Permit CITY TI GARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 -00081
-1-1-"111111' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/8/2005
PARCEL: 2S 109DA - 05600
SITE ADDRESS: 12785 SW SUMMIT RIDGE ST ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 033 JURISDICTION: TIG
Project Description: Low voltage, security, audio, intercom.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: X AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: X BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: INTERCOM : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
DON MORISSETTE COMMUNITIES LLC QUADRANT SECURITY INC
4230 GALEWOOD ST PO BOX 14833
LAKE OSWEGO, OR 97035 PORTLAND, OR 97293
Phone: 503- 387 -7538 Phone: 234 -5558
Reg #: SUP 1211 JLE
LIC 96806
FEES ELE 26- 565CLE
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 4/8/2005 $75.00
[TAX] 8% State Surcha 4/8/2005 $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 . Permittee Signature: pnp 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.
.. :�= - - -. -- - totbruoatian
-- - j C E V SJ ED -- - -
City of Tigard DatdB Y Q -p-6 Permit No.: �/(�OQ
Phone: 503.639.4171 Fax: 503 .598. t 960 r r . Nee Review o
Inspection Line: 503.639.4175 I NK o a 2005 , .'u1 - J�� DerrRea � Y. OmorPomti�
Internet: www,ci.tigard.or.ua - ± aly/p
Airier
qR Nor c d/M sr bod; 7 S
sepia ,r +,cr��i � t • �C? i r a i I see Pogo 2 fur
SaPl�meatrl
Y . -` . tel
. A : " 1 ...:'... _ 4 J.. I } 'LL i l �� - T• r, a
'�_c . '.,' .,. k'.Y' r r a.„, r ,. ,! :;. t ' :L r t 4 , *;ir y r cu.r ,i:u,•
II'. New construction i T 7J i .d r� F ". iL { ; ',� '�ia.' y .. f y .,.,. ref :.. n c { ri
❑ A ��� a Rp - i . 31tC19tiotl/replBCOrttent Please check 1st] that apply:
r te a 6 ti' #; s:
El Demolition 0 Other
c; . r . ❑Service over 225 amps. comet 1 DH azardous
; ;a� `.:' -:''f 17. , ,.. P location
f � s s., -.r ., ;; a ' !.�., :; c , , „_ :: , .: J e �' i'�s � ..7 :..• y' DService over 320 amps — rating °Bullda over 10,000
• c• a .: k ' JE4:r t Q e AA V.'
of I- and 2- S s q .
; l
l- and 2. family dwelling ❑ Commercial/industrial family dwellings 4 it more new residential
0 building ❑System over 600 volts nominal units in one structure �C v. a+n a Master builder ❑ QdLeOther:
['Building over three stories ❑Feeders, 400 amps or mar
❑ Multi family
�rc ,7 °i 7a our. �, r
, : 3"lr..,,;. Q s ` , ys � :4 �]Oe ess/li load over 99 persons ❑RV park
eluted structures c
I CI Egress/lighting plan RV path
Job no.: Job site address; I l 5) S ei • OHealt1 - twig facility ❑Other,
Ciry /State/Z1P: U r Submit 2 sets ofplans with any of the above.
Suite/bld J Ct ' The above are not applicable to temporary construction service.
rvit e.
g apt. no.; Project name: r o PO /710/5> .: • ': , 71FFrF' s r I ; •
Cross Street/directions to job site: °°°10a Orr. P.. nerd
—
•
New residential single. multi t.
or multi - r dwelling unit
Jacinths attached garage.
