑ D ❑O
"v "1 n v°s Demolition
Y'',t ",,i° Y i, u r 5. ar etc �taevOt Other
.,rt„ ^asst ryan tiKmnsaagr pqm o .Ir�nt' 'a F . saf s +i1„, ❑Service over 320 amps - rating ❑Buildngover 10,000 sq, ft.,
y + a '¢�' s 4, t + ,� r t� r i ry a s•• � s � n a a • r.. " i IM,f} tiiik.
le3 .or M # oft - end 2- family "'Hine' 4 or more new residential
� f a 7 y dwelling tfx7Su'a' uCommercial/industrial n.Sn, w. A .f atf.,fl.kfLr t.,,, ,lfi.
„f. - r ” "z, -, 4,,41',1:i �,
y ❑ ❑ Accessory building °System over 600 volts nominal units in one structure
❑ Multi- t�lttily ❑ Master builder ❑ C °Occupant load over 99 persons El Manufactured structures oI
Other:
['Building over three stories I�Feedets, 400 amps or more
�� +: 14 "' multi h m ;}S,fS 'A � .8d>1u {�mm�rU mnut�lsr u Master bui l F U i >r,� l} ��uunt��{{n n a'�+r In r: �.,rs }.�
i � li,'L'' ' "1` < i,a . a YYY , r + l< a su, i s, ; p, a" c }t P ° , . t iiimtuiti. I f 1ri ss I
I�B ress/li n Ian RV park
l! 1 a, If t' f ' " ails f'xI t rL,1.:/hnl, „N" i h�,1 � " �dt�5s1r7X•'r)1ki�a "T fiii . re r� s riFi a YI f f k '' .: it bt>1"t- t".-1 g Sh ti g P
❑Health -care facility ['Other.
Job no.: Job site address; ID/ y , -.` — .— • , Submit sets of plans with any of the above.
//
'fog et � P� OA Th e above are no applicable to tempo construction service
City/State/ZIP: PP P
rrr r, t t 't �,yr ., 115 ;t YA' b •wt�. /rti ��. i tr n ni Tl"rT'
. If ' ' ..� T �� G m a "l l l'4i�h Y' �' ;° i'!ir}
Suite/bldg./apt no.: I Project name: il A: �,� „t�a,,,x.� tt xlraf 1,,..l.: 4 ,�,.l.Ylr t,.ln,
Deeorlption Qty. Fee. Total ”
Cross street/directions to job site: New residential single- or muld - family dwelling unit.
Includes attached garage.
1,000 sq, ft, or less 145,15 4
Subdivision: . - .,nrm 2 ' e Lot no.: #7 4/ Ea. add'i 500 sq, ft. or portion 33.40 1
Limited energy, residential 75.00 75 °J 2
Tax map/parcel no
r�8 4 4 s 7 t !r " 1Y, 11 "r aw.;e uusYt w3 +4 a h`"�rr µ r do n •1 a �,1a Limited energy, non - residential 75.00 2
al i 0 tq yn 1 s O. 1 1 r e 9 Y , a Gd Y i' '' x d ) 31 tb K 7 1 , 1 ; , r , 1}• t v�+
i< 1 ' Y d45�t{S I R P:d'� a 'a12 ;; .::: 1:gm.Muv s rA.,,,,....4s, ».,;,AiIx xI TC4S >s,,,,' .'.,5
� .,,., R ,..
dm . Stn• ienY:'d :aw..o�tl'uaE1,'p.b;}rY'H, Each manufactured or modular
// / dwelling, service and /or feeder 90.90 2
// r�weoe'0 I - - ■ •• Services or feeders installation, alteration, and /or relocation
J � r /. D 200 amps or let's 80.30 2
v n 1i h `ft + v �'s�l npreu {a f7 r +' 1 °k'w " 3 r! r ∎0.0 S nY rsai rap'raa + t, y 7 ' r I '0 201 amps to 400 amps 106.85 2
,::US t. � d m' Yix : ,i , .,," h ;� lF (� ,' a . r , ,, fal f l i t /q::
1..,1. 1u,,, t,.,t�,kaae - .,�i2m+t'i.nlxou shit s_ is 1(4�t + : . , / 40i amps to 600 alttps 160.60 2
Name: Q � d S S to 7"'rt� /hill a �, 601 amps to 1,000 amps , 240.60 2 ,
Address: 6zie a o d fP & #, .J _44 /Q e Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
'4 ei._
City/State /ZIP: L� S t�j O ®.� & 6 .- Temporary services or feeders installation, alteration, and/or
n � relocation
Phone: (SW) j 7 .. 7 J 0 I 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 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
"�
1 "� °i ppii' k p 11� i 1: ,� ' 1 g s i: ` M ' r v ?S?A��� .0 ra aavaa�ag�ux ', A. Fee for branch clroults with
f., 10,1,SS , .:N�7.,w„m,,,,,, 4.,t, ,1 dubo.h�} 4i,p,,0444 454 1,A m i+2 +z+Y^hwYtt , m.v... r.i+: sS k 7i service or foedcr fee, each
Business name: branch circuit 6,63 _ 2
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46,85 2
Address: Each edd'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not Included)
Phone: ( ) Fax: : ( ) Pump or irrigation circle 53.40 2
Sign or outline llgbting 53.40 2
E-mail:
p m Y,,������ ��� 41 �S p aa��j�J �,{; Signal circuits) or limited -
us'�N."r1q.S �•aiiG'iYhel ii'�y tAX�UU"�xRi"t/"ttltN �� 1 ' LZZ �� ,�uun,m t, l �'" ":stivl,d'tt� ' A 7.Va�r , , .. .�,�'ti'� , i n, ar
„1 a f vi ,�t�., +ta aktas� Iv,1�, +5 i t.! „Y,tt,su « �fu� 4 anal° Panel ' 'iteratio extension. Describe: Page 2 2
Business name;
Address:, �_ - Each additional Inspection over allowable In any of the above
- - ---
Per Inspection 62.50
City/ GENESIS HOME TECHNOLOGIES Investigation per hour (1 in min) 62.50
8104 SW Nimbus Ave. #4A Beaverton, OR 97008 Industrial plant .er hour 73,75
Phan Phn- 503 43 -1704 Fax - 503- 843 -3300 ''dirt sx,; ' ik III V ..w�sv; a. �r; °, 4� . ,..., s , ... aim'' .,I' ns, 1 PA
CCB . �` - 101, . •+r , COB 128098, CLE2B -989, Subtotal 75— f9
Supr V 2885 -JLE Plan review (25% of permit fee)
State surcharge (8% of permit fee) ° — d -
Print name: ... wi 4 p 7 4_ Date: a. ,,,,,,-
TOTAL PERMIT FEE B( °
Authorized signature: This permit spplicetion ex pires if a permit is clot obtained within 180
- days after ai has been accepted elf complete
Print name: Date: • Fee methodology set by Tel- County Building Industry Sorvica Hoard
• Number of iaspeetione per permit ;Rowed.
I ;tBuddiegwermitemr- Permltkppdoe 12/03 440 -46 t3T(I0/02/COM(W813