Permit CITY OF TI GARD
DEVELOPMENT SERVICES ELECTRICAL RESTRICTED ENERGY PERMIT
PERMIT #: ELR2005 - 00095
611. , DATE ISSUED: 4/20/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S109DA - 08800
SITE ADDRESS: 12928.SW SUMMIT RIDGE ST ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 082 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 COMMUNITIES LLC ALL WEATHERIZATION
4230 GALEWOOD ST 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 4/20/2005 $75.00
[TAX] 8% State Surcha 4/20/2005 $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: / 4 rs, &) Permittee Signature: _ P
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.
0006/007
04/20/2005 08:47 FAX
r , 44
Electrical Permit App
.. ,,..
licRECEIV :
'1 li..,.,:.
-;•• . ••
FOR OFFICE USE ONLY
City of Tigard Received
Permit No. . c ., 6 „ od
--,
13125 SW Hall Blvd.. Tigard,OR 97223 APR 2 0 21, Ak A Date,13v: - Iv& 0 - 05' '6
Plan Review
Phone: 503.639.4171 Froc• 503.598,1960 ' Datelay. Other Penult:
Inspection Line: 503.639A175 ;ii, '-
It 1' • . Date R
Internet: www.ci.tigard.or.us CITY OF TIG ;--,'": - ' -' ' NorifielNielh
Ait x.r. I T up S p e l e ein Fa e g n e ta 2 n
gi. p...il I ps:A 1 0, 14 , ,,pd-ougoo ki i ii , i
Riqew construction O Addition/alteration/replacement Please check all that apply:
°Service over 225 amps, comml °Hazardous location
0 Demolition 0 Other:
; ... , . . ....„„ rvi
0Sece over 320 amps - rating 0 Buildng over 10,000 sq. ft.,
. , 26 0# '1,1 ; , ppyg* . 1:011 , 60 1 antan.imgot : 5; of 1- and 2-family dwellings 4 or more new residential
g' 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building 0System over 600 volts nominal units in one structure
0Building over three stories °Feeders, 400 amps or more
0 Multi-family 0 Master builder 0 Other:
., . ...... „ 00ccupant load over 99 persons (=Manufactured structures or
1 20:01-10- KNONSION4q.4.1 1 , 1 0PRON.i.nal-Mha.;1 DEgress/lightin plan RV park
Job no.: iJ site address: i i " f .: ;S L., ,.. , _,..- --' , ,.,.'! . 0Health-care facility 00ther:
,-,
Submit 2 sets of plans with any of the above.
City/State/ZIP: 7., ,.., c_....11 OEZ. The above are not applicable to temporary construction service.
Suite/bldg/apt. no.. Project name: - 56'.:leitelb:VA .............................................................................................................
____
Description I Qty. I Fee. I Total I "
Cross street/directions to job site: ,....: t., ,, il ii v- \ .' 7 i ,i) New residential single- or multi-family dwelling unit.
Includes attached garage.
1.000 sq. ft. or less • 145.15 4
Subdivision: . e , ;,....,. vii [-,,:..-.,...)i...4..... I Lot no.: .....- -, Ea. addi 500 sq. ft. or portion 33.40 1 ,
Limited energ, residential 75.00 I 2
_
Tax map/parcel no.: ‘ii
. Limited energy, non-residential 75.00 2
giNIIIPPR.finnant'iitA.10,00140$10.N4WiNinigiNIMMiNegi.::: L
Each manufactured or modular
..
(( • t . dwelling. service and/or feeder 90.90 2
:. t t.` L
Services or feeders Installation, alteration, and/or relocation
200 amps or less 80.30 2
::','-,ii:''.;f2.0:404#04#00:8ii*NtiiiagettglatilierI.:01-0M-Ingen. 4 a w m „p Ps s t 4 6 ° 0 ° 0 a ai n „ i p Ps s
160.60 2
Name:
.1... • :
1....!. ,..‘ ::•; ;.:..- c- , ,../i.11 : i c 1 601 amps to 1.000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP:
Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( )
20(1 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange. according to ORS 447, 449, 670, and 701.
401 amps 10 600 amps 133.75 -,
Owner signature: Date: Branch circuits-. new. alteration, or extension, per panel
3:113 . 4.004 . 0 KOW- 11 44X4111,060.11="41g00:00#;;;$#$0,i - i! - A . R. e
...:8 A. s Fe rv e i f c o e r b h irh
6.65 1
Business name: ! 1 1 ,., fe ,, ti„..,.,,,„. „•. , L,.,, 4., ,, branch circuit
B. Fee for branch circuits
Contact name: ..': . , 1 ... .. t -- 7.i. -.. without service or feeder fee.
. each branch circuit 46.85 2
Address:
...' 5 ...- :•-: ',:,.,,.. if... ' i I. .
Each addi branch circuit 6.65 2
- . - -
City/State/ZIP: j4 1 )...-., 1:::.,, ie (..,. ... -
u k..... -, r , ;,.._. \ Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( Sz.1 ) 6, , , 6 . ,: -;,,. I Fax: : (11 ) ( ci . 4 . - . )
Sign or outline lighting 53.40 2
E-mail:
Signal circuit(s) or limited-
i I I, MiiiRangaMingtglgOiRAMOVAWAR,MIEMigg..iggiftga; energy panel, al or
extension. Desc e: Page 2 -
_
Business name:
.. i i 1// kl (' ..1) :k in •••• "
Each additional inspection over allowable in any of the above
Address: -. LI . 3 (''.; l ' i il i
Per inspection 62.50
City/State/ZIP: 4.- . ; Lj ;„...::.. . ,,.... L.... .:_ ,-... z -:-: _ Investigation per hour t1 bran? 62.50
Industrial plant per hour 73.75
Phone: ( , i , ::' ) ) i .:.,, i ,i ,,;...p. z I Fax: ( , i,, ) i , --I i .1 i
:
CCB Lie.: er ,, y ,..,,. Electrical Lie.: Suprv. Lie.:
Subtotal
Suprv. Electrician signature, required: Plan review (.1.5 of permit fee)
State surcharge (8% of permit fee)
Print name: . ,. -,,' L . 1 ......1..: ;A. '1....- Date: ;..../ ... 2
TOTAL PERMIT FEE ‘......-- 1
Authorized signature . • •
: :( _,.------••
This permit application expires If a permit is not obtnined within 180
days after it has been accepted as complete
j
Print name: Date: • Fee methodology' set by Tri-County Building Industry Service Board
' •• Number of inspections per permit allowed.
i \Building \ Ponnics \ ELC-perroitApp doc 12,03 4 10.102/CONMED
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR200S -00096
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/20/2006
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175 '.L.
INSPECTION WORKSHEET FOR DATE: 6/30/2005 TIME: 7:06AM PAGE: 72
SITE ADDRESS: 12928 SW SUMMIT RIDGE ST CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 082 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Vacuum system.
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503. 387 -7538
CONTRACTOR: ALL WEATHERIZATION PHONE #: 503 - 64 - 6542
Inspection Request Scheduled For: Date: 6/30/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
1 99 Electrical final 010524 -07 503 -209 -4837 N
Corrections/Comments/Instructions:
11 W■0 It\NI 50 3Sdb• • 8 15
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL s ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: _/ _ Date: 4 1 '3 Phone #: (503) 718-