Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 - 00822
DEVELOPMENT SERVICES DATE ISSUED: 10/20/2005
°--� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 2S 103 D 6 - 08900
SITE ADDRESS: 11245 SW MORGEN CT ZONING: R - 4.5
SUBDIVISION: GENESIS NO. 3 LOT : 086 JURISDICTION: TIG
Project Description: (2) branch circuits, heat pump & GFI.
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:
MICHAEL WELCH HILLSBORO ELECTRIC
11245 SW MORGEN CT 21185 NW EVERGREEN PKWY #110
TIGARD, OR 97223 HILLSBORO, OR 97124
Phone: 503 - 538 - 2953 Phone: 503 - 439 - 9666
FEES Reg #: ELE 34 -4399C
Description Date Amount LIC 134481
SUP 4941S
• [ELPRMT] ELC Permit 10/20/200' $53.50
[TAX] 8% State Surcharge 10/20/200` $4.28 REQUIRED ITEMS AND REPORTS
Total $57.78
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: ;V Permittee Signature:
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.
10 -20 -' 05 10:43 FROM- Hi11sbN r . - t dc 503 - 601 -3681 —_— T -731 P002/002 F -285
,._=
t,tCC:t.r r crusts. .yl�}ris • �. 1 � ()R OFFICE ltS1•' ONLY
Ciiy of Tigard Rceeived , �2 _
13125 SW Hall Blvd.. Tigard, OR 97 2 3 Date/B : � � ( � j /�� p� / �/�
O � ....11 ..: -!4$111"i" Plun RCVICW
Phone: 503.639.4171 Fax: 503.598.1960
��[[ 2 � Date/6v: Other Permit; .
Inspection Line: 503.639,4175 �,, ap
P Q " - ,� Date i e /thy: 211 See Page? for
Internet: tvww.ci.tigard.or. as 1 ' - Notified/Method:
Supplemental Information
...: TYPE ; �• ..
- •- --D.,' :' PLAN REVIEW
❑ New construction ErAdAiiki�t let s . replacement Please check all that apply;
❑ Demolition ❑ Ot r: ve 225 amps, co 'I ❑Hazardous location
❑Serviced over comm
'l
over 320 amps - rating ❑ Buildng over 10.000 sq. ft..
• • CATEGORY OP CONSTRt1CTION 1. r • • • ' ' _ of I. and 2- family dwellings 4 or more new residential
Eh and 2- family dwelling ❑ Conlntercial /industrial ❑ Accessory building ❑System over 600 votts.nominal units in one structure
❑Building over three stories ['Feeders, 400 amps or more
D Multi- family ❑ Master builder ❑ Other:
urc
• ' ` JO Sn'E INFORMTION : ' A NI'1 LOCATION' : :: ti b plan persons ❑ RV par t
.• .:;..... � :: • .. : .:, . A
... ' . ; . ❑E gress/ligh d st uctures or
r99 r
Job no,: i 'L Job site address: II ip U , / /A .tom ❑Health.care facility ❑Other
/1 • Submit 2 sets of plans with any of the above,
City/State/ZIP:1 y / F 4>- 011' j T The above are not applicable to temporary construction service,
Suite/bldg. /apt. no.: Project name: WGIG0 `; . . . . .. Pte* SCHED,IL$ r'. `:
•• De scription . . 1 Qty" L Fee 1
,..' ., :.: Tot4l "
Crass street/directions to job site: New residential single- or multi- family dwelling unit.
•
Includes attached garage.
•
• 1,000 sq, It, or less 145,15 4
Subdivision: Lot no.: Ea. add'l 500 sq, R. or portion 33.40 i
-
Tax map /parcel no.: Limited energy, residential 75.00 2 •
:.., : ..::.: energy, non residential 75.00 2
DESCRIPTION OF W ; • .r -Y.;
Limited
• - • - � � • � Each manufactured or modular
dwelling, service and/or leader 90.90 , 2
Services or feeders installation, alterat and/or relocation
amps or less 80.30
ROPERTY:OWNER ," •.' ■ TE tips to 400 amps 106.85
kh t - , 401 amps to 600 amps 160.60 2
Name: V1 /�.l�n
601 amps to 1,000 amps 240,60 2
Address; Yk� -d IM A S • - 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: ( ( % � 4..1 Fax: ( ) relocation
J 200 amps or less . 66.85 1
Owner installation: This installation is being made on property that 1 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 s 133.75 2
Owner signature: Date: ' Branch circuits - new, alteration, or extension, per panel
.
,..., • ..... , icy: • . • . A P CA
P t NT.:; ^ ? ; . `,:� : :,.;, , _ :: �;::.❑ A. Fee fo b
• ....:, ...• ❑` .... ... .,�� (; ONTA 'PE %i,:, -,;, ranch cirduitswith
service or feeder fee, each •
Business name: , _ branch circuit
_ 6.65
Contact name: - B. Fee for branch circuits
wittnin/ service or feeder fee, I 46.85 ' W x 2
Address: • each branch circuit _
-• Each add'l branch circuit 1 6.65_ (Q ,� 2
City /State/ZIP: Miscellaneous (service or feeder not included)
Phone: Pump or irrigation circle 5140 2
( ) Fax: ( )
Sign or outline lighting 53.40 2
E - mail; Signal circuit(s) or limited-
' "'1 i :. ' 'CONTRACTOR " - energy Panel, alteration, or
extension, Describe: Page 2 2
Business name' Hillsboro El ec tric L. L.C_ _
Address: 21185 NW Evergreen PKWY Ste #110 Each additional inspection over allowable in any of the above
Per inspection 62.50
City/ State/ZiP: Hillsboro, OR. 97124 investigation per hour (1 hr min) • 6150
Phone: (503) 439 Fax: •(5 0 3)601 industrial plant per hour 73.75
' ELECTRICAL :PERiVIIT FEES* •
CCB Lic.;1 3 4 4 81 Electrical Lic.:3 4 - 4 9 9 0 Suprv, Lic.: 4941s Subtotal 2, ��
Suprv, Electrician signature, required: . ....._.....• Plan review (25"%ofpermit fee)
Print name: Joey Vi tiacco , Date: 14 t o' D< State surcharge (8% of permit fee) L-
L� TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained ISO
days after it has been accepted as complete
Print name: . Date: • Fee methodology set by Tri- County Building Industry Service Board
" Number of inspections per permit allowed
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