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Permit � s .A,. CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2005 -00173 Q.^ � ft. DEVELOPMENT SERVICES DATE ISSUED: 3/22/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S134BD SITE ADDRESS: 11645 SW HAZELWOOD LP ZONING: R - 4.5 SUBDIVISION: ENGLEWOOD NO. 2 LOT : 101 JURISDICTION: TIG Project Description: 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: • BLAKELY, ROBERT C /REBECCA L WILLAMETTE ELECTRIC INC 11645 SW HAZELWOOD LOOP PO BOX 230547 TIGARD, OR 97223 TIGARD, OR 97281 Phone: Phone: 503 - 624 - 3631 FEES Reg #: LIC 75059 SUP 1965S ELE 3 Description Date Amount 34 --2828 3C [ELPRMT] ELC Permit 3/22/2005 $93.60 [TAX] 8% State Surcharge 3/22/2005 $7.49 REQUIRED ITEMS AND REPORTS Total $101.09 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-;!0-332-2344. Issued By: 410i � _ Air �f Permittee Signature: (i) 1 Q (\z 1-- J7 v 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. MAR 22 2007'''.1A4 : 44AM HP LASERJET 3200 p. 2 Electcal <'ermit A FOR OFFICE USE ONLY City of Tigard Received Permit No.: i'S 2 2005 Date/B�: os d. � • / 13125 SW Hall Blvd., Tigard, OR 9722 l an Phone: 503.639.4171 Fax: 503.598.19 60 Date/BY: to Other Permit: Inspection Line: 503.639.4-175 L 1 " V (I�H . 11041( \ j Date Ready/By: Ill See Page 2 for ' w Internet: ww.ci.tigard.or.us BUILDING D V SIM' NotifiedMethod: gin Supplemental Information .fit. . R s ' ?i - v .s , ' 3,. , """r n a7 e 4 41 t ' - >[ w i r o, i . e.r r; , y�,,. » �,H,�ti n.� a . {; . �h�� � ,i.I ��; � �P ,) �5` ' �+;� � ,6.;; ,, k ?je t'; H,��,,, ;,..��:,.: �{f; "� sil r 4 5..� � . 4 i i ' q A t I re d m ei t . ,� t „• ,: , 1 i „ :`. a _ r Ana � � �`� n � y �ui � tT�p.„r.:..au3.,.3 �'�t� s� L1� ='ta,M`` r i�w +N V ■ u. �af �Zit9�uul�r; tFref., i �«.��:.���wr ';' ,'. I ❑ New construction U. Addition /alteration/replacement Please check all that apply: ❑ Demolition ❑Other: ❑Service over 225 amps, comm'I ['Hazardous location ® 5: ¢ ns r t l, rl �_ , . , 7 ,; i u ❑ Service over 320 amps - rating [OW king over 10,000 sq. ft., � 1 ; � t ' ' t ' P,r1 iVi 1p d i l s tili q 4 ,Aff , it t'0 ` i.r i{"`i i ti fi l . i r,,..1 -'l l ,, f ..... j l .ltd n Y g y Jl.t1a q v t. liir. i t ,, sit . ft A'A E 17 y F Y �,,, vaiieig&m 4 , F $ 4N ;� of . -and 2-family dwellings 4 or more new residential XI 1- and 2- family dwelling ❑ Conunercial/industrial ❑ Accessory building El System over 600 volts nominal units in one structure E] Multi-family ❑Master builder ❑Other ❑Building over three stories ['Feeders, 400 amps or more ❑Occupant load over 99 persons EManufactured structures or W ! ! a I tf7 iC � I T' `USY� NWij 3a'I 873+34 'ii° l or y1'� s trip. ,EAU p Y +- lE# ; a 3 "l. r L 0 tr l5 fl `ii' art i "I A 1 , , •: f , tP ii 1 } i 1 < r {fY i� ❑E ess,7i brim plan RV, park �3.Gk.li . i v. 64is.'. tla- �,,,.ss �'}�,,.; rsil�ntt'�n, ncnrPtrolrr+ni a n �!e i Aid, ! � � ,,i,„,, �d�ri�,�llF:'r+�...:. gr g g P Sob no.: ' Job site address: ` ❑health -care facility ❑ ter: �' 1d +' Submit 2 sets of plans with any of the above. City/State/ZIP: 1 gr The above are not applicable to temporary construction service. Suite/b1d ./a t. no.: J ill ��� . "!: "",' 1Il I tli1. ..,.. '' :r...,..,..a;. st:; `, . g P Project name ,, h p t6 e . I `� Description Qty. Pee. Toal � i " Cross street/directions to job site: New residential single - or multi - family dwelling unit. Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: I Lot no.: Ea. add'l 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 r'' (q� l� i 3 §§ 3 a.a� i)t1i 1 .. ::, -ig b rt l�ilt1�� , sy. Ij II'I�hk � ��4a 1 8 F,� > C . l l $t l p S 3 �q@ l ,..,I1 i 3 R><Eb i it i ili;2 1 t n' ifY� .,. . �.