Permit A 1
C ITY OF T I G ARD ELECTRICAL RESTRICTED ENERGY PERMIT
• ,, DE VELOPMENT SERVICES PERMIT #: ELR2006 -00263
6 : I DATE ISSUED: 10/31/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S134DB - DG011
SITE ADDRESS: 11374 SW MEGAN TERR ZONING: R - 4.5
SUBDIVISION: DAKOTA GLEN LOT: 011 JURISDICTION: TIG
Project Description: Low voltage for vacuum.
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: LL ENCOMP : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
DON MORISSETTE HOMES, INC. ALL WEATHERIZATION
4230 GALEWOOD ST # 100 3030 SE 59TH
LAKE OSWEGO, OR 97035 HILLSBORO, OR 97123
Phone: 503- 387 -7538 Contact #: FAX 503- 649 -2680
PRI 503 -649 -6542
Reg #: LIC 46969
FEES
Description Date Amount
[ELPRMT] ELR Permit 10/31/200€ $75.00
[TAX] 8% State Surcha 10/31/200€ $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 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: Permittee Signature: _
OWNER INSTALLATION ONLY
ill
The installation is being made on property I own which is not intended for sale, I • ase, 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.
Electrical Permit • 0:1,'. t all. ' IV Et)
Na.:
FoR OFFICE USE ON1,1
City Of Tigard i t, ^oOC RE!0 ei
13125 SW Hall Blvd., Tigard, 0'• 97223 OC1 d ` U D O1bt / t 9 d, PaParma 1 �04° - O0 Phone: 503639.4171 'Fax: 503 598.1960 pp Dae e w /
S, � � 0 'nl' NI � " ` OlherPennit:
Inspection Line: 503.639.4175 CVIY (Q Ti�� r(II' � Date/By.
-` '� �
Internet www ci tigard or us DM DiV i Notified/Method: Ready/By ru °s e/ l Supplemental See Page l Information
� ��� �������� `�� 2 � � f � h / Supplemental Information
.,. ^: �a"', "'*; y -.. xvC nts Sd£ eti '��b.:t# 1 ! X •`' ;`:S :?,�::.u�p': a ,3 €.1?, n :Y 9.G -.c,
-.J to . '...:f i ,I .,s <.r� ";; >' :,. "a 1 , : i t a; 3` g,S S`
,. �4 Fr ==, i f �.a'��3� Via. tzr kF r ars ' � in �, r, °�7 ;; �.� ��a� '¢&7�+`� ,..tri:.a ��x{��'.t�Y 4�� t �� ���"( ±� ��f�tt�°I;
[id New construction ❑ Addition /alter: tion /replacement Please check all that apply:
❑ Demolition ❑ Other: ['Service s, comm'I Service over 225 amps, ['Hazardous location
'
l r„ 5 fr ° / t ct ' 1 i ti as ( v r $ r Service ❑
Service over 320 amps - rating Buildn over 10,000 sq. ft.,
r i:;!i , : +at `,r i 1 4 °„ ' , J , a ,=', ; � , :: ` ,,„ F r r : , , -1 '� ` of 1- and 2- family dwellings 4 or more new residential
IIK 1- and 2- family dvYelling ❑ Commercial /i )1 dustrial ❑ Accesso !y building ['System over 600 volts nominal units in one structure
❑ Multi-family Other
[Mudding over three stories Feeders, 400 amps or more
Y ❑ Master butlde ❑ g ❑
� r l {tug , { t Master : h ['Occupant load over 99 persons ['Manufactured structures or
" r» at; w .� �� st�S . =4 y F` ?r gS F "" it
` .� ��: �.�..,.� ��•: ,.,,_�,,, ,..�N ❑Egress /lighting plan RV park
Job no.: 3hZ.ei Job .ite address: 1 t -/ 4s i4 .� ed✓t ❑Health -care facility ['Other: ' " J Submit 2 sets of plans with any of the above.
City/State/ZIP: Ti The above are not licable to temporary
W (7 aPP construction service.
