Permit A:4 , CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00127
VI
DEVELOPMENT SERVICES DATE ISSUED: 3/18/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S134AC -02604
SITE ADDRESS: 11375 SW COTTONWOOD LN ZONING: R-4.5
SUBDIVISION: ENGLEWOOD NO.3
BLOCK: LOT : 161 JURISDICTION: TIG
Project Description: Install (2) 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: 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:
BOESCH, MARK L HILLSBORO ELECTRIC
LINDENBERGER, BARBARA H 21185 NW EVERGREEN PARKWAY
11375 SW COTTONWOOD LANE HILLSBORO, OR 97124
TIGARD, OR 97223
Phone: 503 - 590 -3232 Phone: 503 - 439 -9666
Reg #: ELE 34 -4399C
LIC 134481
FEES SUP 4941S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 3/18/04 $53.50
[TAX] 8% State Surcharge 3/18/04 $4.28 Rough -
Elect'I Final
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- 3
Issued By: Permit Signature: QA/ / 97 0 / 7 1- I C4
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: D 470,0 . �776 DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
•
F r om : H I LLSBORO ELECTRIC LLC . 5036013680 03/17/2004 15 : 35 #270 P002
-1 -
Electrical Permit A i ea
"EZEIVED FOT1 OFFICE 11',t ONLY.
City of Tigard MAR 1 7 2004 0 Received ,.. A .
Date/B : —, if 7 4441 Perna hi
.. V- Oa/ , 2 7
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie
Phone: 503439.4171 Fa: • 503.598.196D, 4 '4 0 Date/I3 v Other Permit:
Inspection Line: 503,639.4175 LA i Y OF TIGARD, ) .4. A li \ Date Ready/By: y/By: Jurte: 65 See Page; for
Internet; www.ci.tigard.or.us BUILDING DIVISI • . Norified/Method; Supplemental Information
.,--
- '''.. :";...... '.. • • • .: . • . .: ' TYPE' OF WORK :: ...1 , :: :::',:.;.:::, . ::'•: :. :: :•'''' • ' . •.!.:.: .. REVIEW • :• .... :.. • -:••••• :. ': ::,.. .
0 New construction A dditiOn/alterationircplaceMent . please check all that apply:
0
°Service over 225 amps, comm'l OHazardous location
Demolition Other:
. EService over 320 amps - rating 1:113uildrig over 10,000 so, ft.,
• • • • . • .CATEGQRY OF CONSTRUCTION ••••:':::.:•::.::::; ''' • . . i• • ' :•::. : of 1 - and 2-family dwellings 4 or more new residential
and 2-family dwelling E Commercial/industrial 1:1 Accessory building . . ElSystern over 600 volts nominal units in one structure
I:Building over three stories laeeders, 400 amps or more
0 Multi-family 0 Master builder 0 Oth Occupant load over 99 persons ['manufactured structures or
.-. . El
. : ::.•,• .:. :.:..:! ',..• • „ ' JOU SITE INFORMATION AND 'LO :: • .H.::: '' ••• ' : ''''••'?•' CEgress/lighting plan RV park
Job no.: 1jj Job site address: t t31; St4 CONY A ( . I:Health-care facility 170ther:
l..____ Submit 2 sets of plans with any Of the above.
City/State/ZIP:1 i ? r17;t
vet Cie (9-) _
The above are not applicable to temporary construction service,
f .......;::.:.:..i:;;.::- ,
: '''.' ;.:•.:.: .FEEf.". SC.HED101.1 ::' .':::. • ''. ::;:.
Suite/bldg./apt. no.: Project name: cr 0
, .....,... 1 01Y. I Fee- [ Total I "
Cross street/directions to job site: . New residential sinile or multi dwelling unit,
Includes attached garage.
•
. . 1,000 sq. ft. or less 145,15 4
•
Subdivision: • Lot no,: Ea..addi 500 sq. ft. or portion 33.40 1
Limited energy, residential • 75,00 2 •
Tax map/parcel no.: . ,.. , Limited energy. non-residential 75.00 2
.•••....•-,..-.•!.• .:,... :;:•... ..., .::• •• ,, :: :,, •,,,:.
