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Permit CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2005 -00476 1li , tbiE ELOPMENT SERVICES DATE ISSUED: 7/6/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S103DA -06400 SITE ADDRESS: 13300 SW 110TH AVE ZONING: R - 4.5 SUBDIVISION: MIRA PARK LOT : 002 JURISDICTION: TIG Project Description: Installation of (3) branch circuits for a /c, furnace & GFI. Job No. 3264 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: 2 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: PERRAULT, STEPHEN & KIM HILLSBORO ELECTRIC 13300 SW 110TH AVE 21185 NW EVERGREEN PARKWAY TIGARD, OR 97223 HILLSBORO, OR 97124 Phone: 503- 639 -5726 Phone: 503 - 439 -9666 FEES Reg #: ELE 34 -4399C LIC 134481 Description Date Amount SUP 4941S [ELPRMT] ELC Permit 7/6/2005 $60.15 [TAX] 8% State Surcharge 7/6/2005 $4.81 REQUIRED ITEMS AND REPORTS Total $64.96 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spedalty 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 suspend than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules set forth in OA' 95 101 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questio s to OUNC at 503 -2 6 -6699 or 1-800-31 -234• Issue By: � �� i� .� Permittee Signatu , OWNER INSTALLATION 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 -41111 d SIGNATURE OF SUPR. ELEC'ka '� /�' r �� 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. From:HILLSBOR0 ELE LLC. 5036013680 07/01/2005 16:56 4973 P.002 t. Electrical Permit Application . . FOR OIFFICE 1`1SE ONlY Ciy of Tigard d UL 0 2U f Received � � M / Perm No.: 5 -'O� 76 City Data /Bv: 7�.7 ♦ 13 )25 SW Roll Blvd -, Tigard,- OR- \ TIGA(�® plan Review / Phone: 503,639,4171 Fax: 1 503 1 .598 - 19 60 D `V' i� ", i M"j � ' Dare /8v; Other Pennit: Inspection Line: 503.639.413' JtLd�NU n.... t Data Ready /By: BJ Sec rage for Internet: www.ci.tigard.or.us Notified /Method: Supplentental Information 1'Pe OF WORK ., • ' • • . • ' PLAN REVIEW " ❑ New const ructionddition /alteration/repiacement Please checl; all that apply OService over 225 amps, comm'l ❑Hazardous location [] Demolition ❑Other: ❑Service over 320 amps — rating CIBuildng over 10,000 sq. ft.. CATEGORY OF CONSTRUCTION • • • .•' ` '' of 1- and 2- family dwellings 4 or more new residential ICJ 1- and 2- family dwelling © Commercial /industrial ❑ Ac cessory building ❑System over 600 volts nominal units in one structure Q Multi - family © Master builder CI other: ❑Building over three stories ❑Fecdcrs, 400 amps or more ❑Occupant load over 99 persons El Manufactured structures or ' JOB SITE INFORMATION AND LOCATION : :•'.,...*.: ' . :Egress/lighting plan RV park $ OHealth -care facility ❑Other: _ Job no.: jr / Job site address: 1 OD I 1 r l' .. sets of plans with any of the above. City /State/ZIP: ' • applicable to temporary construction service. J ner� abo are not appl FGE ". SCHEAC7J >E t Suitc /bldg. /apt- no.: Project name: { at. l • pd i Qty. I Pee. 1 Tate! L — 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: Lot Q. Ea. addl 500 so, ft. or portion 33.40 t Limited energy „residential 75.00 2 Tax snap /parcel no.: Limited energy, non- residential 75.00 2 r .. ,...