Suite/bldg./apt. no.: ' ; a" \l!:x 3
Project name: l o t�fri* 1,A `
De crlptlon Qty. Fee. Total
Cross street/directions:to job site: /3 ,J
I ( /441 � P... f New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: � k p �.. I� 1 of no.: it Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: _ ` V Limited energy, residential / 75.00 7S 2
.` f o t/ arc x o.: '' 2 . F -� r- r r s Limited energy, non - residential
75.00 2
• ;� -_�� ., �..•.. _° s,. .(.- , %::.t <i:: .;L.. r .:t'£; 1 Each manufactured or modular
CC- n -� f '; t /� dwelling, service and /or feeder 90.90 2
V ,• Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
° v r rte, r : = 01 am s to 106.85 - 2
� i �A igni I I d�S �1 ns �t a X� '�d`ylr,, l 5 y 3.., r i �� 1',.1 kt 1.1: . q :; ` �}b A? : p 4600 amps
�,ru �. , ... .�x..� . , . a,� �a., w ,.,� ..2 :i 401 2 amps to 600 amps 160.60 2
Name: f)0(0 �� i {S- L am _ Flom eS f 601 amps to 1,000 amps 240.60 2
s t ""f' ►T� I
Address: 4 Z 3Q ,-, I Q ,...t.)•.0 S Over 1,000 amps or volts 454.65 2
City /State /ZIP: / � Reconnect only 66.85 2
" 1/•e_ 04 W e y Q Q 70 Temporary services or feeders installation, alteration, and /or
Phone: (� )'� ^ 4 3 k U I F ( S O ) relocation
/ 3 46.7 Na '� 200 amps or less 66.85 I
Owner installation: This inst.Ilation 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, actor• ing to ORS 447, 449, ■ 0, and 701.
401 amps to 600 amps 133.75 2
Owner signature: Date: �+�, 1 ��22 ,� k�z u� {� � � Branch circuits - new, alteration, or extension, per panel
.• 1� 1 rP .l� itiJ S 1 4;UIk 1 3: s + 4i lir't, S , 1 ( r Yf - -
a..A2�'aU r,a.,.�rl�'u�+j .. ��. <_z�. -r�� 43,�� �t�,ta S�'1 5 r , k�� � ? � A. Fee for branch circuits with
Business name: + EA,,, I {-tOr� Gp j. e service or feeder fee, each
Ar t 6.65 2
i b ranc h circuit
B. Fee for branch circuits
Contact name:
r D n G v 1 j without service or feeder fae, 46.85 2
Address: first branch circuit
Q 5 >' Each add'1 branch circuit 6.65 2
City /State /ZIP: p
F f 't Ii' �j t� • P 0 Q • q 11 zs Miscellaneous (service or feeder not included)
Phone: (5Z ) I F 1 Pump or irrigation circle 53.40 - 2
4 6 ' N 2 ( ) ‘ 7 2.16 Sign or outline lighting 53.40 2
E marl Signal circuit(s) or Iimited-
it i rlt� itaZi1 ",; . ri 1- t'' Y,Saj i ,/• m Y s 4 , , t . } a3,!4! 1 energy panel, alteration, or
+.,w.�af �Pt�;R4�r _...,, ,.�'AL..t ,.5 tri
z ��llF ,< , : a v n.. „� 7..._ .m .p:
Business name: extension. Describe: Page 2 2
/I d1/, a to� iZa ; o� con . . 7 L .
Address: S Each additional inspection over allowable in any of the above
6' S Per inspection 62.50
City/State/ZIP:
ids 0 +k' O 77/i 3 Investigation per hour (1 hr min) 62.50
� 1
Phone: (5--11 i )) 6 G/ Z` Z I F: : ( ) 6� 6 D Industrial plant per hour 73 75
CCB Lie.: 6 t0 C r lectrical Lie.: Suprv. Li,'
`/ g 7: J Subtotal r7 3
Suprv. Electrician signature, re.uired:
�, I Plan review (25% of permit fee)
Print name: ' .......t ... State surcharge (8% of permit fee) C S °
�/ y L� Date: f' TOTAL PERMIT FEE 6�
Authorized signature:;: , i
, .�� /�_ This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: ., Date: J , • Fee methodology set by Tri- County Building Industry Service Board
Number of inspections per permit allowed.
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