Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2007 00308
COMMUNITY DEVELOPMENT DATE ISSUED: 5/4/2007
TD I�GA.R SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S1 10 B B -05500
SITE ADDRESS: 14210 SW 121ST AVE ZONING: R - 3.5
SUBDIVISION: ARLINGTON RIDGE LOT : 032 JURISDICTION: TIG
PROJECT: HOSMAN
Project Description: Branch circuits (4).
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 3 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
TILLEY, BRUCE L + KERI A LITE -RITE ELECTRICAL
14210 SW 121ST AVE 28820 SW BURKHALTER RD
TIGARD, OR 97224 HILLSBORO, OR 97123
Phone: Contact #: PRI 503 - 693 -9775
FAX 503 - 963 -9775
FEES
Description Date Amount Reg #: ELE 34 -358C
[ELPRMT] ELC Permit 5/4/2007 $66.80 LIC 89854
[TAX] 8% State Surcharge 5/4/2007 $5.34 SUP 4041 S
Total $72.14 REQUIRED ITEMS AND REPORTS
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 or 1.800.332.2344.
Issued By: f / / ` / .•/� Permittee Signature: S"-- Hp, p i lcP -h )
1 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 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.
Tigard, O
"'•triC1 Permit Application - - FOROFFICCYlSCO1�LY
T. j ag Received y �� �
s11' Permit No.: .L.c _ S
lvd., OR 97223 ltt Pl Re '- "'" -'',
li � y Flan Revew
Phi. a Other Permit:
: ;03.. , 9.a171 Fax: 503.598.19ti0 411* .Qiinii__ELate.
Clat e,Re .
In spection Line: 503.639.4175 ' jl '4 - ^ I1 - • . -yUpty Ready/ be it: 51 Sec Page 2 for
Internet: www•ci- tieatd,or•us ed;Ntethod' ---. Supplemental Infurmatin
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�. .L,.. .y „ } '�' ..._s... ... . • ., •�A°i :•�: �:�4`l %i"t' `•.' y.V ^� • � ,..� ..i =+� e, .. , . �., • El New construction 1 Ig Additionlalterition/re placement Please check all that apply:
320 a
Demol.iti0zi ❑ OtOther: ❑Service over 225 amps, comm'i ❑ Hazardou s location
:.; ,... r.,,, .t... r1Gr• •?! _ •. r..�.• �,,. ' ,
.. ❑Service over' amps rating ❑Eluildng over 10,000 sq. ft
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�''" r ,.{{ JJ My. :;; �.d`A',. �- 5::... .,�,,.� � .,r.:,...'„•: ?rd::i4'f•.':':c,� :.':"i�•i`=`"L;.': �•lF;t Of 1• and 2 dwellin or more residential new • I -$ �� :n,5 ";1,r ^Y'a�,.i�!'A rr ,. " Y�` a
SW 1- and 2- family dwelling ❑ Commercial/industrial 0 Accessory building ❑System over 600 volts nominal units in one structure
QBuilding over three stories ❑.Feeders, 400 amps or more
0 Multi-family Master builder 0 Other r Manufactur d structures or
Y � r .,� ❑Occupant load over 99 persons ❑
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.r;'` `� , J.O.I" S�'tiTP'1', uC{ tU1m'skTi'IO I;.O.Gt :./t1 ��; r
t 5 :„t;N ❑Bigress /lightinb RV. park
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❑ Health -cure facility ter: _
lob no.: y4w Job site address:�� . �� S /i f jig/ _ Submit 2 sets ofplans with any of the above.
City/State/ZIP: e / / N! The above are not applicable to temporary construction service.
Suitc/bldg. /apt no.. mj J:J ?� r . 4J;P ?
P act name: IAG417 = iy= U b .1. Imo' 'rival ,,, 1 Q. 1 Fie. Total - „ '•
Cross street/directions to job site: b'r.^ New residential single- or atniti- family dwelling unit.
