Permit 2-69
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ELE'eTRICAL PERMIT
CITY OF TIG RD
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00271
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/05/2009
Parcel: 2S 111 AA00200
Jurisdiction: Tigard
Site address: 14075 SW HALL BLVD
'Subdivision: Lot: 0
Project: Bozich
Project Description: Install 200 amp service and (10) branch circuits. 6/12/09, adding add'I feeder.
Owner: FEES
BOZICH, DANIEL SR & MARSHA L Quantity Description Date Amount
9860 SW HEATHER LN
BEAVERTON, OR 97006 1 ea Services or Feeders - 200 06/05/2009 $80.30
amps or less
PHONE: 10 crt Branch Circuits w /Purchase 06/05/2009 $66.50
Service or Feeder
1 ea 12% State Surcharge - 06/05/2009 $17.62
Contractor: Electrical
HILLSBORO ELECTRIC LLC 1 ea Services or Feeders - 200 06/12/2009 $80.30
21185 NW EVERGREEN PKWY #110 amps or less
HILLSBORO, OR 97124 10 da 12% State Surcharge - 06/12/2009 $9.64
P
Electrical (manual)
PHONE: 503 - 439 -9666
FAX: 503 - 601 -3680
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $254.36
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in - - • • • e with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. AT' NTION: Ore..n law equires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 8010 through OAR • .2 -•.1 -0 00 ou may obtain a copy of the rules or direct questions to OUNC by callinerfa.6699 or 1.800.332.2344.
Issue. :y: i / Permittee Signatur•41111M • . _
OWNER INSTALLATION ONLY I
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' —.at" 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.
:,. /.7' , :, L 06- 10 -'09 15:38 FROM- Hillsboro Electric 503 - 601 -3680 T -646 P002/002 F -0 76
Electrical Permit A,pplicatiQn l , i t
`s City O� Tigard Tigard hC F Ew d s ' 'f 11'1' 1',, l I w l 1 1 I l r 4 f 1 .
• !3125 s Ball Blvd., Tigard, OR - 47 223
alma ro Phone: 503.639.4171 Fax; 5035981
•
1 1 r i; r
Notified/Method:
Inspection Line: 503.639.4175 l
3n 1 0 2009 Dine/Sy:
Permit:
• a
Internet: •www.ti and -or, p Date dv�y" �( � ® for
See Page l
g 6� 1 �� � 4'S Notified/Method: �( L Supplemental Information
TYPE nit j ni \ISI PLAN REVIEW `�
Q Now construction P lease c heck all that l (submit p
Addition /JI)te`lation/replaoement apply ( Z acts of lens w /teems checked below)
❑ Demolition ❑er: 0 Service or feeder 400 amps or more El Building over three stories.
where the availabl fault current ❑ Marinas and boatyards.
CATEGORY OF CONSI<'RUC FION exceeds 10,000 amps at 150 volts or El Floating buildings"
- and 2- family dwellin ❑ CommereiaUindustrial [] Accessory building Iraq m ground, or insudi exceeds 14,00p El Commercial-use roes.
❑ Multi family agricultural
❑ Master builder amps u all other installation,. buildings,
0 Other: ❑Fitt pump,
p. Q Inaratletion of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency aYaom. larger separately derived system.
Cl Addition of new motor load of 1:1"A", "E", "1 -2", "1-3",
Job no.: Job site address: �r 10o[IP or more ccupancy.
• • � �� i • i ❑ six or more residential units. ❑Recreational vehicle petits.
City /State/ZIP: / i / El/14'1111-cm facilities. ❑ Supply voltage for more than
[ �/ ❑ Hazardous locations. 600 volts nominal.
U
Suite/bldg. /apt. no.: Project name: ■ O service or tam 600 amp, or more.
Cross street/directions tojob site: FEE SCHEDULE .
