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Permit t � CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2007 -00659 COMMUNITY DEVELOPMENT DATE ISSUED: 9/21/2007 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S134BD-04100 SITE ADDRESS: 11760 SW HAZELWOOD LP ZONING: R -4.5 SUBDIVISION: ENGLEWOOD NO.2 LOT : 129 JURISDICTION: TIG PROJECT: HOLTON Project Description: (2) branch circuits for A/C and air handler. 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: HOLTON, JAMES FRANKLIN + HELEN E HILLSBORO ELECTRIC 11760 SW HAZELWOOD LP 21185 NW EVERGREEN PKWY #110 TIGARD, OR 97223 HILLSBORO, OR 97124 Phone: Contact #: PRI 503 - 439 -9666 FAX 503 - 601 -3680 FEES Description Date Amount Reg #: ELE 34 - 499C [ELPRMT] ELC Permit 9/21/2007 $53.50 LIC 134481 'TAX] 8% State Surcharge 9/21/2007 $4.28 SUP 4941S Total $57.78 REQUIRED ITEMS AND REPORTS 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 -4I ' • ough OAR 952-001-010e. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344. Issued B //���J� 4 j ' 4 " Permittee Signature: I ( OY1 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. - 09- 21 -'07 13:34 FROM- Hillsboro Electric 503 - 601 -3680 T -614 P002/002 F -692 ,n pe heat Permit Application 1 Oh, l(l l sl (> la lir City if Tigard V €- L' Received Permit No.: • • . o 13125 S W Hall Nlvd., Tigard, OR 97 DateB : Plan Review Phone: 503,639.4171 Pax: 503.598.1960 2 ] ' �uu, ' *!I' Data/13 : Other Permit: Inspection Line: 503.639.4175 S EP _ ,1�,;, �_I_� D R dy/Ey ]uric E( See Page 2 for Internet: www.ci.tigard,or.us ll F Notified/Method: �+ i �9�� 1 ' I ` Supplemental ] aformalion gn t 0 New construction on p nt , .r, , .: : .�.,,;:� . ,; ,,;,,,,,,; ,,,,, ,,, El Demolition CI 6 Other dion/alterati /re laceme ' �.,... Please ❑ Srvice overl225 that ampsy comm 'I , El Hazardous location .,...,..- ' ,, e;- a ;,' .',.; . ,a• er 320 amps — rating ❑Builds Os ,ft. . a .., : ...n 'iy.. x •• SerV1CC ov ❑ Accessory building 1 : y g ❑Commercial /industrial ��-� - • , ��.. �,, . .,. . ...,'.' of l - and 2- family dwellings 4 or more new residenti 1- and 2-family dwelling ❑System over 600 volts nominal units in one structure ❑Building over three stories ['Feeders, 400 amps or more ❑ Multi - family I:3 Master builder [j Other: 4 i i, i` - ; ;i v 1:ar '14.46 .1%;,...i.., , ❑Occupant load over 99 persons ❑Manufactured structures or ti. +� , t.01 ,_ :';,?.; •Ni � , •6 . a ' �1 , !..,. ..� i1 „ Y , t., . ; I N fk.: ��� ?� t ,, •; , =s$,r �1 ;aoYa ©R Sress/lightingplan RV park Job no.: 1=11 Job site address: I , P % _ e , ' / ❑Health -care facility ['Other: ['Other: �� o Submit 2 sets of plans with any of the above. City /State/ZIP: r i 4 44. Is The above are not applicable to temporary construction service. Suite/bldg. /apt, no.. t name: ' ;li ,-- h; fs n ' i l' ,a. ;f:,;' . } :r, Project �� 45a � , l,,.A ,.rr:.;r :<; „1;• Desertplioa Qty. Fee. Total •• Cross street/directions to job site: New residential single- or multifamily dwelling unit. Includes attached garage. 1,000 sq, ft, or less _ 145.15 4 Subdivision: Lot no,: Ea. add'l 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 , ,wy u �,. Limited energy, non - residential _ 75.00 2 f'� +' w t . �r ' � , .FS,,e. � ��. ' nr r Sr • i � C , g� t . �!l , init* -",i 11,,t ,10 , , i , . , Ah'c)'` ,: U, f6'n ;: 1 �'��,� v .. 