Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
�L�ier DEVELOPMENT H BMENT r S o ERV SERVICES 639 -4171 DATE ISSUED: -00251
13125 ED: 8/9/2004
SITE ADDRESS: 12260 SW THORNWOOD DR PARCEL: 2S1106C -05600
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 027 JURISDICTION: TIG
Project Description: All encompassing low voltage.
Job No. J -2904
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: ALL ENCOMP : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
DON MORISSETTE HOMES 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 Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 8/9/2004 $75.00 Elect'I Final
[TAX] 8% State Surchar€ 8/9/2004 $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 foil w nil -s adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
thr OAR 952 -00 -0100. may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
Issued by ;4,1, , 4..41.434/14 Permittee Signature lC
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 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Electrical ern,..Z.,._ion For: I :: !( i•: 1..s 1.: 0N1..1
City of Tigard Received
trd c 7 falai I I rilf I 0 -
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 ''"`. i 'lrai 1 ..;;" Date/By: Other Permit.
Inspection Line: 503.639.4175 4W 1. Date Ready/By: 3 ,;.- • I El See Page 2 for
Internet: www.ci.tigard.or.us NotiffecVMethed: /ia . I Supplemental Information
‘4 .11,, :■VIC Y . 1 n I;':. 4;-..'.'i,.?:.41,'P,t,c::1,4{1qi)C;),i,r.V.Vr':,01■ 4 ,%q 1 :0 ' f ' t'l.. tf i1! ','';',.;;':'
..:'',,, .. ,..,,;...,,,...,,,;,... - ,.1,.jy4,,#,,F.Ato,..,N1wilpNo.,;.4,e.....1.1!..„..;„.:„..,, W , a' .', , ,...lreMP' , ..:, , •'.. I , , ' ,O , 1, • '' 7 . - , i , , A , ,„■': , 4'' '',.'
Q44ew construction El Addition/alteration/replacement Please check all that apply:
DntOliti Other: OService over 225 amps, comm'l ['Hazardous location
0 eon 0
320 amps - rating 0Buildng over 10,00 0 sq II.,
,,. ,,,,,,,,:xo:Y: ".::7011 ' ...-NrWL.-''' , ',2 1 1.1b1, # 72: /4e ' ' 4 '''"%fe,i11.11 ji ld.''''" ' '''"P.M.IVi; '. ''''
')., '''c■-•"'',,,,,, .4 ,i °Service over N'1,; . , ...0,■ , ,mt . . 1 4; - ,Vk,1Syt% , , ... bligl Zit Reft, ' 4,;. ,:eg. of 1- and 2-family dwellings 4 or more new residential
Ili 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building ()System over 600 volts nominal units in one structure
['Building over three stories ['Feeders, 400 amps or more
0 Multi-family 0 Master builder 0 Othr: ['Occupant load over 99 persons 0Manufactured structures or
„ j.e.' ihaakifk l'y ',,,,,,VV0-:;:"." 13"):
f7A " r ' 'YP.0t,7■1111111,Yetf4'1 W :,.. 4 !'''.. DE plan RV park
['Other:
Job no.: "'i- )_q0 LI I Job site address: 1 22 c9c., _s 4.0 0valk OHealth-care facility
Submit .2. sets of plans with any of the above.
City/State/ZIP: - 6 ex i.01, Cle The above are not applicable to temporary construction service.
0 AV:Val!'..:;;
Suite/bldg./apt no.: 1 Project name:
Description I Qtr. I Pea 1 Total 1
Cross sheet/directions to job site: New residential single- or multi-family dwelling unit.
Includes attached garage. -
1,000 sq. R. or less 145.15 4
Subdivision: - 1.--N . e y - e ., A I Lot no.: _2_9 Ea. addl 500 sq. ft. or portion 33.40 1
Limited energy, residential I 75.00 , 2
Tax map/parcel no.:
_ Limited energy, non-residential 75.00 2
.' •''..;:i7 '. "* -: M , 0#1*i.!:C.%?:IT . Each manufactured or modular
dwelling, service and/or feeder 90.90 2
I--y, L. 1/0 i - 1 - 0 - 3e_ I/4 CUL) AN. ..1 c!,*1..".. Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
0011* ' - • ' ' - amps 106.85 2
** :1" 201 amps to 400 '14 : ' ' .°. '
401 amps to 600 amps 160.60 2
Name: Dan 4/ 0 r% , S5e 1 hlz,v4e_S 14 t 601 amps to 1,000 amps 240.60 2
Address: Li ) 3 0 e r : le in WO CZ 5 - Over 1,000 amps or volts 454.63 2
Reconnect only 66.85 2
City/State/ZIP: L.-6 Ve 0 1./el 0 0 e q Temporary services or feeders installation, alteration, and/or
t.,) relocation
Phone: ( ) Fax: ( )
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
, P 4°.0 , 436 RPPM0 \ 401;WANi: ', '"X■5?' 7 1'V,; ,.' t‘A ., II:reetNVII'Veogli:AtiOliiiii**4.A4 4 : i.'{' A. Fee for branch circuits with
. :0* ,,,,,,,. ",. . , :. , .-,,, .,..-' ..,.. , . :, ":., .,‘ 1. -do. ,i). ?, ::,, - '-' ,4,,, '''...- . , :+.,,.•... ,',, ,. ,,' . , • . - '':iki'''' ,' -`. ,:.' '" service or feeder fee, each
65
Business name: A I 1 t, 01/4 H f. C.iorl 4v C 4-04....C. branch circuit 6. 2
B. Fee for branch circuits
Contact name: s ed , rti
14A Pel LAC -k vs. without service or feeder fee,
46.85 2
each branch circuit
Address: ' 36 e C s 4-1- Ci Each add'l branch circuit • 6.65 2
City/State/ZIP: 1.4 Is 6.„ a r) oe qr — 7 I 1 Miscellaneous (service or feeder not included)
, Pump or irrigation circle 53.40 2
Phone: ((z a" ii _ a s L iz . _ I Fax: : ( 9..3 6 ak, AA,
Sign or outline lighting 53.40 • 2
E-mail: Signal circuit(s) or limited-
' : ,' " ':', ..';' ,1, ... : ;',: !, " ,. "; :4 ' ,;: ' , % :' ''i•!'''' ', ;)1l10#A70041V, , '"''',.';':: . 'n'::V(•":":t,i,:;r" ;: !;X:‘'!': energy Panel, alteration, or
extension. Describe: Page 2 2
Business mune: A n ive. Lk 4 I/2/N i>_"-Ile.;..
Address: - 2 ) ( - ) r c,r- c -I 41 C- 4- Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: 1,1 ) Is bole rfe 7 ( . l Investigation per hour (I hr min) - . 62.50
Industrial plant per hour 73.75
Phone:( -5-03) 414 4 .. (,5(.j) Fax: (5z3 ) 6 4 f 2
CCB Lic.: LAI C, 1 I Electrical Lic.: I Suprv. Lic.: Subtotal 75-
Suprv. Electrician signature, required: Plan review (23% of permit fee)
/13
State surcharge (8% of pennit fee)
_ P ,-•
Print name: Date: e ..... _ o q
TOTAL PERMIT FEE 47
'-.Authorized signature:
This permit application aspires if a permit Is not obtained within 180
days after it has been accepted as complete
Print name: -5 ,... M 6,,c,v,k,,,, I Date: 8 - - OLk • Pee methodology set by Tri-County Building Industry Service Board
•• Number of inspections tier permit allowed.