Permit ELECTRICAL PERMIT -
C ITY O TI GARD RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT #: ELR2004 -00140
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/1/2004
SITE ADDRESS: 12072 SW WHISTLER'S LP PARCEL: 2S103CC -WW277
SUBDIVISION: WHISTLER'S WALK NO. 2 ZONING: R -4.5
BLOCK: LOT: 077 JURISDICTION: TIG
Project Description: Low voltage: alarm system.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: 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: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
DON MORISSETTE HOMES INC PROTECTION ONE ALARM MONITORIN
4230 SW GALEWOOD ST 100 15500 SW 72ND AVE
LAKE OSWEGO, OR 97034 PORTLAND, OR 97224
Phone: Phone: 624 - 0244
Reg #: ELE 34- 428CCLE
LIC 116325
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 6/1/2004 $75.00 Elect'I Final
[TAX] 8% State Surchart 6/1/2004 $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 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
Issued by �s • 6 _ ' � Permittee Signature x ,
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
E1ettrical Permit Application FOR OFFICE USE ONLY
l. i
lty of Tigard
Date/B Permit No .C� e )o L f -4 Q(�/ 7 0 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone. 503.639.4171 Fax. 503.598.1960 i, , I � i .r Date/B Other Permit
Inspection Line 503.639.4175 e' Date Ready /By: Kai ® See Page 2 for
Internet: www.ci.tigard.or us Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction • Addition/alteration/replacement Please check all that apply:
❑ Demolition ! her: ❑Service over 225 amps, comm'l ['Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
LJ - and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure ❑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
QQ�� Job site address: /a01(9.54) facility ❑Other:
Job no.:
t6361,53 Sao ..54) � Submit 2 sets of plans with any of the above.
City /State/ZIP: T'j y C9e- F 1 .7t, The above are not applicable to temporary construction service.
Sul te/bldg. /apt. no.: Project name: • i��Qo FEE* SCHEDULE
�• « 1 ' 4V '{ "^ Q Description I Qty. I Fee. I Total I **
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145 15 4
Subdivision: I Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
��
dwelling, rfee service feeder 90.90 2
Services es or feeders rs installation, alteration, and/or relocation
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
12 PROPERTY OWNER I ❑TENANT
401 amps to 600 amps 160.60 2
Name: 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
Phone: ( ) I F ax: ( ) relocation
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 6.65 2
Business name: (62/0 branch circuit
Contact name: I o8 3u) 'lv` p � #1a B without for service circuits
� 1 without service or feeder fee, 46 85 2
{ yY.� I ?16� l �
each bra ci
Address:
'„" ' ale 1 - Each add'I branch circuit 6.65 2
City /State/ZIP: Miscellaneous (service or feeder not included)
` ' _ � V � I dn t v l ,�',3 ^3 _� Pump or imgation circle 53.40 2
Phone: "� 1 Fax:: `-'l "I '-(
Sign or outline lighting 53 40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
�� ce✓ extension. Describe Page 2 2
Business name:
Address: Each additional inspection over allowable in any of the above
Per inspection 62 50
City / State/ZIP Investigation per hour (1 hr min) 62 50
Phone: ( ) f/� I Fax: ( id. I Dli Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.:O 1 p Electncal Lic.:34_t1agaeSuprv. Lic.: Subtotal 15 t 00
Suprv. Electrician signature, required: �" 4 Plan review (25% of permit fee)
Print name: Date. State surcharge (8% of permit fee) Co r Cad
TOTAL PERMIT FEE 15 ( wv
Authorized signature This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board
** Number of inspections per permit allowed.
i \Building\Pemuts\ELC- PenmtApp doc 12/03 440- 4615T(10/02 /COM/WEB