4`,'t"� y37i Each manufactured or modular d 0 Ular 4 ,-, U/I V 1 4 ` ' dwelling, service and/or feeder 90,90 2 Services or feeders installation, alteration, and/or relocation I 200 amps or less 80.30 2 x r i m - 4 0. �,„ . g; *; •; >I' 4 t , timoriv 201 amps to 400 amps _ T 106.85 2 e wn. , nix, .. ' a _ , W ! ,•,i 1 . fa. as s AA,A,U 401 amps to 600 amps 160.60 2 Name: 601 amps to 1,000 amps 240.60 2 Address: Over I.000 amps or volts 454.65 • 2 City/State/ZIP; Reconnect only 66.85 2 Temporary services or feeders installation, alteration, and/or • Phone: ( ) Fax: ( ) relocation 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 441 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 rw n `gy �( tvsN� $ � ?'� p r $ 1�” � r:(S+ °� 4 p• r 1f �', ata `'TIVO IYS "�"a ,� ; * i .n n e�..t, � r , �. A. Fee for branch circuits with .�.ro,y,$ " w,• a'e, Sr.A. e ! h� ,at'aw�'+ f 1' , Vl , C r ', .i^ N rh Business name: • service or feeder fee, each 6,65 2 branch circuit Contact name: B. Fee for branch circuits without service or feeder fee, 1 46,85 q1 0 2 Address: first branch circuit City/State/ZIP: Each add'1 branch circuit i 6.65 (i,1,05 2 Miscellaneous (service or feeder not included) Phone: ( ) l l- Fax: : ( ) Pump or irrigation circle I I 53,40 L 2 Sign or outline lighting 5140 2 E-mail - $p�y,�{ � j �� y Signal circuits) or limited- r r p g Fr t" S' I !�e.. 1 •';} @,1r arzt �Yirig�i"s 1 �y1.L' `6a wi1< v. lFi i '"�-" i sar �' energy panel, alteration, or 1 ♦ O 4.1P extension, Describe: Page 2 2 /I _ Address: 24 ig ^ , V i'l • Each additional inspection over allowable in any of the above — `� Per inspection 62.50 / �i City / State/ZIP: iS 7 1 o q-n Investigation per hour (1 hr min) 62,50 Phone: it / - F es; ( ) 1 /1n _ 1 - 'T Industrial plant per hour 93,75 CCB Lic.: k Electrical Lic.: 3! J ~ i j tl up ry . Lic.: (� L4 q _!� t z ,:,',:+ ` 1''f" `'a e. z'.>Itl ,=i`;"°u � t: :.I i'`:s ' Su . - r _ Subtot Suprv, Electrician signature, required: Plan review (25% of permit fee) Print name: bate: State surcharge (8% of permit fee) - Vg � ' ; ■ . TOTAL PERMIT FEE • - ,g Authorized signal.) e' This permit application expires If a permit is not obta nod within 180 days after it hat been accepted as complete Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board •• Number of inspections per permit allowed. GAtuildingTermitSl LC- PermitApp.doe 12/03 440- 4615T(Iwovc MAy 5 CITY OF TIGAR BUILDING DIVISION #: El 02007 -00659 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 9/71/2007 Phone: (503) 639 -4171 ��� Inspection Requests (24 Hrs.): (503) 639 -4175 A INSPECTION WORKSHEET FOR DATE: 9/3812007 TIME: 7 :00AM PAGE: 37 SITE ADDRESS: 11760 SW HAZELWOOD LP CLASS OF WORK: SUBDIVISION: ENCLEWOOD NO .2 LOT #: 129 TYPE OF USE: PROJECT NAME: FIOLTON DESCRIPTION: ( branch circuits for A/C and air handler. OWNER: HOLTON, JAMES FRANKLIN + HELEN E, PHONE #: CONTRACTOR: HILLSBORO ELECTRIC PHONE #: 503 - 439.9666 Inspection Request Scheduled For: Date: 9128/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final M6567 -01 503- 538 -2953 V 1),/d- Corrections/Comments/Instructions: pA")-00k ck rim oc.P ' O \' ..,,---.3 y PASS n PARTIAL APPROVAL n CANCEL I I NO ACCESS In FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: '� Date: / i o Phone #: (503) 718-