1,000 sq. R. or less 145.15
Subdivision: 5q7) 1 , k a 1'
Lot no.:33 Ea. add 1500 sq. R or portion 1111111 33.40 _
Tax map/parcel no.:
r l ;:2Y N,^y ' .... fT Limited energy, residential
��,,rr,� ,.,t ' 75.00
4 .>, :, . , ^ : r .. : : r a' I .� 1 1 - r ?, A.. . ry Limited an - , non-residential _
'-n 6 • N 1,.. P .� t ...1%......” 3h . t� . esidential 75.00
I) r • Each manufactured or modular
w (� V c r - Ct — c iO • dwell _ service and/or feeder 90.90
Services or feeders installation, alteration, and/or reloca
•
' :x � ; }. ,. ,7,1'17 200 amps or less 80.30
lion
; •�:1 .. F,' ° . . ! 7Ji' '7 . , . ,' 4i .. ... J � u t ' ..,3 tr'r2 N 51� it ; ti'F:•�. elk i 201 amps to a00 W - :' . s " Hi31i G,'' �! amps 1M 106.85 r
'
Name: " ' 401 amps to 600 amps 160.60 IIIIIIIII
Address: Ov er 1,0 amps amps or volts ill 240.60
Over 1,000 amps 454.65
City /State/ZIP: Reconnect only 66.85
Phone: ( ) Temporary services or feeders installation, alteration, and/or
Fax: ( ) relocation
Owner installation: This installation is being made oat o which 204 amps or less r 66,85
intended for sale, lease, rent, or exchange, according to OR.S property that own 0 1 not
Owner signature:
201 amps to 400 amps 100.30 Min
gna tuue: 40 1: ,s to 600 um
ft
Owner s Date: '` 133.75
tl st' w r i ; ;; � a , • branch circuits — a
:i : r' %': r.' , „ �� . 7m :, new. alteration, Or extension, • , .:,,. . a n ca . ;" ;s � '>i A. Ft for branch circuits with
n, Per Pane!
Business name: or feeder fee, each
�'�' branch circuit 6.65
Contact name: B. Fee for branch circuits
Address: without service or feeder fee,
each branch circuit circuit 46.85
City /StatclzIP: Each add 1 branch circuit 6.65
Phone: ( )
Miscellaneous (service or feeder not included)
E-mail:
r 53.40 r
x+ ace, Sign or outline ti : ling
l-r•., ij. ,. F.r r y�r ° '�n".p+o•r fih'A ; ' ar k lw�Ci'j��. �Y .,�,l� c! • _ 5�1:; u :+?.�tT� v;i� a � .1. �;r - •--y r Signal circuit(s) or -
i. 53.40
•• 1 7 1 .y, l � 'i: r L , s limited
BualneSS name: `l ` < i r a w � energy Pane], alteration, or �j
:`" : r 1 I'`Y -�
Address extension, Describe: Page 2 -
' 1 ` zc:_> t ! `•
Each additional inspaedun over allowable in any of the above
Ciry /State/ZIP:
a dm it '[ r , �C
% � Par inspection _
. ( - � V 62.50
Phone. � L C . •5 FaX: ( ) . : - Invosuxarton per hour (1 hr min) r 62.50 r
CC/3 L" o -� , p
Ic.: C . '�� , Electrical I.ie... ,-i . .raj . -9,, �• t . .,n,' .4 J a c rti Lr,tL: y , 7 F ' s - v ,.' N '� • % :
Suprv. Electrician signature, required: �4 ' „...(` "' Subtotal
Print name: Plan review (25% of penult fee)
Date: U � State surcharge (8% of permit fee) , •
Authorized signature: TOTAL PERMIT SEE
1 at L „ Thus p ermit application expires Ira e CD
tame: ' ` P permit is no t obtained within 150
l • / t. // Date: day. attar It bars been accepted are wmpiete
Print
5 • Fee methodology set by TA-County Building Industry Service Board
•• Number of inspection per permit allowed.
ZO 30tid SW31SAS 1Ntiiyavrn Zi;EZ9EZE09 Z0 :bt 500Z/8O/00
Electrical Permit Application / FOR OFFICE USE ONLY
City of Tigard / Received
Date/By: PermitNoMSt .)r,`J _ -,‘./
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 / ;_� ' I'i' Date/By Other Permit:
Inspection Line: 503.639.4175 I �!L 0! Date Ready/By: Juris: 0 See Page 2 for
Internet: www.ci.tigard.or.us t . �1. j Notified/Method: Supplemental Information
.
