Permit CI TY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00333
�I� DEVELOPMENT SERVICES DATE ISSUED: 6/10/2004
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S103CB -11400
SITE ADDRESS: 13482 SW 122ND AVE
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R-4.5
BLOCK: LOT : 072 JURISDICTION: TIG
Project Description: 2 branch circuits for a/c & plug.
Job No. 2898
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: 1 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:
JEFF MALDANADO HILLSBORO ELECTRIC
13482 SW 122ND AVE 21185 NW EVERGREEN PARKWAY
TIGARD, OR 97223 HILLSBORO, OR 97124
Phone: 503 - 524 -1474 Phone: 503 - 439 -9666
Reg #: ELE 34 -4399C
LIC 134481
FEES SUP 49415
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/10/2004 $53.50
[TAX] 8% State Surcharge 6/10/2004 $4 Rough -
Elect'I Final
Total $57.78
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speaalty 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 :10 -3 : -2344
Issued By. ;
Permit Signature:
� �ii . _ ,� � 9
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 7:00pm for an inspection the next business day
From:HILLSBORO ELECTRIC LLC. 5036013680 06/09/2004 08:51 #086 P.002
- - Q, •
Electrical Perm t it Ap , oo y 1:01t 0I :1 1 5u: O \L \'
ReGO' "°� / /
Permit No -:
City of Tigard � Q D ate /Bv l� Q
Ci 05, 1 ' - i i 'V 3
13125 SW Hall Blvd., Tigard, OR X7223 `\ C./I- r Plan Review
Phone: 503.639.4171 Fax; 503. 598.1960 �^c .t‘ , . , '.' Date/By: Other Permit:
Inspection Line: 503.639.4175 O Q\ -!!3 Pate Ready/By: luri: ®See Page t for
lntemet: www.ci.ti( rd.or (,,-� \ _ \C? Notified/Method: Supplements) Information
., \ N REVIEW.
❑ New construction ' Addition/altcration/r lacement - Please check all that apply:
❑ Demolition ❑ Other: ❑Service over 225 amps, comml ❑Hazardous location .
Service over 320 — .
'/...‘ ' -'` CATEGORY OF CONSTRICT
rION ", a ; :: : ' ; :,r:! of I- and 2-family dwellings 4 or mo a new r residential
nli.
1 - 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 D Master builder ❑Other: _ ❑Occupant load over 99 persons DManufactured structures or
- ,.::... RV •
,.,: �: JOB SITE LOCATION • ".:;- ,.:��..` �'':' „''!�.'•. :- ark ❑Egress/lightingplan P
Job no,: j ❑Hearth cart facility ❑Other
' ' I Job site address:' ( � , Submit 2 sets of plans with any of the above.
City /State/ZIP1 11 , o _ 4:172. 7.: � �/� ^� l� The above are not applicable to temporary construction service.
Suite/bldgiapt. no.: Project name: N\ AITA t” ;; F11F.'..SCH$AQLE.;
nescrianoe I Qty. I Fee- i Total 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: . 'I Lot no.: La. add') 500 sq. It or portion 33.40 I
Limited energy, residential 75.00 2 •
Tax map /parcel 75.00 2
.,
[P 1 1V F WORK"
D65CR T O O i.
' 1:i ' "''' Each manufactured or modular
(� 1, Al(' ' AAA /� 1 � dwelling, service and/or feeder 90.90 _ 2
1 lV�?1/ �� l �` 'U` U i Lt VL Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
PROPERTY .QWNR1- 7.''.7 -', ... - .. .❑:TEN.A.: 'n,/•:.',. . ,, r, • : "''
• ,- . X01 am to 400 amps 106.85
40 1 amps to 600 amps 160.60 2
Name Li , i / i la 601 amps to 1,000 amps 240.60 • 2
Address: j/i ^� -s -A� � - Over 1,000ampsor 454.65 2
' ` Reconnect only 66.85 1 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
- ( 1 /+ Fax: ( ) reIoeittion •
Phone: ( �}i 00 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
- -.,
;.,,. . ,.., ... - �.... Fee branch circuits wH
APPLIC �. ; .::`:..,.,... - , : ❑� COl!tTAGi<''IrEYtSONi,;: �:�:- ._,,.�;,,;
service or feeder fee, each 6.65 2
Business name: branch circuit
— B. Fee for branch circuits I
Contact name: wi hom service or feeder fee,
each branch circuit 46,85 2
• Address: Each adel branch circuit l 6.65 (j .0 5 2 ,
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) ( ) Pump or irrigation circle 53-4 2
Fax: •
• - Sign or outline lighting 53.40 - 2 -
E-mail: Signal circuit(s) or limited-
- :. ,,. Q , or
ONTRACT R
Describe: � • extension. Cti - Page 2 2
Business name: Hillsboro Electric L.L.C.
Address: Each additional inspection over allowable in any of the above
271 85 NW Ever- PKWY Ste i 1 • Per inspection 62.50 .
City /State/ZiP: Hillsboro, OR . 971 2 4 Investigation per hour (1 hr min) 62.50
Phone: (503) 439 --9566 Fax:(503 )601 - 3680 industrial playa per hour 73.75 ,
:. •:• ;,' .:.- : :ELECTRICAL 'PERMIT FEES!".." !' :::;
CCB Lic.:1 3 4 4 81 Electrical Lic.:3 4-499C Suprv. Lie.: 4 9 41 S Subtotal t. 51
Sttprv. Electrician signature, required: AIv� �0 r Plan review (25% of pemtit fee)
Print name: Joey Vitacco Date: U[ alay- State su (5% of pcnriit
t TOTAL PERMIT FEE 6-7.--7 �
Authorized signature: This permit amine don expires ifs permit is not obtained within ISO
- days after it has been accepted an complete
Print name: Date: ° Fee methodology net by Tri County Auilding industry Service Board
*4' Number of inspections per permit allowed,
is\ Bonding \PerOtits\2LC- PorreitApP.doe !Vitt 40461Sr(I0/07JCOMIWEB ,
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
it' -� BUP
Received Date Requested �� C AM� PM BUP
Location l3 «8c ) Suite MEC ,2 Dc i
Contact Person / t�Bh ( ) PLM
Contractor Ph ( sd /'/4L7 SWR
BUILDING Tenar ELC 0 Li . 0 a �3
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: 6 o k jvvis cJ' SIT
Post & Beam
Shear Anchors �1 P7 4 0 6 '
Ext Sheath/Shear (��, ' V -1 5 l
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final pi/tilt= i gi- t ,fF
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain // (��s .-
Shower Pan �' J L� c (� v19 cog �" -v pi px
Other:
Final
P T FAIL
MECHANICA
Post & :earn
/�
Rough -In t /
Gas Line
..•.e Dampers L
Fi.-
. PART FAIL
- •T AL
Service
Rough -In c , f t
UG /Slab
Low Voltage
-Eirsit Alarm
Al ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SI ---46 ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date V4 Inspector /44 --1 — A Ext
Other: / � / ^r �
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL