Permit C ITY OF TI GAR.D ELECTRICAL RESTRICTED ENERGY PERMIT
PERMIT #: ELR2005 -00224
DEVELOPMENT SERVICES DATE ISSUED: 8/8/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S109DA - 04000
SITE ADDRESS: 12892 SW PINE VIEW ST ZONING: R -
. SUBDIVISION: SUMMIT RIDGE LOT: 017 JURISDICTION: TIG
Project Description: Low voltage - 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 COMMUNITIES 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
[ELPRMT] ELR Permit 8/8/2005 $75.00
[TAX] 8% State Surcha 8/8/2005 $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: '�' Permittee Signature:
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.
08/08/2005 10:18 FAX Ij002 /003
0, -
• Electrical Permit Ap I il Sna!VED '
City of Tigard receive � /�j
13125 SW Hall Blvd., Tigard, OR 97223 AUG 0 8 Plate/By. O n � �v (`'' Pemut No. /65-'06,210.2
2005 i+ � 1..:; D to /B y: Other Review
Phone: 503.639.4171 Fax 503.598.1960
. � � Dote/B
InapectionLine: 503.639.4175 4.1.41.- . DateReady/By: r`� ®eeePage2for
Internet: www.ci.tigard.or.us CITY OF TIG Noliflod/Method:
y r I Supplementallnformatlon
JQI [� J y
` :i`?.j �:� l` -- - J)�� ' .:x�f!.K�'1 . ) 1 .. •Y✓ _ -._�. ' .. , ;F , .
1 �r}',: - ".S , ill IX '!� titijr" t ;iN.: {::! "nl Tr: } r r• ,
• '.:Ytl.' .1:, rr .�.? J.• .! a '0:' i .'CM1'.�[[`��. I��':. t.. "Zy, .. •�• t� 'i 5....
r.':.:f. � .. t, J'..ds i' `P ,1 i. aH i,l •le ,.N,? y1 � :V7,' • "7
�:� a, v ,.+<. ni.v6a�:�au�n•�..,r .. ri: ^.�tr. '�.•^ :r;'!:,.: `: 4 .'1" }� ,l•� � d'r"' < <�n •1
:: - ! ` F::, ... ,. ? =, ��. �{. , Inn �- �a'b�•.n:a:�� A. .'•,. �, {�YF':ia �..'�•:,,.• I: .� "1m}x,trl.it1 ,•i,z:�:..,9:.:! ?.'(+iii
ew construction 0 Addition/alteration/replacement Please check all that apply:
[a emolitiori ❑ Other:
over 225 amps, comm'I ❑Hazardous location
I " {fit P %I ;!+ 4e;.3 ` �' •,,. +•in , "�r, t , +. "F�r yt;.v_u r�. „ • • 1 .,,, , El Service over amps ❑But) over lO OOO 9
*t:. .r � .. , ' j Y,' >A' p). •+t.. r. 11�1.;'I {firr ` ;j� • 'e ,
#: `'.� , � � l ,r.� , +�13,<a� . �«., �ir; �r .,: ^�;'!.,;�:� ` of 1- and 2- fntni1y dwellings 4 or more new residential
and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building 0System over 600 volts nominal units in one structure
Multi - family 0 Master betide ❑Building over three stories ❑Feeders, 400 amps or more
::.' , <; { ; ^ : ;. ;:; t >.�, Z ❑ e . , 0 Occu ant load over 99 persons ❑Manufactured structures or
.. .... .. i; , r, _ t 1 , 1,,..':.: r f�'; ;,. %;'
::.;..: r •.i :�.. , >f �t 5a, �; 2 � at§ ' >,.r :,•3:,r:t::; : }" ['Egress/lighting plan RV park
Job no.? '� 1 0 lob site address: ( 1 r cf i Y1C' t �'f U
l El Health-care facility ❑Other:
¢�¢ s u b m i t seta of plans with any of the above,
l
City / State/ZIP: •( L `k AiJ ' y • ~ t The above are not applicable to temporary construction service.
Suit&b . no.: ,1, t° t y Y,...�w, •li i l l�r; :,,
lets,/ t .. 'i;', ?;�; t car # �,i, �.':'!'; !:: _:
aP Project name: < ;1, fie . , .,r � W,r. ,,' i� E' ..:- • :'., '1 , •
Daclptka j Qty. ( Fee r f idly r • •
Cross street/directions to job site: 1 L i (� rI � `� _, New residential single- or mufti-Bunny dwelling unit.
Includes attached garage,
/- ) 1,000 sq. f. or less 145.15 4
Subdivision: � ^ ' r _-- I ; ( Ea. add 500 s ft. or / � ^ L , � - � . L no.: sq. portion 33.40 1 p
Tax map/parcel no.: Limited energy, residential _ 73.00 1 2
` ; ;,r:, ,.,:�,-. X Limited energy, non.residentu+l 75.00 2
��R!e l •,d ar1(r,.ati:'..f'�r +<_t Gl "a " !i {": t
,�: ' , �,`�'�• �'� ,.��: -r': ��� :�.. �;; = ,' �s��''�'" " � Each manufactured or modular
dwelling, service end/or feeder _ 90.90 2
Services or feeders Installation, alteration, and/or relocation
200 amps or less 80.30 2
:�:l {� � • ' � , i' �lT '= J f ':}'J ' ,, , ;' , .,4 -7 '7 ,- ..,' - ' , , , , C • - ..r ,. �.
