Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
.. DEVELOPMENT SERVICES PERMIT #: ELR2005
,04 DATE ISSUED: 4/20/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2 S 109 D B -03700
SITE ADDRESS: 12996 SW HAZELCREST WY ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 075 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 HOMES ALL WEATHERIZATION
4230 GALEWOOD ST 3030 SE 59TH
STE 100
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HILLSBORO, OR 97123
LAKE OSWEGO, OR 97035
Phone: 503- 387 -7538 Phone: 503 -64 -6542
Reg #: LIC 46969
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 4/20/2005
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$75.00
[TAX] 8% State Surcha 4/20/2005 $6.00
Total $81.00
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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: D Vp Permittee Signature: t �
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.
04/ ',0/2005 08: 46 FAX 'ZOO 3/00 7
. . - • . - •• .
A . .
E 1 ztrical Permit A.
t ',• 1 lication . - FOR OFFICE USE ONLY
13125 SW Hall gar BlvdTieard OR 97_23
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C'i,y of TId
Rece,,ed i )..).- p ...... _,
Date y - /-,........, Perm it No.: alz
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Plan Review
P AFR hone: 503.639.4171 Fax 503.598.1960 .ft
20 205 iii: Pe'. Date:By: _.1 0111a Permit:
Inspection Line: 503.639.4175 i ,-i Date fteady
Internet: WWW. C i.tieard.or.us NotifiedAlcthod. j r) 6 .-- S 2 See Png
etneit 2 f
tal Information
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'# 1° ' ' ' ' '' :; • Y-:-', - -% . :- . ; -.:; -i!•i;,ll 'i gli.:;:111.': 1 0 1 1' . : . ..:t :;:..
Eg 'New construction El t i l t " i;' b erLonli : eplacement - Please check all that apply:
pService over 225 amps, corrn'l [Mazardons location
0 Demolition E Other:
['Service over 320 amps - rating ICIBuildng over 10,000 sq. ft .
5:. ig ' Vi . :T; '' ;titi ' :" : a.. i .t ' 44.:V.P4,00, 1 0f 11 0FAPOqgf,:fO ; iON,W9,!',; , .MV111;;M;':iM.:„ . : , ,'&'o':,:' - :.;' , of 1- and 2-family dwellings 4 or more new residential
ci 1 and / dwelling 0 Commercial/industrial 0 Accessory building 0Systern over 600 volts nominal units in one structure
['Building , over three stories DFeeders, 400 amps or more
El Multi-family 0 Master builder E Other:
pOccupant load over 99 persons OManufactured structures or
: foRAMme4. DEgress/lighting plan RV park
01-care -care facilit} 00ther
Job no.: Job site address: ,..' ,:.' .: ';', [4, :::,-,, ; -L : -,,...t..
Submit 2 sets of plans with any of the above.
City/State/ZIP:
'71 '• / ' „•%, The above are not applicable to temporary construction service.
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Suite/bIdglapt. no Project name: .= ; ..t•il. 1 f'-' 40. .....................................
Description 1 Qty. I Fee, I Total
Cross street/directions to job site: New residential single- or multi-family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: 4 -,;„ .. „ .., .::'' ...-.. . Lot no.: - 7 r: Ea. add'! 500 sq. ft. or portion 33.40 1 ,
Limited enerv. residential 75.00 ( 2
Tax map/parcel no.:
Limited enerT, non-residential 75.00 /
V.it0 Each manufactured or modular - -
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dwelling. service and/or feeder 90.90 2
.,
_ Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
; :,!%wii : o . g114.,wd.ivpo l a. fi -B; : g , 201 amps to 400 amps 106.85 1
401 amps to 600 amps 160.60 2
Name:
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP:
Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) 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
- 0 iiiO440.3Tei.:iq;;'NV1a3.: ! 411 A. Fee for branch .circuits lytin
service or feeder fee. each
6.65
Business name: .i i.,' , : !H., •, - .... . I,. branch circuit
,:•.- : •.•,. ', , ,.• .- , ,:.. ' Iti : 'i i
B. Fee for branch circuits
Contact name:
without service or feeder fit.
46.
ress: 85
Add 7
each branch circuit
-• • Eactraddl branch circuit 6.65 2
... ...,
City/State/ZIP: .-.-) • - ' - .-. - . :
.., -.:•'
....: ..... .„ ; . ,. ., Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 '
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Phone: (.. i ) L., t.. . , - Fax: : ( ) 4 ' :,,'. (....... Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
:1-;:!:',':, : ;.-'ji.''i ; ':. n :11: P• 77:77 r 0 .0. 1 44:00 - Z'i' -1 ;Va . lillVig:A:Pi';!;-:::i: - ;1q:1Vq:;;':) . :: ener P anel ' alterati°11 or
extension. Describe: Page 2 2
. . .
Business name: ,
Address: a., 2, . Each additional inspection over allowable in any of the above
, :, ,,:,:,: ..:, '-' C i-
) , ; ;:i ., c
Per inspection 62.50
City/State/ZIP: r - ,'...., ,, --- ,--..,.•, .1: .:1 . Investigation per hour 0 hr min J 62.50
Industrial plant per hour 73.75
Phone: ( -.:,;') ) ,,-. ...: . -, t :? Fax: ( , ....,,l/ .".;' ) t ' .. ,-:. i-1 ,:.;, .,,-:', i ',,;,, '''-:::..
'
CCB Lic.: ' • ..:- - e Electrical Lie.: Suprv. Lie.: 1 , 1 , Subtotal
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of pennit fee)
Print name: . 1.,./ - -1‘„,• --... '
'-' . • : 5 !. - • , - v• -: ',,.":1;:,•,.... - - . f
• 4- TOTAL PERMIT FEE -.,.s f
. ,1 -....,.......„--
Authorized signature:
This permit application expires if a permit is not obtained within Isu
clays after it has been accepted as complete
Print name: . Date: . Fee methodology set by Tli Building Industry Service Board
" Number of inspections per pennit allou ed.
i 03uildin5WermitAEL.C-Pern-atApp doe 1.1 440-4615T( 10;02COM E 0
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005 -00094
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/20/2005'
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 ;
INSPECTION WORKSHEET FOR DATE: 6/10/2005 TIME: 7:05AM PAGE: 80
SITE ADDRESS: 12996 SW HAZELCREST WY CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 075 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Vacuum system.
OWNER: DON MORISSETTE HOMES, PHONE #: 503- 387 -7538
CONTRACTOR: ALL VVEATHERIZATION PHONE #: 503 -64 -6542
Inspection Request Scheduled For: Date: 6/10/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 008966 -01 603- 209.4837 N
Corrections /Comments /Instructions: -
►z e o��- � 4 C - g
e r -k-
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PASS IN PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL rA C.' FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: . _ Date: v � Phone #: (503) 718 -