%•,..”' • ,: . • . DESCRIPTION OF WORK ;a .". % :,:;rbi.:,:;, ' D ESC Each manufactured or modular dwelling, service and/or feeder 90.90 2 .s Servi or feeders instaFiution. alteration, sad /or relocation 300 a mpsort -- or less 80.30 • t..... 201 amps to 400 amps ' 106.85 2 ' Ti ..PROPERTY OWNER' :''.,'. ; ;.. TENANT:';';::'.'.. — • 401 amps to 600 amps 160.60 2 Name: M� 4 .601 amps to 1.000 amps 240.60 2 S n L A ' I% �1 . Over 1,000 amps or votes 454.65 2 Address: (/� y � Reconnect only 66.85 2 City/State/ZIP: r S7 __ ; Temporary services or feeders installation, alteration, and /or relocation .. Fax ( ) Phone: ( r' � ttra - 200 amps Or leas I 66.85 1 Owner insts Cation: 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: _ Brandt circuits — new, alteration, or extension, per panel _ ...,..,. ❑ APPLICANT .:....•::...... . . . :` `:❑ CONTACT T'7CRSON,;:' >: "t::�:I;'';.: A Fee for branch circuits with ' ' service or feeder fee, each 6.65 2 Business name: � branch circuit _ _ _ B. Pee for branch circuits Contact name: without service or feeder fee, each branch circuit 46.85 2 Address: Each add`I branch circuit � 6 "65 17). 2 City/Stale/ZIP: Miscellaneous (service or feeder not included) — Phone: ( ) Pump or irrigation circle 53.40 2 Fax: Sign or outline lighting 53.40 2 E-mail: • Signal circuit(s) or limited- .. r :..,, ,... ......: •. 'CONTRACTOR' ' '_;';' ..... ,. energy Sane • , alteration, o r extension. Describe: Page 2 2 Business name: Hillsboro Electric L.L.C. _ - Address: 21185 NW Evercfreerl PKWY Ste Each additional inspection over allowable in any of the shove 1 9 _ P er inspection 62.50 City/State/ZIP: Hillsboro, OR . 97124 investigation per hour (I hr min) 62.50 Phone: (5 0 3) 439-9666 FaX (5 0 3) 6 01 - 3 6 8 0 Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* • cce L.ic.:1 344 81 E lectrical Lic.:34 -499C Suprv. Lie.: 49415 5 Subtotal ego• Is Suprv. Electrician signature, required: 1 _ ../ Plan review (25% of permit fee) Print name: Joey V1 t 1 C CO / D ate: � State surcharge (8% of permit fee) ; a( TOTAL PERMIT FEE! 11° Authorized signature: This permit application copiree ifs permit Is nat abtained within t8n days lifter it Ins bean accepted as complete Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board • "• Number of inspections per permit allowed. i;t gilding \PcruSIla1.C- PormitAPp.dac I2 /tO 44iI4(1ST110/02/C:UM/WE© . CITY OF TIGARD BUILDING DIVISION PERMIT #: ELC2005.00476 1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/6/2005 Phone: (503) 639 -4171 in$ Inspection Requests (24 Hrs.): (503) 639 -4175 L . K .L4 = IL INSPECTION WORKSHEET FOR DATE: 7/2 #06 TIME: 7 :12AM PAGE: 60 SITE ADDRESS: 13300 SW 110TH AVE CLASS OF WORK: SUBDIVISION: MIRA PARK LOT #: 002 TYPE OF USE: PROJECT NAME: PERRAULT ' DESCRIPTION: Installation of (3) branch circuits for a/c; furnace & CFI. Job No. 3264 OWNER: PERRAULT, STEPHEN & KIM, PHONE #: 503- 639 -5726 CONTRACTOR: HILLSBORO ELECTRIC PHONE #: 503 - 439 -9866 Inspection Request Scheduled For: Date: 7125/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 011994 -02 503 -536 -2953 Y Corrections /Comments / Instructions: ill i:52) -- Pu j e_ 1 P Kf< .. ..:co A-M kit- - p u P'! - v % [ a / ti ' •- a 4-7 f e .. I Sc a//n/c? 6.7i o i+v\r 54T t I i )--- • PASS 1 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL F C FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector. Date: 72-C-6 Phone #: (503) 718 - r