Permit • r CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00392
��i DEVELOPMENT SERVICES DATE ISSUED: 6/8/2005
�'! 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2 S 110 B B -05900
SITE ADDRESS: 14199 SW 120TH PL ZONING: R -4.5
SUBDIVISION: REDWOOD VISTA LOT : 001 JURISDICTION: TIG
Project Description: (3) branch circuits.
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:
MONTY WISEMAN HILLSBORO ELECTRIC
14199 SW 120TH PL 21185 NW EVERGREEN PARKWAY
TIGARD, OR 97223 HILLSBORO, OR 97124
Phone: 503 - 620 -0129 Phone: 503 - 439 -9666
FEES Reg #: ELE 34 -4399C
Description Date Amount LIC 134481
SUP 4941S
[ELPRMT] ELC Permit 6/8/2005 $60.15
[TAX] 8% State Surcharge 6/8/2005 $4.82 REQUIRED ITEMS AND REPORTS
Total $64.97
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: zz_cA t Permittee Signature: 52..-C, pl
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.
F rorn : HILLSBORO ELECTRIC LLC. 5036013680 06/07/2005 16:17 #771 P.002 •
'Electrical Permit App1 j E I c►r•1(It :L USE ONLY
u
City of Tigard �'� Received :. A 6 , �' � L L�C��!/d . "
Date /Qv: P e rmit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
0 Phone: 503.639.41 71 Fax: 503,598,19600A lY � � iii( Date/B . Other Permit
Inspection Line: 503.639.4175 1 .1GARCz* „ i N 7 oti atc fied /Metho koady/eyd $upplementa1 Information
: M Sec Pnge2 fair
Internet: www.ci.tigard.or,us Ci�� 0F o Y- � f �tttlg{ ® _
_ P " E f : ' .. PLAN REVIEW •
❑ New construction Addition /aiteration/replaoement Plcaae check all that apply:
Service over 225 amps. eomm'I ❑Hazardous location
❑ Demolition ❑ Other: ['Service over 320 amps - rating DBuildng over 10,000 sq, R„
• CATEGORY OF CONSTRUCTION .... ' .. of 1- and 2- family dwellings 4 or more new residential •
121< and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi family I=1 Maslerbuilder ❑ Other:
['Occupant load over 99 persons EManufactured structures or
.. JOB SITE INFORMATION AND LOCATION . •. • : DEgress/lighting plan RV park
Job no.: lob site address: i I / '. i - --- 2 AI 4��
❑Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City/State/ZIP: i , / �, ' / - r r The above are not applicable to temporary construction service. .
Suite /bldg,/apt. no,: Project name: VVI `^ ....... l:Irlr SCHEDULE.... �. . ..
Description I Qty. I Fee. I Total + a *
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 no.: Ea, add'! 500 sq. ft. or portion 33.40 1
Limited ener!' , residential 75.00 2
Tax map /parcel no.: _ Limited energy, non - residential 75,00 2
••.'
� � . � . � � modular • .. • ::..: DESCRIPTION OP WORK .:,.w : : :... :_� : : �
:: . ° � : �.. :�'�'' :1'� .::.:`::. ;. :�' ;: Each man ufactured or m
dwelling, service and /or feeder 90.90 2
t l) . kr 4, / .A—.' _ ! r Services or feeders Installation, alteration, and /or relocation
200 amps or less ! 8 2
...:..,.. PRO P1!✓RTY OFVNER `: '..:.'‘::%.."'..!'.: : ,,,. ;. : , . .... TENANT : : ; ;�! ,...: ;, ° �: :, ,.,':..:;:::.•: 201 amps to 400 amps 106.85 2
❑ :.� 401 amps to 600 amps 160.60 2
Name: t Ali 4 A 1 . 'A / 601 amps to 1,000 amps 240.60 2
Address: i / /)A °. Over 1,000 amps or volts 454,65 2
Reconnect only 66.85 2
Ci ty/State/ZIP: Temporary services or feeders installation, alteration. and /or
2D D ^ ` F relocation
Phone: / L ( 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 7
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701 401 amps to 600 amps • 133.75 ?
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
:..: :., ::.;.•:,:::: ❑'APP ICANT ,, . ,,,. , , : : : ; : = ::::`.°..:. ;. , : :❑ CONTACT • PERSON': ` : .�: ; - :; h
A Fee for branch etmufts with , ,. , : 'service or feeder fee, eac
6,65 2
Business name: branch circuit -
B, Fee for branch circuits
•
Contact name: wllhuul service or feeder fee, I 45.85 14j S' 2
each branch Circuit
Address: Each add'l branch circuit 6,65 I% .
City / State/21P: Miscellaneous (service or feeder t included) !!
Pump or irrigation circle 53,40 2
Phone: ( ) Fax: : ( ) Sign or outline lighting $3,40 2
E -mail: Signal circuit(s) or limited-
.. :::-:.- '..' „,,, CONTRACTOR ' :'.:.: _ -_ •. >'; . ` : : :. • .:. • . -:., ., ..;., ;..: •••;:::
energy panel. alteration, or
extension. Describe: Page 2 2
Business name :Hillsboro Electric L L C -
Address: Each additional inspection over allowable in any of the above
21 1 8 5 I:dW Evercireen PKWY Ste # 1 1 0 _ Per inspection 62,50
City/State/ZIP: Hill sboro , OR. 97124 Investigation per hour (I hr min) 62.50 ,
Phone: (5 0 3) 439-9666 Fax: (5 0 3)601-3680 industrial plant per hour _ 73.75
NGRMIT
CCB Lic.:1 3 4 4 81 Electrical Lic. :3 4-499C Suprv. Lie.: 4941 S Ei:ECTR FEES" Subtotal 1 U'
•
Suprv. Electrician signature, required: . pJs? 4, Plan review (25%ofpermit fee) 4 ^� —
Date: 1 9 ' w State surcharge (8% of permit fee) - � Print name: Joe Y Vita lV 11)5----
G�
TOTAL PERMIT FEE
Authorized signature: This permit application expires ifa permit Is not obtained within ISO
days after it has boon accepted as cumplete
Print name: • Date: . Fee methodology set by Tri- County Building industry Service Board
. - ' * Number of inspections per permit allowed.
i;\ nuilding \Pennnrls \ELC- Pormi1App,doc IV/bn 4411.4615T(l0A02 /CUMFWEa
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005 -00392
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/6/2005
Phone: (503) 639 -4171 A �-� e 4gliiiipy l)I0 l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/17/2005 TIME: 7:11AM PAGE: 40
SITE ADDRESS: 14199 SW 120TH PL CLASS OF WORK:
SUBDIVISION: REDWOOD VISTA LOT #: 001 TYPE OF USE:
PROJECT NAME: WISEMAN
DESCRIPTION: (3) branch circuits.
OWNER: W1SEMAN, MONTY PHONE #: 503 - 620-0129
CONTRACTOR: HILLSBORO ELECTRIC _ PHONE #: 503 - 439~9666
'•1be
Inspection Request Scheduled For: Date: 6/17/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 009571 -02 503 -530 -2953 Y
Corrections /Comments /Instructions:
1 . 7
•
P
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL r1-- CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 6-11- Phone #: (503) 718-