DESCRIPTION OF wot.iS...,:i;$:;.;: Each manufactured or modular
i(Vii • a 04, (Jr 1 r ?‘11:11/2 lAVI•d / n, a ion
dwelling, service and/or feeder 90.90 2
Services or feeders installatio alter andio reIocio
0 200 amps or less 80.30 2
.•:: ';:.::!:'' 1 " RTY: OVVNER.: ':...:,..''!";::: :S. ' II= TENk4T :..''':.;. '''1:•:t2;%!...'..::..:2::' 201 amps to 400 amps 106.85 2
N
Name: .. u \-- A vv.,,., „ c 7 xi . e.)coi
. • • • • 401 amps to 600 amps 160,60 2
601 amps to 1,000 amps
240.60
2
Address: 50111A t) 715 /1 Ye) . 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; (562? gi 0 ' 37 Fax: ( ) relocation
200 amps or less t 66,51 . _ 1 _
Owner instal tion: 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 - 133.75 2
Owner signature: • Date: Branch circuits- new, alteration, or extension, per panel
.::.:-;f .'. 0 -.APeilq :.: ;'. RI .:CONTACT.:PERS6N•;A:!i..:0;:°:i:: A . Fee for branch cirouits with
service or feeder fee, each 6.65 • ')
Business name: IJ
— B. Pee for branch circuits •
Contact name: without service or feeder fee, 1 46.85 /4/ 35 2
— each branch circuit
Address: •
_ . Each add'l branch circuit I 6.65 II . AO
City/State/ZIP; Miscellaneous (service or feeder not Included
Pump or irrigation circle 53,40 2
Phone: ( ) . Fax: : ( )
, Sign or outline lighting 53.40 2
E-mail: . • Signal circuit(s) or limited-
' '' :':' •••• ::r.::•• :•i - • •::- .• • :;• .:•• :::* .. • ' CONTRACTOR :..:::,-:::•••:.,....,.;...:.:,::!: :.:!•:':.::::''.; ..• •••••.••••••••• ....• .% , energy panel alteration, or
, .••.. • ... _ ,.. . extension. Describe: Page 2 2
Business name: Hillsboro Electric L. li . C .
Each additional inspection over allowable in any of the above
Address: 2'I 1 85 NW Evergreen PKwy, Ste #110 Per inspection 62.50
City/State/ZIP: Hill sboro , OR . 97124 investigation per hour (I hr mm) 62.50
PhOne: (5-0 3) 439-9666 1 Fax )601-3680 industrial plant per hour 73.75
.. .:•:...: :.ELECTRICAL 'PERMIT FEES'i• :: :.:•:....• • .:"."..''. ....
CCB Lic.:1 3 4481 I Electrical I S pry. Lie.: 4941S Subtotal
Suprv. Electrician signature, required: /. • , . Plan review (25% of permit fee)
• AI... All.../L1110
/ / + • Z
Print name: Joey Vitacco
Date: Irl 0
, 1 State surcharge (8% of pennit fee)
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
.. - days after It has been accepted as complete
Print name: . Date: * Fee methodology Set by Tri Building Industry Service Board - •• Number of inspections per permit allowed. .
. '
i: \ Building \ Permits\ F LC•PamtitApp.doc 12103 4410-10 Inflognicomfwes
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
L BUP
Received / -* - 1 ) . � Date Requested 3 Z - 04 AM PM BUP
Location / / J ? 5 e-'Jr-4 (11717) Suite MEC
Contact Person />k' Ph (5.3) 4/.3 y — 6' /'PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner _ CO / Z 7
Footing
Foundation ELC
Access:
Ftg Drain t ELR
Crawl Drain
Slab Inspection Notes: ` /� SIT
Post & Beam °���- T VWZ 1 C- OC�Gt/J
Shear Anchors ltI /Y ,, n p
Ext Sheath/Shear
� ! / C
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
1 ?
Low Voltage
�, r •
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SI 0 Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line AA
ADA Date L1 3 - o
- q Inspector V tV ) 66 Ext
Approach /Sidewalk
Other: Q
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL