Permit CITY TI GARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 -00079
•
DATE ISSUED: 4/6/2005
4, ---& 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S109D6 -02700
SITE ADDRESS: 13089 SW HAZELCREST WY ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 065 JURISDICTION: UR
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 COMMUNITES LLC ALL WEATHERIZATION
4230 GALEWOOD ST # 100 3030 SE 59TH
LAKE OSWEGO, OR 97035 HILLSBORO, OR 97123
Phone: 503- 387 -7538 Phone: 503 -64 -6542
Reg #: LIC ' 46969
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[UELPMT] ELR Permit 4/6/2005 $75.00
[UTAX] 8% State Surc 4/6/2005 $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:
.7)7 Al` Permittee Signature: ,;e
• • 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.
04/06/2005 11:00 FAX a 002 /004
:, Elly.2.tril Permit A lit t' :-.. — --- - FOR - OFFICE - USE - ONLY ONLY - - -
City R e of Tigard Dateft'ed pt � 1 �g 7
Tigard e; v Pemt No..
13125 SW H all Blvd., Tigard, OR 97223
Plan Rectet r!
Phone: 503.639.4171 Fax: 503.598.146 l 05 DateBy': 0• -emu .
Inspection Line: 503.639.4175 P 0 6 24 e! ! : ::. Data Read yrBy: ru, o See Page 2 for
Internet: www.ci.tigard.or.u; �+1 YOF T!G R "' „ Nout ledlfeth tJ� PP to mentallnfotm.mon
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Est New construction ❑ Addition/alteration: re lacement Please check l l:,r;,';< app :.;
p ck all that apply:
❑ Demolition ❑Other: ['Service over 225 amps. comm'l ❑Hazardous location
. , � ;.:...,.•:: +; _ amps rating Buildng over ft..
..
.. , . , ,
- -
-.: ,. _. , .:•,,,,: ar
;:.,.. ,,.; •;;;;,,,;,,;;,,,,;,,;,.. OService over 320 am
..•;.,,.:.:..._:.., ,., ca. rlc�, o�s�co: rsTnLCT�t�n�1: : __= ;`: 2-family,: ....:.:....:::::. �:..:.:.,:,.,:, •,,;.:,,::.:.:.::.,,,��,...,1 - , �:•:,,::,: :;.::, ..,, .,.,:....:,,:,•.;,,;,,: :•.f`•� .a..>. :,:. ,.... of 1 -and dwellings 4 or more new residential
ID 1- and 2- family dwelling ❑ ContmerciaUindustrial [] Accessory building ['System over 600 volts nominal units in one structure
❑ Building over three stories [Weeders, 400 amps or more
❑ Multi-family ❑Master builder ❑Other:
:<;:: ;,;.,, : ,,. ups
:,• :,.,..,:.; .:, l :, ._, _ ., , .::-:»; � . .. . .::..:. .:....__•,..,:.,;;:;:..::.. ..:; -. persons lredstruchtre�or
1 Oce nt load over 99 pe � ['Manufactured
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IA TtI. IAN.
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I't7 �7`�it�T�^
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Job no.: Job site address: 7. ❑Health -care facility DOther:
' 4 i ' , Submit 2 sets of plans with any of the above.
City /State /ZIP: .. "" The above are not applicable to temporary construction service-
. ` ..t "___
.
tt' ,
S Ite /bid ./a t. no.: �r. , r::` ....,,..
Suite/bldg./apt. P Project name: ,i;;ii;;:i,i:; -.; • :.. ; t. `- '���`� .
Description .,, : ,t;: , :., .., .. _ ,:.I:.,Qty. I Fee. _ ,, :' r' 1 ..
Cross street /directions to, job site :.:_} ) ; • ; New residential single- or multi - family dwelling unit,
•y ` Includes attached garage.
1.000 sq. ft. or less _ 145.15 4
Subdivision: 1 . I .. } Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: h Limited energy. residential 75.00 / 2
a,x;,::.;:, ,,.,.., 75.00 _
• n ; ..: y +
.
Limited energy', non-residential
. -,.. ClOt1' Oh'tiTtOR3%� ` -.:' ;:, ;:. ;,.,,.::.
;,;;,,;,;,;,.;';,,. •....,,;..: .....,•.,, ;,. r..::. ;:,..:,,.,:.:,•.,..,,..,. ,,:;',.::a,;:,::; r,`i ':' L-ac h manufactured or modular
dwelling, service andlor feeder 90.90 2
( --C.-;''
--C ° ' ' A '` , 't = '^ Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
Viii: ; - "i:" P
.113 .;PR P
PERT2'i ±, „��':
Q O 'IVEi'L2`:i''`'i�;
Name: 401 amps to 600 amps 160.60
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
Phone: ) relocation
( ) Fax: I. 200 amps or less 66.85 _ 1
Owner installation: This installation is being made on property that I own which is not 201 snips to400 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
Owner signature: Date: Branch circuits – new. alteration, or extension, per panel
7 ::' ii; .., .:... ,:, :':� ,.: .'; �':'• "::'; •:'i'r'... ::: Iii.✓,.:-•: : � : , i iii ..::::::::
::APR : - , i A. Fee f circuit, with
• service or feeder fee. each
Business name: L ' i _'s : .• ; {;l r _ i" branch circuit
e1 " e 6.65 -
B. Fee for branch circuits
Contact name: . ., : . _ without service or feeder fee,
Address: y each branch circuit 46.85 2
Each add'l branch circuit 6.65 2
City/State/ZIP: '., r; t ' °) Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: Phone:('') `r (: '. ''.. Fax :1';.;.iy) c:?1-'t. y ;,:
/ / Sign or outline lighting 53.40 2
E -mail: Signal circuits) or limited-
^
,:..- J :,,. • . ,::, .,,: :, . . :^,. ,< (:Q:::;I?R:%�.°TOltsi energy panel, alteration or
Business name: ' _ ' ? extension. Describe: Page 2 • _ . i
Address: µ ._ . `'. Each additional inspection over allowable in any of the above
—
(,..-1'
Per inspection 62.50
City /State /ZIP: i _ . I ; „ ._ ,, : ' : Investigation per hour t 1 hr min) 62.50
�C_, /, r ; :(, L , . : f P
Phone: ( Industrial ) .- -; '..:1 e, Fa~,: (,r � ) .. - . 1 plant pc
,, 1 u stna
4 .
i CL :cTRT'C ^L;: PFRMI:'I'7;'• + ES ; ' a: i ;,; °,;';:< ^ ::;
CCB Lic.:dl 6 : :
c:'' Electrical Lic.: Suprv. Lie.:
i ,, c! Subtotal
Suprv. Electrician signature, required: ; Plan review t25% of permit fee)
State surcharge (8% of permit fee)
Print name: ': ?�:, : " •,,:. - _.. ' Date: i.,/ '. ;. '
'' TOTAL PERMIT FEE
Authorized signature: t
This perrnit application expires Ira permit is not obtained within ISO
days after it has been accepted as complete
Print name: Date: • Fec methodology set by Tri- County Building industry Service Board
"* Number of inspections per penmt allowed.
i ''Building ,Permits \ELC- PerrnaArp doe :2/03 440- 401STI 1 0 1 0 ?C'0 \1 WEB