Permit / CITYOFTIGARD ELECTRICAL PERMIT -
A
RESTRICTED ENERGY
eii DEVELOPMENT SERVICES PERMIT #: ELR2004 -00175
" R � 111 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/23/2004
SITE ADDRESS: 14250 SW WALNUT LN PARCEL: 2S1046C -07600
SUBDIVISION: BAILEY WOODS ZONING: R -7
BLOCK: LOT: 012 JURISDICTION: TIG
Project Description: Installation of all encompassing low voltage
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:
BUENA VISTA CUSTOM HOMES ALL WEATHERIZATION
6932 SW MACADAM AVE STE C 3030 SE 59TH
PORTLAND, OR 97219 HILLSBORO, OR 97123
Phone: 503- 443 -6033 Phone: 503 -64 -6542
Reg #: LIC 46969
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 6/23/2004 $75.00 Elect'I Final
[TAX] 8% State Surcharl 6/23/2004 $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 follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010
through OAR - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
Issued y reeLEAA&AalLi 4 Permittee Signature _- Q� /r
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
06/21/2004 12:36 FAX 81001 /003
El car Pe t ADDlic iii .'U C I V ' IJ { • r , i ; L ) ! ( , 1,1 , , ,
City► o ' Tigard . ' . , I firiffallall -All / 7 5
13125 SW Hall Blvd., Tigard, OR 97223 -, „ I Plan Review
Phone: 503.639.4171 Fete 503.598.1960 "" Other Permit:
Inspection Line 503.639.4175 CITY OFT .--:1..1.9.- � D atdBY: Date Ready/By: See Pegs 2 for
Internet: www.eitigardor.us
BUILDING DIVISION Notified/Method: (' j. I RI Supplemental Information
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ii7 New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other ['Service over 225 amps, comm'I ['Hazardous location
", �9,, - ; •• <r,,, ,. n ,;,,a eww:i. ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. 8,
#' ' � . ; } M : i ' . ,, ,. '.
... ..i: sn...,:.v l 7 t T , -`'� I i t ' . dwellings 4 or more ne w residential
• � : �,a.. :h; �u.�_ �, l' , '
•�v. 6G'�
►� 1 and 2 family dwelling 0 Commercial/industrial ial ❑ Accessory building O of l - end 24snlil y syatem over 600 volts nominal units in one etniatu e
❑Building over three stories ❑Feedora, 400 amps or more
❑ Multi ❑ Master builder 0 Other
`•'rN. , .v. � ' t : ,�I, �. ,,'; c -: n c;: ; e ,., z , ; ❑Occupant load over 99 persons ❑Manufactured structures or
4 ' ' '1 I I ! - t C.'l „ t l b ` P3 { ri �^fIi`�i f •�x-d � (4 r Y '�S„
: 's:.. :> : A'' - - ,: i.. i '. s. �' - L . 2.71.�T ��ee �i k. . • gresslligbtmg plan RV park
• ` .CLC• , .I.C.P..d; •.!h•i- t:::z� � -v cFk " * [' E
Job no.: Job site address: 5o c,,,i, 1 r ,A " idol a ['Health-care facility ❑Other.
f
Submit 2,_ seta of plena with any of the above.
City /State/Z.IP: T ,,, ` el x. I li n The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: f � � : i� s�'i r
�..c AA. 1/1 Ctb�nn kS a Qtr. a rteu Total ••
Cross street/directions to job site: 54 errs.,5 e F17.()v‘. New resldeadid single- or multi -family dwelling unit.
Includes attached garage.
1,000 sq. R. or less 145.15 I 4
Subdivision: j'; o. ; \woo&S I Lot no.: I ')... Ea. add'! 500 sq. R or portion 33.40 1
Tax map /parcel no.:
Limited energy, al / 75.00 2
.� , , ; , �, ff t' k ' e Limited energy, naniesiderdial 75.00 2
s•i b'i t6 ,
'' . •'' :.. „ i 4 • :r s 1 ! R;,, N' 1EST l r:< - t�:, ` < . Each 1man facto eel or modular
�I'f
0 VD 1 0 is/ Q dwelling, service and/or feeder _ 90.90 - 2
"� Services or feeders installation, alteration, and/or relocation
J 200 amps or less 80.30 2
'" .:::ki ;: v i,L ire j €P`x l . .. ° 4 iN., •.:- 201 "'Psto400amps 106.85 2
:�riwx' `: . 401 amps to 600 amps 160.60 2
Name: /g vL n 4. IA y C-t 5 1-6 A. j41,44 eS 601 amps to 1,000 amps 240.60 2
Address: ( 1 S Z >!1.- _44 M, &VA t . 1 c G Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City / State/ZIP: p, I f 1 Temporary services or tbedere installation, alteration, and/or 14.
Phone: (9$) (A bo 3s Fax: ( ) � J 200 amps 200 ampps s
or less 66.85 1
Owner installation: This on 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 drains - new, alteration, or extension, per panel
'.F ^w,�' . fuw x '• x� S n -r� ;cyst��; ;,tP^2..1 ', t circuits with
,.`:ir.'?1 ',(y 1 IZETT . !>, ..�5 A fs, LY gatalt ,�i., eY e � I :t A. Fe e
^STS. m,1Y�v. ,7r,�w sery or f fee, e ach
Business name: Pis 11 k/P„ 4 e r 1 2_4 I i Oi•■ branch circuit 6.65 2
B. Fee for branch circuits
Contact name: -s p_ r(- il1/l p, OA. iir■ without service or feeder fee, 46,85 2
Address: each branch circuit
30 5n S g 11.1A Cj Each add'I branch circuit 6.65 2
City /State/ZIP: NA LS t o / 6e a - 7 12 3 Mlecellaneons (service or feeder not included)
Phone: ( ) 6( 'l 6 I Fax:: (S ) / ' , Z o Pump or irrigation circle 53.40 2
�� l J v Sign or outline lighting 53.40 2
E y Signal dvcuit(s) or limited -
v •;�., , - er -erne
e : ? . •,�i.:: lit- { }.;:, - ' a ; x ' 3i�if,,, ;i -•, -, i .�C_ i k� � ?'r'•'" •tea ..ff" e�'`6 t , . . cum' panel alteraUon, or
e xtension Deacaibe: Page 2 2
Business name: Ail v alt 11 e,, I.a -l't o ,. - -
Address: 36 ' � U 5 . 5 .41-°- Ck Each additional inspection over allowable in any of the above
Aye 1 � - 7 Per inspection 62.50
City/State/ZIP: ii 0 (9'7 /2 3 Investigation per hour (1 hr min) 62.50
Phone: ( Pho ( ) G 4 q . 5-q.2., I ` ax ( Sti? ) 6 q 1 - .6 o Industrial plant per hour 73.75
CCB Lic.: SIG f to I Electrical Lic.: /) 1.v7 t S L e 0, Il 'list:^ :` `=I.: ; :4' ..1.727=, z ;:k ,., ... .
� � �'��� � nc.. • subtotal
S � Suprv. 131ectriciau used Plan review (25% of permit fee)
Print name: •-, f , 1 ,/6 t A+Dn. Date: /? _, r slo
surcharge (8% of permit fee) (z'
` ,' Y' I TOTAL PERMIT FEE
Authorized signature: This permit application expires If a permit Is not obtained within 180
Print name: 3 Pit r ' Ili l Date: & _.) t " •
days alter set y tt � Building I disoy Service Fee methodology s Tri• Hail Indus 3erviceBoatd
J •• Ihanber of insaaatiom net strait allowed
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