Permit CITY T I GA R D ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 - 00087
�' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/14/2005
PARCEL: 2S 109DB -03700
SITE ADDRESS: 12996 SW HAZELCREST WY ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 075 JURISDICTION: TIG
Project Description:
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: X 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: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
DON MORISSETTE HOMES QUADRANT SECURITY INC
4230 GALEWOOD ST PO BOX 14833
STE 100 PORTLAND, OR 97293
LAKE OSWEGO, OR 97035
Phone: 503- 387 -7538 Phone: 503- 234 -5558
Reg #: SUP 121 1JLE
LIE 96806
FEES ELE 26- 565CLE
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 4/14/2005 $75.00
[TAX] 8% State Surcha 4/14/2005 $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: �'nLG Permittee Signature:
OWNER INSTALLATION ONLY \\ v
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.
' •
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A ofT] and ReCtlivtld PermitNo.: dd0 7
13125 SW Flat Blvd., Tigard, OR 97223 1 2005 Plan i w Rev /y J
Phone: 501639.4171 Fax: 503596,1960 ��� "'•'8' } °riV I" • Dale/Of
Other Permit
Y� 'd L Dace Re
Inspection Line: 503.639 -4175 d inye kids: r� ufuF go. Poo 2
Internet: www.ci,tigurd,or.us OtTY OF TIGAR �" NotNotified/Method; 1 U I 10 go. I for
inarluu
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New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Service over 225 amps, comm l ❑I•lueardous location
El olition ❑peace:
i7`ti' fn : �pa+tr. mr,-�MSe�,r..r.: a rv �rvr��fw:,rr..e..�:ru =nu• � r , . �,. q l� r•.,.: ; �w +?���
❑Service over 320 amps -•- rating ❑ Buildng over 10,000 sq. fl
54,: +.�: 'f+ 1,4t ,. s 1',rEbi. •y ` f K^ y1�^ �.: il , ') i ",: :: : of I- and 2-family dwellings A °..A a,:�.c:1 ?.::.;t, 4.,,:s � •' � .'�i;r Y Sa 4 or more new residential
1- and 2- family dwelling D Commercial/industrial ❑ Accessory building ❑Syattxn over 600 volts nominal units in one structure
Multi -famil Mager builder 0 Other: ['Building over three stories ❑1teeders. 400 amps or mot
1:1 y ['Occupant load over 99 persons ['Manufactured structures C
~s: `.: �0.' ,„ 'r.4. a ? ' a ' .0 y 1 o `h►], j " 4 ;/�4 > ';":.� e rr.: ! �M t H ress/li tin RV perk
.�: . � :. �'., ��:... �' �•.� ��1�� �'. �.. .. , �� ; :: �� . ��.�::.:. . �. ❑ s s� i s p len
job no.: �� Q („ I Job site address: I QS' {.*c \Csr ❑Floaltlt -cars facility ❑D 01 ' -
� tin' Submit 2 seta of plans with any of the above,
Ci ry " /State /ZIP- - c - 9 ,> The above are nut applicable to temporary construction service.
fl C l 1 C� am. �� ! 1 +�� / ' 4/111511g1 - +,!' 8''116^ .11:. 1}':''
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Suite/bldg. /apt. no.: Project name [V C ">(1 1 e - J<t ... b s ' " rialloa Qty. FAO q `N' Total
•
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
- - Includes attached garage.
1,000 eq. R or less 145.15
Subdivision: ` o 61 i . , -- / A Lot no.: 75 Ea. rind 1500 sq. ft, or portion 33.4U
-� Limited energy, residential 75,00 75.00
Tax map /parcel no. Limited energy, non - residential 75.00
r '!: +,uriI SINI -NBitel 11ifigu t N. :00i±kG 40M g Each manufactured or modular
dwellintl r service and/or feeder 90.90
� A ) �- `' Services or feeders installation, alteration, and/or rclueittion
200 amps or less 80.30
., •. ,, rvr;. :r w aa.x� .rN la t�`tii Y x, ° "c•• -"`( � f ' . t ,( - •••1 it 201 amps to 400 amps 106.85
,w ' t , ; r.-
; " - 44 ,, , . , R' . : . _ , ai!p n•Vd,a._ssxgial
401 amps to 600 amps 160,60
Name: \\,-\� e 1 s',, ? --Q,.. 601 amps 10 1,000 amps 240.60
Address: Over 1,000 amps or volts 454.65
RecoMOctonly 66.85
City/State/ZIP: Temporary services or feeders installation. alteration, and/or
relocation
Phone: ( ) F ax: ( )
200 amps or less 66.85
Owner installation; This installation it:•being made on property that I own which is not 201 amps to 400 amps 100.30
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
0% • r �, �� •; �y ....
S , • ;J -*' ' •' sett 'r. : ar r.•� `o'f''+ A, Fee for branch circuits with
- .+..., ... .5° �f4gsald'r .yt ,t- • ^• '°ire- ..-.3''`a.A4 ;. , u 'F y i.- R! ".. k.11.., !�i'i4217,,;+1. Z: � • service or feeder fee, each 6.65
Business name: branch circuit
.. - B. Foc for branch circuits
Contact name: without service or fender fee,
each branch circuit 46.85
Address: Each add! branch circuit 6.65 I
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax: ) Pump or irrigation circle 53.40
Sign or outline lighting 53.40
E -mail: Signal circuit(s) ur limited-
W r.,, a i,. :•:s" r " • 7a�;�'e�`,�Mr�' �;� ��?3'J6 �f�` ",�; x ,,,`1(ltwc+,•,.'�"'�,, Y' energy Panel, alteration, or •
Business name a extension. Describe: Page 2
) . c'1..'�: L ' , a t e
Address: � C - J c. .) • X15( Each additional inspection over allowable hi any of the above
Per inspection 62.50
City /State/ZIP: PC (
ti 0 C� 1 Investigation per hoot (1 hr min) 62 -50
Phone: L Fax: c, Industrial plant per hour 73.75
CCB Lie.: CAI Electrical Lie - :' it _c• x ,s (02 Suprv. Lic.: ). 1 Lt -r subtotal 75
Suprv. Electrician signature, required //, a d ` , .(1 i:--�___ -___„ Plan review (25% of permit fee)
Print name 7:77' �, y ` Date: / `� , State surcharge (8%s of permit fee) (Q
t � _y �! � \ 1 Ems' .!^ � � V � TOTAL PERMIT FEE . 1
Authorized signature: y p -r p i (VIN.,? Q /� 9/ TM* permit application expires it a permit is not obtained whirls 180
1 l+� . days after It bag Non accepted am complete • Print name: 1 '- , - Date: ■ •� Fee methodology am by TO-County Building industry Service Hoard
Number of luepectlous ter oernilt allowed.
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