New residential single- or mulil- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. It or loss 145,15 IIII 4
Tai map /parcel no.:
Ea. add'I 500 sq, ft. or portion 33 - 40 1
DESCRIPTION OF WORK Limited energy, residential
with above • , , it. 75•00 2
r / ( /i !' /� L energy, multi- family
L. 1/� ,[ Vt Vt residential w i t : , .ye.. it. 75.00 2
Services o
.. �� c -r nstallatiou alteration aud/or rte .ion
D PROPERTY OWNER . — — 200 amps or less 80.30 � 1 2
Q TENANT' 201 amps to 400 amps 106.85 2
Name:
401 amps to 600 amps _ 160.60 2
Address: 601 amps to 1,000 amps 240.60 2
Over 1,000 amps or volts 454.65 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or leas
66.55 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 599 anise 133.75 _ 2
Owner signature: Date: Branch circuits - new) alteration, or exteusion, per panel
L� APPI,IC�►;V P - - - - — A Fee for branch circuits with • . • ID to cT PERSON above service or feeder pt,
Business name: _ each branch circuit 6 . 6 5 2
B. Fee for branch circuits _
Wilma Contact name: service or feeder foe, fiirst branch nch circuit ' - 2
Address: Each add'I brand[ circuit 6.65 1 2
City /State/ZIP; Miscellaneous (service or feeder not included)
Each manufactured or modular
Phone: ( ) Fax:: ( ) dwelling, service and/or fcxda 90.90 2
E-mail: Reconnect ° n' 66.85 2
Pump or imgapon circle 5340 2
CONTRACTOR . Sign or outline lighting 53.40_ 2
Busintsss !!setts: HZLI,$,$ORO E Signal circuit(s) or limited- —
�TRIC' I _ energy Penal, altaratiott, or
Address: 21185 NW EVERGREEN PKWY #110 Eton' Dessnbc: Page 2 2
City /Slate/ZIP: HILLS BORO OR 97124 Each additional ins , lion over allowable in b of the above
Mime' (5 0 3 439-9666 Fax(503)601 • Per inspection 1111 62.50
Investigation per ecru (1 hr Gain) r 62.50
CCB Lic.: 134481 Electrical Lie.: 34_499d. -Suprv. Lic.: Industrial lent per sour
49 415 P IIMI 73.75
Suprv. Electrician signature, required: ELECTRICAL PERMIT FEES
Subtotal: - 0
Print name: J Ry V ITACC 1 ( Date: Ill ►t' )_ �]Jl Plan review (25% of permit fcx):
4 11 - 1 State surcharge 1 N"
Authorized sign: ME, 1P (290 of permit Pee); , ti
Print name: -� — TOTAL PERMIT N$E: IPS Pte,
•
. Date: This permit application expires if a permit is not obsl - , within 180 a LI
Y days after it has been accepted is complete. ' 1
• I:U Building lrsrmitalEl GPdtni • Number of inspections allowed per permit I
tAQp.doc OS(a3/(lo AAl1. Aa /O
Tl11QIMVmmn •
•
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00271
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/05/2009
Parcel: 2S 111 AA00200
Jurisdiction: Tigard
Site address: 14075 SW HALL BLVD
Subdivision: Lot: 0
Project: Bozich
Project Description: Install 200 amp service and (10) branch circuits.
Owner: FEES
BOZICH, DANIEL SR & MARSHA L Quantity Description Date Amount
9860 SW HEATHER LN
BEAVERTON, OR 97006 1 ea Services or Feeders - 200 06/05/2009 $80.30
amps or less
PHONE: 10 crt Branch Circuits w /Purchase 06/05/2009 $66.50
Service or Feeder
1 ea 12% State Surcharge - 06/05/2009 $17.62
Contractor: Electrical
HILLSBORO ELECTRIC LLC
21185 NW EVERGREEN PKWY #110
HILLSBORO, OR 97124
PHONE: 503 - 439 -9666
FAX: 503- 601 -3680
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $164.42
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 -001 -e 00..- ou may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: 41 - Air Permittee Signature: /14/ iP/ Q
L+/ 69
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' 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.
- 06- 02 -'09 15:16 FROM- Hillsboro Electric 503 - 601 -3680 T -616 P002/002 F -918
fi t
Electrical Permit ApQlication
, I (,rlt l 11 l 1 I s.1 i )■1 i f i
� ' � � •
City of 'Tigard Receiwa s n 7
a 13125 SW Hall Blvd. , D ae/B , T tgiitd OR 97223 DatclO f� 0 ' . !'emit No -: 001 d
� � / c� 09 ��
Phone; 503.639.4171 Pax: 503.598.1960j 0 �+ 20 to /B c
;
i r, r' F i lnspeetiort Line: 503.639.4195 Date Readylby. Other Permit:
Internet: w.hv.tigard or.gov Notifi ga Page for
CITY OF TIGARD e>d: SuppkmenL i 7aformation
TYPE of DI CraDIVISteN PLAN REVIEW
❑ New construction Additiort /alteration/replacement Please Check all that apply (submit a,ets of plans whams cheeked below):
(1 Service or feeder 4ao amps or more ❑ Building over three stories.
