Permit A ) ~ CITY OF TIGARD E RESTRICTED ENERGY
r yc DEVELOPMENT SERVICES PERMIT #: ELR2003 -00223
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/24/03
SITE ADDRESS: 12285 SW THORNWOOD DR PARCEL: 2S110BC -TS023
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 023 JURISDICTION: TIG
Proiect Description: All encompassing low voltage.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: X AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: X BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: X CLOCK: MEDICAL:
HVAC: X DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: X FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: ALL ENCOMP : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
DON MORISSETTE HOMES CITY ELECTRIC + SUPPLY CO
4230 GALEWOOD ST 8900 SW BURNHAM F -27
STE 100 TIGARD, OR 97223
LAKE OSWEGO, OR 97035
Phone: 503- 387 -7538 Phone: 503- 387 -7538
Reg #: SUFI- 8012592S
LIC 42422
ELE 26 -289C
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Pcrmit 7/24/03 $75.00 Elect'I Final
[TAX] 8% State Tax 7/24/03 $6.00
Total $81.00
•
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speaalty 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 throuc
Permittee Si natur `
Issued b _ _ , g erl . /
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
• •�- • FOR OFFICE USE ONLY
E�� °'trical Permit Received / Electrical Q
— Date/By: 7 #' S _9) Permit No.� . -/\ob2 `ad c2c? 3
Cl of Tigard ` Planning Approval Sign
City g JUL 24 NO Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 311N OF f f O ``' ® Date/By: Permit No.:
Phone: 503 -639 -4171 Fax: 50buttritSIS DI 1 1 ®1, Post- Review Land Use
��"1 t Contact Case No.:
Internet: www.ci.tigard.or.us e . � I Contact luds.j,
/, ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 "" "'" Name /Method: .7 Al _ Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
■ ew construction ❑ Demolition ❑ Service over 225 amps- ❑ Health-care facility
commercial ❑ Hazardous location
• ' ddition/alteration/replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
O_ 1 & 2 -Famil dwellin' ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFO TT�ON and LOCATION Submit _ sets of plans with any of the above.
Rl _ The above are not applicable to temporary construction service.
Job site address: / f-2� T4e1ru ((/hoer TiGay0/ 8 U FEE* SCHEDULE
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
• Project Name: Description Qty Fee (ea.) Total 1
New residential - single or multi - family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
i1 � �t„ Service Included:
��' 1000 sq. ft. or less 145.15 4
. Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 4, j 75.00 1 )5 ••`-'-' 2
Subdivision: ''at Lot # : ,sr n woo Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
Services or feeders - installation,
d t LOW ■ LTA- alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY.OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: 0e)m HC^»7/ 5" 'e He. Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
4 APPLICANT ❑ CONTACT PERSON Branch circuits - new, alteration, or
Name: -._ _ — _._ K _ extension per panel:
�" �± A. Fee for branch circuits with purchase of
Address: 81;100 5,1,1 �� r , rn t\c . 5r♦• E 277 • service or feeder fee, each branch circuit 6.65 2
City /State /Zip: 9 -] 223 B. Fee for branch circuits without purchase of
t r service or feeder fee, first branch circuit 46.85 2
Phone: 'd- L4M3 - /01 I Fax: 563- ( Z5- 30 2 Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
• Each sign or outline lighting 53.40 2
Job No: ,21 00 Signal circuit(s) or a limited energy panel,
C �� 4..LdYIL alteration, or extension Page 2 2
Business Name: Description:
Address: X900 S &3 '. B, r rr.6 , Sk
City /State /Zip: G Each additional inspection over the allowable in any of the above:
l rt,„rr Or I 7') Per inspection per hour (min. 1 hour) 62.50
Phone: 503-41-1-ii-j12, 3 Fax: 5O3 4 -P-13 - Lb5 2 Investigation fee:
CCB Lic. #: Other:
4ZLLL2 #: z6 - Zfi� Electrical Permit Fees *.
Supervising electrician Subtotal $ 1 75" r4)
signature re • ui ed: Plan Review (25% of Permit Fee) $ eo • c)
Print Name: 1 I , e ,, Lic. #: S - Z State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $ SI • cc '
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it.has been accepted as complete.
*Fee methodology set.by Tri -County Building Industry Service Board.
- - (Please print name)
i:\Dsts\Petmmit Forms\ElePermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information • t
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
▪ Audio and Stereo Systems
D Burglar Alarm
Garage Door Opener
❑ Heating, Ventilation and Air Conditioning System
❑ Vacuum Systems
Ell Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
0 Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
instrumentation
El Intercom and Paging Systems
❑ Landscape Irrigation Control
O Medical
Fl Nurse Calls
❑ Outdoor Landscape Lighting
O Protective Signaling
El Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms\ElcPermitAppPg2.doc 01 /03