TYPE OF WORK PLAN REVIEW
1 1 New construction . ❑ Addition/alteration /replacement Please check all that apply:
❑Service over 225 amps, comm'1 ['Hazardous location
0 Demolition ❑Other:
EService over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
g 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi- family ❑Master builder ❑Other: ❑Building over three stories ['Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION . ❑Egress/lighting plan RV park
Job no.: 3 9 7 I Job site address: p�j , _ ` ❑Health -care facility ['Other:
' � a " Sw St/ it gaff 5/: Submit 2 sets of plans with any of the above.
City/State /ZIP: � a Q . �j applicable ! ((((////����
� r /1 q7 Z J The above are not pp licable to temporary p ary construction service.
Suite/bldg. /apt.no.: I Project name: t/, � F FEE* SCHEDULE
!� Description I Qty. I Fee. I Total I "*
Cross street/directions to job site: B?
[� New residential single - or multi -family dwelling unit.
• � • Includes attached garage.
•
1,000 sq. ft. or less 145.15 4
Subdivision: tivi J f t Lot no.: 33 Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: 7 r Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK
• Each manufactured or modular
dwelling, service and/or feeder 90.90 2
N°v holl3 taper A Services or feeders installation, alteration, and /or relocation
✓✓ 200 amps or less 80.30 2
PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name:
pad 0rr�, S FITZ' C dMM d Ad r ��3 Ur 601 amps to 1,000 amps 240.60 2
Address: 1 7 `? ^ �, d 0 0 571 C-71----- Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: 1 16•L V �
L141�E DS �✓ C� 6 R, 4 , 70 Temporary services or feeders installation, alteration, and /or
Phone: ( 5 3) 3s7 ' — 5 d ' Fax ) 3 relocation
G tJ 7 200 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
❑ APPLICANT I ❑ CONTACT PERSON . A. Fee for branch circuits with
service or feeder fee, each
Business name: branch circuit 6.65 2
•
Contact name: B. Fee for branch circuits
without service or feeder fee, 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: ( ) I Fax: : ( ) Pump or irrigation circle 53.40 2
E -mail:
Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
Business name: fI. k r� CZ..EZ. e ( extension. Describe: Page 2 2
LI, C.
Address: 1 d , ) ® Each additional inspection over allowable in any of the above
q �- Per inspection 62.50
City/State /ZIP: 6� O g * / 7 7 v C0 Investigation per hour (I hr min) 62.50
Phone: (6- 33 3tSZ,..... 81, 24/ Fax: (a3) ("13— — q yq - Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES* _
CCB Lic.: 1 3 222 Electrical Lic.: z./... t� j'3 L Suprv. Lic.: L G 7 5 Subtotal
Suprv. Electrician signature, required: _ G/ Plan review (25% of permit fee)
Print name: L �FI'r �0 ! J � G � �� D 1 State surcharge (8% of permit fee)
/ TOTAL PERMIT FEE
Authorized signature J This permit application expires iC a permit is not obtained within 180
Print name: Da ,,\ / / * d after it has been accepted as complete
Fe e me set by Tn - County Building Industry Service Board
/ "" Number of inspections per permit allowed.
i:\ Building \Pennits\ELC- PemutApp.doc 12/03 440- 4615T(10/02/C0M/WEB
•
CITY OF-TIGARD
BUILDING DIVISION PERMIT #: ELR200S -00081
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/(;/2005
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 - 4175'' �..
INSPECTION WORKSHEET FOR DATE: 6/6/2005 TIME: 7:13AM PAGE: 65
SITE ADDRESS: 12785 SW SUMMIT RIDGE ST CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 033 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Low voltage: security, audio, intercom.
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503- 387 -7538
CONTRACTOR: QUADRANT SECURITY INC PHONE #: 2345558
Inspection Request Scheduled For: Date: 6/6/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 008501 -01 503 -234 -5558 N
Corrections /Comments /Instructions:
01(%
r PASS ❑ PA APPROVAL CANCEL ❑ NO ACCESS
FAIL ❑ • LL F0047 E ION ❑ ADDITIONAL FEES ASSESSED
" 2
Inspector: Date: hone #: (503) 718-