Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2008 -00657 12/2/2008
C OMMUNITY DEVELOPMENT DATE ISSUED:
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 134 B D -00600
SITE ADDRESS: 11515 SW HAZELWOOD LP ZONING: R -4.5
SUBDIVISION: ENGLEWOOD NO. 2 LOT : 094 JURISDICTION: TIG
PROJECT: HUGHS
Project Description: (1) service and (4) 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: 1 W /SERVICE OR FEEDER: 4 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 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:
KENNETH & PHILIP HUGHS JEROME ELECTRIC
11515 SW HAZELWOOD LOOP PO BOX 751
TIGARD, OR 97223 HILLSBORO, OR 97123
Phone: Contact #: FAX 503 - 648 - 9723
PRI 503 - 648 -5144
FEES
Description Date Amount Reg #: ELE 34 -119C
[ELPRMT] ELC Permit 12/2/2008 $106.90 LIC 158119
[TAX] 12% State Surchar 12/2/2008 $12.83 SUP 2877S
Total $119.73 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 -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.
411111.10 .
Issued By: " i� O,Z • . Permittee Signature: ,). /75
ter►
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.
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l , . CITY "" � _ ELECTRICAL PERMIT
a . ' V I OF TIGARD T o � OfCt $2 • PERA6T ELC20OB 00657
COMMUNITY DEVELOPMENT C OtTE ISSUED: 12/2/2008
•
13126 SW Hall Blvd., Tigard, OIL 97223 503.53g.417t r
, . ,. 1 „ , ,. +�,� ` ®�`�A�tCImL; 15134BD-00600
SITE ADDRESS: 11515 SW HAZELWOOID LP � . r ,� r 1) ZONING: R-4_5
SUBDIVISION: ENGLEW00D NO. 2 r ��i % '' 1 �- '�: 4 4 JURISDICTION: TIO
PROJECT: HU HS T� 1
Project Description: (1) service and (4) branch circuits.
RESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP1IRRIGATION:
EACH ADD'L 5006F: 201 - 400 amp; SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 800 amp; SIGNAUPANEI.:
MANF HMI SVC/ FOR 601 +amps - 1000 volts; MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD% INSPECTIONS
0 - 200 amp: 1 W/SERVICE OR FEEDER: 4 PER INSPECTION:
201 - 400 amp: 1st WJO SRVC OR FOR: PER HOUR:
401 - 600 amp: EA ADD "L BRNCII CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amptvolt: ID4 RES UNITS: a 600 VOLT N • MINAL:
Reconnect only: SVD /EOR» 225 AMPS: CLASS AREA/SPEC OCC:
Owner; Contractor:
KENNETH & PHILIP HUGHS JEROME ELECTRIC
11515 SW HAZE;LWOOD LOOP PO SOX 751
TIGARD, OR 97223 HILLSBORO. OR 97123
Phone: Contact #: FAX 503 -648 -9723
PRI 503.648 -5144
FEES
Description Date Amount Reg #: IrLE j4 -1 I9C
. [ELPRMT] PLC Permit 1212/2008 $105.90 LIC 158119
[TAX] 12% Stale Surchar 12/2/2008 512,83 SUP 28775
Total $119.73 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 le 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 052 -001.0040 through OAR 9524001 -0100, You may obtain copies of these rules or direct questions to OUNC at 503.246,6899 or 1.800.332.2344.
Issued B „a: - Permittee Signature: ,// - r
By: 7 ' J 4_
Aj
OWNER INSTALLATION ONLY
The installation Is being made on property I awn which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
+ NT' CT IN T ONLY
SIGNATURE OF SUPR. ELEC'N: .d%ri ! DATE: Z Z
LICENSE NO: 4 .S
Call 503.639.4175 by 7 :03 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.
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• ]Electrical F ®it Applieatian ®� rc�u c>,r� iu� tlst a►v
Received
"' i Cit of Ti Date/H Pennir Na -: -
d w 13 125 S W Hall Blvd,, Tigard, ,.0 . �� L' (� Plan Review �� /, �% , ' —j- �
Phone: 503.639.4171 Fax: 5 t 5 S: 960 C V ai v: Other Permit
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IGiAIL►7 [ngpection Line: 503,634,4175 0` ` 1 ' e o Read i /Ry; .ludrr CZ See Page 2 for
Werner: www,tigard- or.gov i \ `\ Notified/Method: 714) Supplemental Information
❑ New construction '' • ddition/altcrati • r , i'>1 . cm
Plano chock all that apply (submit acts of plena wlibema checked below):
�� ❑,Service or feeder' 400 amps or more ❑ Building over three stories.
Demolition ❑ 1]cmo 0 Other.
• „ .where thtl availnble fault current Hennas and boatyards,
't , cxcccds 10,000 amps at au 150 v olts or ❑ Floating buildings,
::::'..;
. f,'.:1 1 I,t {UI 1.i VW - 11 ‘ , h I(� d �, I Iwl p 6 s, S
�.... .,. taste grouud, or exceeds 14,000 ❑ Commercial• use agricultural
Al- and 2- family dwelling ❑ Commercial /industrial • Accessory building :amps for all other installations, buildings,
0 Multi family 0 Master builder ❑ Other Q!Fire pmnp. 1 ❑ Installation of KVA or
❑!Bmorgency s slam.
larger se aralel system,
d r i'i • 0' l'Uru'yll9yu t iµ ,11''''', L tu''O) :::s ❑�Additionof awmuto load of 0 "A� .v."1- 2' � de , "I -3" y •
Job no,: 15(9 Job site address: I l 518 SW G7r-+r rG..t41 1 C )cafe 1001>Pormore occupancy.
��-�^ `-'�'�' ❑ISix or moro residential unity, ❑ Recreational vehicle parks.
City/State/ZIP: rtIcv k ,. , 1 U ( ct'�' ).' .' Q!Health-cam facilities. ❑ Supply voltage for more than
❑Hazardous locations, 600 volts nominal.
Suite/bldg /apt. no.: Project name: 0Service or feeder 600 amps or more.
Cross street/directians to job site: •r ` • .. , ... ' ' 4 ' " n.iiil h.1 .-
J Den
0 g y
t .• Tr •
New residential single- or multi - family dwt:llini unit.
it.
Includes attached rarare. _
Subdivision: 1 Lot no.: I,d00 aq, ft, or less 145,15 4
Tax map /parcel eta.: Ea, add'l 500 sq. ft. or portion 33,40 1
I "41" t stile. stun +w IU ` Y 7,,i United wih abo ve q ideas a 75 2
Lirpitcd energy. multi - family 75,00 2
at - . OK r �' 1 residen (with a bove sq tt.) _
Seivices or feeders Installation, alteration, and /or relocation
200 amps or less _ ) 80,30 ' 2
I I l u,p. a I ,? t' t I t o ,'' � 1. 201 amps to 400 amps 106.55 2
Name: 1? C L C wt? 'ACCl ' 4/ Pti l r ' 401 amps to 600 amps 160,60 2
601 amps to 1,000 amps 240,60 2
Address: 9 X) S W �v ct, 1,f) C ` v - j^ n Over 1,000 amps Or volts 454,65 2
City /State /ZIP: Co - \s R `'1 i ' iii*) Temporary services or feeders installation, alteration, and /or
1 relocation
Phone: ( ,) 35 Q.`1 '30 Pax: 05-('' ) 357 a OC.Z1 1.0 200 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 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701, 401 amps to 599 amps 133,75 2
Branch tirenits — new, alteration, ar e pe r panel
Owner signature: Ddb:
4 ,, .• . A. l
c for branch c tcutts with
\t,{, rl, I I v 1 ioay : t 1r, ivvt above service or feeder t fee.
I 6.65 2
Business name: 0 ( . . Fee branch circuit
1 �. B. Fee for branch circuits
without service or feeder fee,
Contact name: (..t'iv � I nc f ` 1 .l a first branch circuit 46.85 2
Address: • Each add'I branch circuit 6.65 2
Miscellaneous (service or fi eaer included)
City/State /ZiP: Each manufactured or modular 94.90 2
dwelling, service and/or feeder
Phone: ( ) I Fax:: ( ) Reconneetonly 66.85 2
E -mail: • Pump or irrigation circle 53.40 2
._.... . :. : :' .. .::::**;.(''',,::'...,:,"•• r "�Y r`� i......i'iii ... ..1.":':',:,',. . -. . Sign or outline lighting 53.40 2 •
Business name: , �. ,� �� f i „ "
� Signal circuits) or limited -
� �1' Q/ f � [! ` ! ` p • .� energy panel, alteration, or
Address: 90 Q 1,5 i extension. Desct'ibe: Page 2 2
City /State /ZIP: k i 5 ) ly'p 0 P• "'7 1 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone. (503) . [ pax: (503) - • - i'l7: Investigation per hour (i hr min) _ 62.50
CCB Lic.: C 5 i [ L7 Electrical Lie.: Lf. L, U17(C.. Suprv. Lic.' ' %i 1 S 1ndustnal !lent per hour 73 - 75
` • wlh: 1` IIV.l31.
Suprv. Electrician signature, required:. :4), Subtotal: t(1
Print name: DPas,. i. , A , L-U ��, _ Dat Plan review 2540 of . emit fee):
� State surcharge (12% of permit fee):' "X .7
Authorized signature: TOTAL PERMIT FEE: '
This permit application expires iris permit is tut obtained within 1110
Print name: I l:)ate. - disvr nf. r it her been Mrrmtwt ti. rn,nolrtr
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