Permit ELECTRICAL PERMIT
CITY OF TIGARD
PERMIT #: ELC2007 -00535
M I I
COMMUNITY DEVELOPMENT
D ATE ISSUED: 8/1/2007
,TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S134DB-10100
SITE ADDRESS: 11279 SW 110TH PL ZONING: R - 4.5
SUBDIVISION: DAKOTA GLEN LOT : 003 JURISDICTION: TIG
PROJECT: SHEIKHLY
Project Description: 1 branch circuit to AC.
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: WISERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 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:
ABBAS A. SHEIKHLY HILLSBORO ELECTRIC
11279 SW 110TH PL 21185 NW EVERGREEN PKWY #110
TIGARD, OR 97223 HILLSBORO, OR 97124
Phone: 503 - 524 - 3449 Contact #: PRI 503 - 439 - 9666
FAX 503 - 601 -3680
FEES
Description Date Amount Reg #: ELE 34 -4399C
[ELPRMT] ELC Permit 8/1/2007 $46.85 LIC 134481
[TAX] 8% State Surcharge 8/1/2007 $3.75 SUP 4941S
Total $50.60 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: — --_ � Permittee Signature: Cy' C.
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.
07- 31 -`07 15:46 FROM- Hillsboro Electric 503 - 601 -3680 T -361 P002/002 F -945
1, 1 ...el lllll .(TN../ U%.wa.aysa • ' ' ( I'.li SI. ) \1.1 •
' City of Tigard Receive.. ,
13125 SW halt Blvd.. Tigard, OR 97223' Y , n Date/By: ' / 67 Permit No.: 1 ,1'F'd U c 4
1 �, e ,17-4- � , Plan Review
Phone: 503.639.417I Pax; 503.598 >1960t, _ . = jJ � ',, /dir r1 , Darts[ : Othe Permit:
Inspection Line; 503.639.4175 _AL; •_ Dates Readyity; fu El See page 2 for
interne: www.ci.tagard,or.us q U 5 0 1 2 n7 Notified/Method; Supplemental Information
'vI
❑ New construction r• .4dditiori%al`tat eplaeement Please check all that apply:
drUlU.i'uNL. d�YCli7 YL6il PP Y
[71 Demolition El Other: ❑Service over 225 amps, comm'I ❑Hazardous location
' • : .... . Service over 320 amps - rating DBuildng over 10,000 sq. ft.,
: . : EGO Y� CONSTRUCT ff N
.' C .T , 0 ' ....... ; : ....:. ' : ; ; :: , .. of 1 - and 2- family dwellings 4 or more new residential
1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
III Multi family [� Master builder ❑Other: OBuilding over three stories ❑Feeders, 400 amps or more
. ,,. ,..:..:::..., :: ..,...:....:�... Oc u ant load over 99
> .:. persons re structures or
�. d
.: �; .:...OBI: O. a , :M
I«<JIT)4 :INF
•• w dC
_ - .........:,:
.: .
. ,:.,:,:: �:.:. �,. , .. , �ii , A..:.�'i i # 19 D..,....... ��1C1 ,.... ....... . . , , .... grass/ligh park
............. , ... ,�'::;::::: ; ;: ;: . ): li ng Pl
RN
Job no.: Job site address: 0--4-1-- ❑Health care facility ❑Other;
5 "7 -7 ` ��� Sw Submit 2 sets of plans with any of the above.
City/State/ZIP :"1 r012_, C'7-7 The above are not applicable to temporary construction service. 1 1 Suite/bldg./apt. no.: ' - ;:,::,::,
4 Descri ties s ;:' k:i:5 ( :I
job Project name; $ New residential single - or multi-family dwelling I 1.'1°1 I •`
Cross street/directions fo ob site: g unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no,; ga• add'l 500 sq. ft. or portion 33,40 1
Tax map /parcel no,: Limit energy, residential 75.00 2
' i:. ,..,, .:.:: ,:.,:., ,,;: T 75,00 2
! H ! Each manufactured or modular
Al / dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
P ... R ,:, amps to 400 amps 10
.. i•:'•! . : 0�)��t` I':Y� O�Ij,VE .; :... .::: ; p 6.85
•.., , . . . TEI� i ;;:.'- : i
%: .: .
'
P 2
... .
• "" ' _ 401 amps to 600 amps 160.60 2
Name: T^ 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; ( ) PAX: ( ) 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:
.: s , :.: . :�.,, ::.;;.: . ..., W', alteration, or extcnnto per panel
i q • :f: :,::,: r e
;:, - :: 'P)C 0•ANTi:i,,;; ; ° ^:: i A. Fee for branch circuits
service or feeder fee, each
Business name: branch circuit 6,65 2
Contact name: B, Fee for branch circuits
without service or feeder fee, t
46,85 Zk 'gam 2
Address: first branch circuit
Each add'' branch circuit 6.65 2
City/State/ZIP; Miscellaneous (service or feeder not included)
Phone: ( ) I p er:: ( ) Pump or irrigation circle
- 53.40 2
Sign or outline lighting 53.40 2
E -mail:
Signal circuit(s) or limited-
, • Ci2D'I`�btA� energy panel, alteration. or
, ::.....:.:..:.... ..... '>C;Cf : ` .. .... ... ..... e
Business name: extension. Describe; Page 2 2
l (, ,I ,� )K) c -tto .,
Address: (A l Q .. U ui J� � ID p any Each additional inspection over allowable in an of the above
Yt - I �, L ' Per inspection 62.5
City / State/ZIP- US � , '/1 \ • r - t Investigation per hour (l hr min) 62.50
Phone: �j 5)t_ r • ' k. Fax: it tt )( D{ • ; 0 Industrial plant per h our 73.75
�J _
t , • •::::;::,:::ElitCTRICAl,' : tli MPT: FE
UL1. Electrical Lie.: ,4 IOU Supra. Lie.: (.,f Is ES'
C CI3 Lic,; \
Subtotal GI ( . $5
Suprv. Electrician signature, required: µ Plan review (25% of permit fee)
•
Print name: Date: State surcharge (8% of permit fee) 3 .1
j /' TOTAL PERMIT PEE SD -
Authori'ced signature: t! This permit application expires If a permit is not obtained within 180
t�� rm
Print Warne; , Date: days after it has been accepted as complete
I • Pee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
iAB uiidisg 1permils \aK.C- PermirApp.dnc i2/Oi 440-46151(1 0/021COM,VHa
CITY OF TIGARD
• BUILDING DIVISION PERMIT #: ELC2007 -Q0535
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/
Phone: (503) 639 -4171 , , i „tt
Inspection Requests (24 Hrs.): (503) 639 -4175 'IL
INSPECTION WORKSHEET FOR DATE: 8/17/2007 TIME: 7:01AM PAGE: 517
SITE ADDRESS: 11279 SW 110TH PL CLASS OF WORK: .
SUBDIVISION: DAKOTA GLEN LOT #: 003 TYPE OF USE:
PROJECT NAME: SHEIKHLY
DESCRIPTION: 1 branch circuit to AC.
OWNER: SHEIKHLY, ABBAS PHONE #: 503- 524 -3449
CONTRACTOR: HILLSBORO ELECTRIC PHONE #: 503 - 439 -9666
Inspection Request Scheduled For: Date: 8/17/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 054211 -01 503- 538 -2953 Y
Corrections /Comments /Instructions:
. t
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
Ii_
❑ FAIL ❑ CALL FOR INSPECTION
461P ❑ ADDITIONAL FEES ASSESSED
D
Inspector: Date: 51// 7 /o? Phone #: � ) 503 718 -
P