Includes attached garage. ___
_ -- 1,000 sq. ft• or less 145.15 4
- -
Subdivision: Lot no.: Ea. add'I 500 aq. ft. or portion 33.40 I
Limited energy, residential ' v...'''.'-.,,.....';.;:...:;a:; - 75.00 2
Tax map/parcel no. 75.00 - 2
Limited energy, non - residential
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�
t dwellin _, service and/or feeder 90.90 _ 2
4 f. 66 CC.. _ '° _ a W Services or feeders installation, alteration, and /or relocation
200 amps or less - 80.30 2
-; *, l ', x r:' _ °' * "="• 201 amps to 400 ants 106.55 2
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4; x 1 r , t.. ,• 1:1Z . ^;�1 { .,, ' 401' amps to ti00 a mps 160.60 - .�. 2
Name: rt 601 amps to 1,000 amps 240,60 2
Address: \ W 1 1 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: ) 200 amps or leas 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 salc, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 441 amps to 600 amps 133.75 I 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per pa net
. ;r•.: r •• , t ,,, • TT nn t, ,• '_ :"•*';;s �i�; �,r.� �:�:� � 7� i , �,.':. . , A. Hee for branch circuits with
:r¢ �!: •c� L'' -,r pl....TrY"l!t'h: � 7.i • ,'', "'.. t .k.sza � L r . „l, ; :'t. iS�VN • • , .� �,,Yr.'r:. . ser vice or feeder fee each 2
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;..,;... 6,65
Busincss name; branch circuit
B. Fcc for branch circuits
Contact name! wit /lout service or feeder fcc,
/
46.115 2
Address: each branch circuit ,/
Each add'l branch circuit ..3 6.65 lJ 7✓ 2
City /State/ZIP: Miscellaneous (service or feeder not included) //
Phone: ( ) Nax:: ( ) Pump or inigation circle 53.40 2
• Sign or outline lighting 5140 2
E -mail: Sigriul circuit(s) or limited-
a: ,Z, r .: ..,,: ..r V'''q. ; ' - ^ .W .".:7: energy panel, alteration, or
. 5 .', ; . ,?.%.1 ;i
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extension. Describe: Page 2 2
Business name Z 2/F f - ' / /g1 / . / -
Address:
1 Each additional inspection over allowable in any of the above
I* r. a . If. ' 1, , . 1 /i / / Per inspection ..� 62.50
Cit /Sttltc/ZIP: ' e. / Investigation hi nun) 62.50
y ,‘ _ / 00 e per hnur (i p
Industrial plant per hour 73.75
jj - / / Pax: .4 ) , O 54 Ltriciii,ie.: - - Supt.. Lie,: Subtotal __4/
Suprv. EIectrician signature, requir = T � y Plan review (25% of permit fee)
rle i/ ,', / � .� � !ly
Print ram . I / . D,.: Sate surcharge (8% of permit fcc) -.
�� .. - ^� TOTAL PERMIT FEE -
Authorized signature: 'li ��� �- This permit application explren if a permit is not obtai t within IRO -
� - - days after it has been accepted as complete
Print ram : !/ 7, i Date: - 9 7 • Fee niethodolotri set by Tri.Cnunly [loading Industry Service Board
•' Number of inspections per permit allowed,
i :lltuildianPumiry \ELC- PermiiAppAtw 17f01 440 4615T(10/021COWVaits
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CITY OF TIGAR®
BUILDING DIVISION PERMIT #: ELC2007 -00308
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/4/2007
Phone: (503) 639- 4171 ;����+�
Inspection Requests (24 Hrs.): (503) 639 - 4175! __..
INSPECTION WORKSHEET FOR DATE: . 5/2212007 TIME: 7:01A11 PAGE: 34
SITE ADDRESS: 14210 SW 121ST AVE CLASS OF WORK:
SUBDIVISION: ARLINGTON RIDGE LOT #: 032 TYPE OF USE:
PROJECT NAME: HOSMAN
DESCRIPTION: Branch circuits (4).
OWNER: TILLEY, BRUCE L + KERI A, PHONE #:
CONTRACTOR: LITE -RITE ELECTRICAL PHONE #: 503-693-9775
' Inspection Request Scheduled For: Date: 5/22/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
125 Walll coveer 048802 -01 503.706 -7333 Y
1 Z'D r� /
cSS 1 1 PARTIAL APPROVAL CANCEL ❑ NO ACCESS
n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: • t Date: 2 Phone #: (503) 718- %TX