C] Demolition Q Other:
/
_ where the available fault pmt 0 M+trions and boatyards.
di CATEGORY OF CONSTRUCTION exceeds 10,000 snap at 150 volts or ❑ Floating buildings.
D 1- and 2- family dwellin [] Co mmereial/industrial 111 Accessory building leas to ground, or exceeds 14,000 0 Commcrciai - use agricultural
Multi-family for all other installation*. buildings.
I_1
[] Master builder ❑Other: ❑ izrra pump. [)Installation of 75 KVA or
JOB SITE INFORMATION AM) LOCATION 0 Batergency Mem larger separately derived system.
Job n0.: ❑ Addition of new motor load of ❑ "A ", "E", "1 - 2" "1 -3"
1 t Job site address: B 0 l i 1rJ J/, • 100111. ear mote• °CO
City/State/DP: f Q Six or morn reardemia! units. ❑ Recreatronal vehicle parks.
at t/ ❑ Hadtbnare facilities. ❑ Supply voltage for morn than
Suite/bldg./apt. no.: D Haamdous locations. 600 volts nominal
Project name: G ( . 0 Service or feeder 600 amps or more,
Cross street/directions to job site: FEE SCfIEI?I7L)E -
- rrwtNYtioa
.1/c. 'row
New residential single- or multi - family dwelling unit -
Subdivision:
Includes attaebed garage.
Lot no.: f. g9• ft. or less 145.15 4
Tax map/parcel no.: Ea. add'1500 sq. ft. or portion 33.40
1
DESCRIPTION OF WORK Limited energy, residential
(with above sq. R.) 75.00 2
/k. ,� 1.4 ` Limited energy, multi - family
residential (with above sq. A) 75.00 2
Services or feeders installation alteration and/or 11 • - !io n
—
(] PROPERl Y t3W R [' ] I NpN �— �— 2 amps or less 80.30 : a • -- 2
Name: 201 amps to 400 amps 106.65 2
- 401 amps to 600 antis 160.60 2
Address: 601 amps to 1,000 amps • 240.60 2
Over 1,000 amps or volts 454.65 2
City/State/Z1P: Temporary services or feeders Installation, alteration, and/or
Phone: ( ) relocation
Fax: ( ) 200 amps or less 1 66.85 1 I 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 2
steps to 599 arms 133.75 2
Owner signature: Date: Branch deceits- new, alteration, or eztensiosper panel
A Fee for branch Circuits with
APPLICAN .. d CO PERSON ' above service or feeder fee,
Business name: each branch circuit �O 6 65 �/ 2
B. Pee for branch circuits
Contact name: without service or feeder fly.
fiat branch circuit 46_85 2
Address: Each add'! branch circuit
6.65 r 2
City/State/ZIP:
Mbedlaneonsiscrvive or feeder not included)
Bach manufactured or modular
phone: ( ) I Fnr1 :: ( ) awe Brig service and/or feeder 90.90 2
E - mail: I — Reconnect only 66.e5 2
Pump or irrigation circle 53.40 2
_ •_ CON I dtACI r jpt Si gn ar outline lighting 53.40 2
Business name:
HILI;SBO.t20 E . F LC Signal circuit(s) or limited -
Address! 21185 NW EVERGREEN PKWY # 1 10 energy panel, a cribe: Page 2 2
lteratioi>, or
extension. Des
City /State/ZIP: HILLSBOI20 OR 97124 Each addit in
p @on over allowable in any of the above
Phone: { 5 ... �) 439-9666 Fax: ( 5 0 ) Per inspection 62.50
CCB Lic.: 6 0 7 - 3 5 8 0 — Investigation per hour (1 hr min) 62.50 -
1 3 44 81 Electrical Lie. 34._499 •Suprv. Lie.: 4941 S end w4 _ trial plant per hour 73.75
Suprv. Electrician signature, required: 1 J _ j r ELECTRICAL PERl.C1T FEES
Subtotal: 1 .2° -
Print name; JOEY VITACCO i Date: 14Z l 1161 Plan review (25% of permit fee);
Authorized signature: State surcharge (12% of permit ttx): • - e
TOTAL PERMIT PEE: .(., 1
Print marts: [Date: Thts permit applic expires If a permit b not obtained within 100
days after it has been accepted as complete.
[:eBUird ng1Pe rmita BLGPermEtApp.dpc 05/23/06
Aetn .< • Number of inspections allowed per permit, / V r