Permit •
TIGARD .ELECTRICAL PERMIT
CITY OF TIGAR® .°
•, PERMIT#: ELC2005 -00489
DEVELOPMENT SERVICES DATE ISSUED: 7/11/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S135DC -02600
SITE ADDRESS: 11665 SW GREENBURG RD ZONING: R -7
SUBDIVISION: MLP85 - 0007 LOT : JURISDICTION: TIG
Project Description: (2) branch circuits, A/C & 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:
KAHALOA, HERMAN HILLSBORO ELECTRIC
11665 SW GREENBURG RD 21185 NW EVERGREEN PKWY #110
TIGARD, OR 97223 HILLSBORO, OR 97124
Phone: 503 - 639 - 0767 Phone: 503 - 439 - 9666
FEES Reg #: ELE 34 -4399C
Description Date Amount LIC 134481
SUP 4941S
[ELPRMT] ELC Permit 7/11/2005 $53.50
[TAX] 8% State Surcharge 7/11/2005 $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: 172 7 Permittee Signature: rs •.e. Qr.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 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.
• Fr ELECTR LL 5036013680 07/08/2005 10:42 #018 P.002/002
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Electrical Permit Application IlOROF 1ICr. LISP ONi 1'
City of Ti and Received �/
�0 �� 2005 Data /Bv: // r�x Permit No,; ' �J 7
13 125 SW Hail Blvd., Tigard, OR 97223 Plan Review - -
Phone; 503.639.4171 Fax: 5 639.4175 v 503-5t t 98, \1r ,960 �F TIG At i ','I r't Date /B : Other Permit:
•
Inspection Line: 03 - +L i;71 • I Al gate Ready /By, l� see Page; for
Internet; wH�v.ci.tigard B UILDING DIVISION ,or.us Notified/Method: Supplemental Information
r
•
TYPE OF WORK •- PLAN RE VIEW
Cl New construction ErAdd ition /alteration/replacement Please check all that apply:
❑ Demoiltion El Other: ❑Service over 225 amps, comm'I ❑Hazardous location
ElService over 320 amps - rating ❑ Buildng over 10,000 se. ft.,
CATEGORY OF CONSTRUCTION of l- and 2- family dwellings 4 or more new residential
- 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
❑ Mtilti- family 171 Master builder ❑ Other:
DOeeupant load over 99 persons ❑Manufactured structures or
. JOB SITE IN FORMATION AND LOCATION . • :''.: ;. • ' :' •• ''. pla RV park
❑Eylress(lighting plan
Job no.: -3`7g � Job Site address:Aiti /t 5 V G� ° �
_ ❑Health -care facility ❑Other
``IPA Submit 2 sets of plans with any of the above, •
City / State/ZIP ",/� t --� , Olf 1172,3 The above are not applicable to temporary construction service.
l FEE' SCHEDULE. %.•!••.:•
Suite /bldg. /apt. no.. + Project name: ,/ A aJ DA Deeer;nti�n Qv,- F'' am! T '
Cross strecUdirections to job site: • 11 New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4 ,
Subdivision: 1 Lot no.: Ea. add'1 500 so, ft, or portion 33.40 I
— Limited energy, residential 75,00 2
• Tax Map /parcel no.: Limited energy, non - residential 75,00 2
• .,
.. ..: ':•••••:,''' ':' .:::.:.•.• D ESCRiPTION OF WORK'c.;: � „: ::: i. •; : : : `. :� ° :.;,,..,. :.. : . :... :. :: `•,;.;. Each manufactured or modular
dwelling, service and/or feeder 90.90 1 2
/ J ■11r4: a #L a Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
.. . . . , :,., 301 amps t 400 am 106.85 2
;: ' : :(, [` .PROPERTY OWNER 1 la TENANT: l: :: r . : - _ •
401 amps to 600 amps 160,60 2 •
Name: 11 L ! / / Ti 601 amps to 1,000 amps 240.60 2
Address: ( 4 4 j ar., 6ll%�W4./ • Over 1,000 amps or volts 454.e5 2
�v •• Reconnect only 66 -85 3
City /State/ZIP: Temporary services or feeders installation, alteration, and /or
' A2 1l/� g . J01 4 Fax: relocation
Phone: ) lf// a I � ) ' 200 amps or less � 66.85 1
Owner installation; This installation is being made on property that I own which is not 201 amp 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
❑ •APPLICANT : "" : : :: i:':` ,' . i 5 : : ;,; :. ' .I]. NTACT PERSON 's: "'5:: ` A. Fee for branch Circuits wil:
i . . CO service or feeder fee, each
Business name: 141,6 branch circuit 6.65 2
B. Fee for branch circuits
Contact name: wit/wul service or feeder fee, i 46 SS ) M SS 2
• - each branch circuit 'lt3r
Address: _ • Each add'l branch circuit ! 6.65 • 2 '
City / State/ZIP: Miscellaneous (service or feeder no included) -
Pump or irrigation circle 53,40 2
• Phone: ( ) Fax: : ( )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) orlimited-
. .....•• •• CONTRACTOR . ' . - ;':':;:: :: 2 ; . • :.. ;: :.`!..,:: :. energy panel, alteration, or
extension. Describe: Page 2 2
Business name:Hillsboro Electric L.L.C.
—
Each additional inspection over allowable in any of the above
Address: 21185 NW Evergreen PKWY Ste #11 0 Per inspection 62.50
City / State/ZIP: Hillsboro, OR. 97124 Investigation per hour (1 hr min) 62,50
Phone: (5 0 3) 439-9666 FIN: (503 )6 01- 3 6 8 0 Industrial plant per hour 73.75
• •ELECTRICAL PERMIT FEES= .
CCB Lic.:1 34481 Electrical Lic. :3 4- 4 9 9 C Suprv, Lie.: 4941 S Subtotal q.
Supry , Electrician Signature, required: I ,6 'e• Plan review (25 %ofpermitfee)
• V i t a C C o ;DDatteu"� �� State surcharge MA permit fcc) 4.—c-s
Print name: Joey ft 1 TOTAL PERMIT FEE 1g
1
Authorized Signature: 'nth permit npplieetihn expires If a permit In not obtained width' IN
days brier It has bean accepted as complete
• Print nurne: Date: • Fee methodology net by Tri- •twnty Building industry Service Board
- 4 .. Number of inspections per permit ullowed,
is! Building \PcroitP\ELC- PmmilApp,doc 12 /03 d41 15T(111R12/C0MJWEa
CITY OF TIGARD - - -
BUILDING DIVISION PERMIT #: ELC2005 -00439
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/11/2005
Phone: (503) 639 - 4171 ° '� "1'10�n "Nliull�I
• Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/3/2005 TIME: 7 :06AM PAGE: 76
SITE ADDRESS: 11666 SW GREENBURG RD CLASS OF WORK:
SUBDIVISION: MLP85 -0007 LOT #: TYPE OF USE:
PROJECT NAME: KAHALOA
DESCRIPTION: (2) branch circuits, NC & GFI.
OWNER: KAHALOA, HERMAN, PHONE #: .. i
CONTRACTOR: HILLSBORO ELECTRIC PHONE #: 503.439 -9655
•
Inspection Request Scheduled For: Date: 813/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 012644 -02 503 - 53&2953 Y
Corrections /Comments/ Instructions:
SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-