. _. $ � .$— --,•,,,, lr ::rr.:' 5 e�. , f . ti. '1 s. ` ., ,,, ' '''•' - ,, 201 a to 4O amps 2
`;'" !u :, 3 ; r -.f !! : �'S•; .: ;:-`'' . yy J ' a. , . •, ' y r' i., „ : . : , +'m 106.65
• ; .'.':.N:. r,!(t_.. r i m �•rd.- ..rg,,.,..>' •..,_. - _
. r r�,�liaL•. �' �� 401 amps to 600 amps 160,60 2
Name a) = , r; �� , _ - � ,
” (' `, 601 amps to 1,000 amps 240.60 2
Address: !�- j (�f) ,, tt {I i _ Over 1,000 amps or volts 454.65 2
City / State/ZIP: / - ••. L/ r Reconnect only _ 66,85 , 2
{ (' ? ` ; i ' ; • 7 1...
L k � ' , I ,! (<< ') • Temporary services or feeders Installation, alteration, and/or
Phone: ('5t)3) . 3 Q - 753 ) Fax: ( ) relocation
- 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: -
,,. wa;:Y, ,.,r • ?,•� .»,::,1 s,l . �, Branch circuits —new, alteration, or extension, per panel
:! ��: r.' .::L`'r'' ;'�� ' �i; +�n`l?;:Tr'''� ?vG.t,�._,y ,.�' a '••• u 3u! c*• \fir, , K H
... ei ' ! l:4: • r! , s':r;: ,. ;+ t ' ; f ; l:'T, I at a t e i.. g A Fe° far branch circuits th —
„p.:,•'.: f.;,y.l. ,. L:.l' �.L4Y�s�'tiv6s�.TS� *'' ^��' ,' W/
service or feeder foe, each 6.65 2
Business name: branch circuit
Contact name: 13. Fee for branch circuits
without service or feeder ibe, 46,85 2
Address: each branch circuit
Each add'l branch circuit 6.65 2
City /State/ZIP: Miscellaneous (service or feeder not included)
Phone: Pump or irrigation circle 53.40 2
( ) Fax:: ( ) Sign or outline lighting 33.40 2 •
E - mail: -
Signal oircuit(s) or limited -
..1'f, _ r�t �V al %+^ J,.',- , )C: r i •:il'�. ^.G4 %C'i: .
,.:
., - t1 '..: •':= r:11.1:...�..t l�;, :� S I'.lir :l: i:',:e .i•:
r #, nf.,_ ._. 4 y ., ,.��,� P;''`':=.. ,�., , _ .;:,, -• f,, . z,.. energy panel, alteration, err
Business name: extension, Describe: Page 2 2
� ( j etl� ,,y l ` 11m ll t ,
Address: L� _' C, ,./ ' Each additional inspection over allowable in any of the above
J Pot inspection 62.50
City /State/ZIP: t' l '
I Investigation per hour (I h r min) 62
Phone: ( ) G - ` ! 7 Fax: ( � / /r.� ,!� ._
.-1 (.... Industrial plant per hour 73.75
CCB Lic.: \ )., & i , 6/ I . Lie.: C ", 'Fleur .i f ;,, >0� n ±fir " •.: ' , 7 ,4 ' : + teii, � ? °1 ;,;,&;'
c Electrical Lic.: 1 Supry ie.: Subtotal e'"
Suprv. Electrician signature, requited: Plan review (25% of permit fee)
Print name: 'cLY r State surcharge (896 of permit fee)
1 1 G' i.i, l-%) Date '�. •L c ,,
TOTAL PERMIT FEE /
Authorized signature: f.::-.==.1 _ This penult application aspires tea permit Is not obtained within 180
days after It has been accepted as complete
Print name: i l Date: a Fee methodology set by Tri•County Building Industry Service Board
•m Number of inspections ocr ocrmit allowed.
CITY OF TIGARD
BUILDING DIVISION PERMIT #:
ELR2005-00224
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
8/812005 (503) 639 -4171 / ■ 'iti' i 'I liy ,
Inspection Requests (24 Hrs.): (503) 639 -4175 . _ ' I •
INSPECTION WORKSHEET FOR DATE: 9/28/2005 TIME: 7 :08AM PAGE: 58
SITE ADDRESS: 12892 SW PINE VIEW ST CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 017 TYPE OF USE
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Low voltage - vacuum system.
OWNER: PHONE #:
DON MORISSETTE COMMUNITIES LLC, 503-387-7538
CONTRACTOR: ALL WEATHERIZATION / PHONE #: 503 -64 -6542
Inspection Request Scheduled For: I Date: 9/28/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 016841 -02 503-209 -4837 N
Corrections /Comments /Instructions:
1/a/ //i/t '
0
IK A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL Fe' INSPECTION ❑ ADDITIONAL FEES ASSES D
I i
Inspector: I / Date: Phone #: (503) 718-