�urlt , ,a;G.c,trri.�.'�.,._.,Rua � I a -lei � 3 1 �G Each manufactured or modular - y, dwelling, service and/or feeder 90.90 2 �q.w�_fL_ 1 I l e H 11 ( - I 0'1 C$ t/ f t Services or feeders installation, alteration, and/or relocation 00 � { i � 200 snips or less f 80.30 F ?..0 2 l ;u , 1 l illi � "a , i irrei. 41 ei�'.«�1h pill ' . Ta r , t t ;S l� i ,1 ii, �;� . ,. 201 amps to 400 amps �� na, .. tomit .il�. �._ n t,rz_ .4 NaitiYi 3 t , . .e s t ! �a , a . ' � . 106.85 2 401 amps to 600 amps 160.60 2 Name: Ron ' 4A. It. e I y 601 snips to 1,000 amps 240.60 2 Address: 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: ( ) l Fax: ( ) relocation 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps I 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: _ Branch circuits - new, alteration, or extension, per panel }tg e irnitrc}u nit p a s r °fir 1 rt r 1 tR 1. ale 'A " rg+ r ,1 n � i` " 3 -1 ) i �tg .� � t , , - ,ii 4, J,. 4 ., , , .iS ' i u l a bg: i t ' t 115 A. service v or rfeeder fee, ?4nat�t: ?:uu anir - l !tutai1rmene iGINCII wl I di .. kt arrnn11Lui i lL VI 1/1! 1.4 svice o feeder ee, each Business name: branch circuit 6.65 2 B. Fee for branch circuits Contact name: without service or feeder fee, each branch circuit 46.85 2 Address: Each add'1 branch circuit 'Z. 6.65 J3,30 0 2 City/ State/ZIP: Miscellaneous (service or feeder not included) Phone: ( ) I Fax: ; ( ) Pump or irrigation circle 53.40 2 Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited - 1 '� 3s('T l r 3a;a° k�xkaliq h "b i t a �.. II , Y 1� i I !,,; � ENiti` � t llslip lail �tlllill. ' .4, CAP. )9, 1, 1'i i ti+ ?f i'g energy panel, alteration, or li. Gdw,. muot.t das8n rl extension. Describe: Page 2 2 Business name: t , i, ‘ 4 a1, it p F. (_e e T n i t i e,.} - Address: Each additional inspection over allowable in any of the above F o A nom. 23 b s q 3 - Per inspection 62.50 City/ State/ZIP: i t H itt Ot a c i 7-2.g ( Investigation per hour (t hr min) 62.50 / p Industrial plant per hour 73.75 Phone: (Sza ) 4 ee l F": ( g. ) W Z-� - Z- *K� ;, 7�aF � 1" 4 lied i iA ^I rl k' 43 1 , ?t(`'S fr Y' =. GCB Lic.: 7. El Lic.: Suprv Li S a OVA 1 riM Aga t4 > •y. C 19 S Subtotal rY . 10 0 Suprv. Electrician signature, required: Plan review (25% of permit fee) e.�, ,, / Print name: L State surcharge (8% of permit fee) 4. F , to Date: a„ Z 2 _ © y TOTAI, PERMIT FEE z! D Authorized signature: This permit application expires if a permit is not obtained wdhin 180 days after it has been accepted as complete Print name: Date: * Fee methodology set by Tr.- County Building Industry Service Board • *• Number of inspections per permit allowed il Building tPermits 'ELC- PermitApp.doc 12J03 440.4d15T(10'02/COMIWBB CITY OF TIGARD - r BUILDING DIVISION PERMIT #: ELC2005 -00173 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 31221200 , Phone: (503) 639 -4171 /,„11, P�� lITA Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 3/28/2005 TIME: 7:10AM PAGE: 57 SITE ADDRESS: 11645 SW HAZELWOOD LP CLASS OF WORK: SUBDIVISION: ENGLEWOOD NO. 2 LOT #: 101 TYPE OF USE: PROJECT NAME: BLAKELY DESCRIPTION: 2 branch circuits. OWNER: BLAKELY, ROBERT C/REBECCA L, PHONE #: CONTRACTOR: WILLAMETTE ELECTRIC INC PHONE #: 503- 6243631 Inspection Request Scheduled For: Date: 3/28/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 002984 -01 503- 624 -3631 N Corrections /Comments /Instructions: e kM' A �- _ L � Ilk ■ A A lommwom , /5e, ...., LEIM#SPAulv■-■ly.7pf.A.m - ww' er Mr yr . i " ----- 1- Z .C ... ..._. ......, -yr) QIP 39 )' MA PASS ik:Ki �-TIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL �v�� , L FOR INSPECTION 111 ADDITIONAL FEES ASSESSED Inspector: Y , / Date: O Phone #: (503) 718-