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Permit A,oi CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2005 -00285 ��1 DEVELOPMENT SERVICES DATE ISSUED: 4/28/2005 A 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S110DD 10200 SITE ADDRESS: 15715 SW HIGHLAND CT ZONING: R - SUBDIVISION: SUMMERFIELD NO.6 LOT : 318 JURISDICTION: TIG Project Description: (1) branch circuit for furnace reconnect. Job No. 3723 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: 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: BERTRAND, RALPH R HILLSBORO ELECTRIC EILEEN L 21185 NW EVERGREEN PARKWAY 15715 SW HIGHLAND CT HILLSBORO, OR 97124 TIGARD, OR 97224 Phone: 503 - 639 -3076 Phone: 503 - 439 -9666 FEES Reg #: ELE 34 -4399C LIC 134481 Description Date Amount SUP 4941S - [ELPRMT] ELC Permit 4/28/2005 $46.85 [TAX] 8% State Surcharge 4/28/2005 $3.75 REQUIRED ITEMS AND REPORTS Total $50.60 • 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 to mare than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are t forth in O 952- 1 -0010 through OAR 952 - 001 -0100. You may obtain copies of these r -s or direct questi.ns to OUNC at 503 -2 -6699 or 1 -800 -3 344 Issu B Per mittee Signatur> _ _.• ' .„ � � 1 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 , vim ..i SIGNATURE OF SUPR. ELEC' _ iI _ '' � 0 DATE: LICENSE NO: . V - e r i / 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. From :HILLSBOR0 ELECTRIC LLC. 5036013680 04/27/2005 16:00 #511 P.002 /002 k., I`ve° . Electrical Permit App W, J V FOR ()WK I JSE ONLY • City of Tigard R �0�5 Received , yG tl l���� f�G .. - °°tom, $ b Re i Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 A p i Plan Review Phone: 503. 639.4171 Fax: 503.598.1960 ` " j I., "i \� Date/BV; Other Permit: . Inspection Line; 503.639.4175 of "( 1G ,I A „,..,.,,,,....1._ I Date Ready /By: 0 Sea Page 2 for Internet: www.ci.tigard,or "us GVI � \ — .. .G Notified/Method; Supplemental information .. YPE �� ORK . • • . . • • •- • PLAN REVIEW p New construction Addition /alteration/replacement . Please check all that apply: • EService over 225 amps, comm'1 ❑Hazardous location • ❑ Demolition ❑Other: ['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft., • CATEGORY OF CONSTRUCTION • • ' • . of 1- and 2- family dwellings 4 or more new residential 1! 1- and 2- family dwelling 0 Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure El Multi-family ©Master builder ❑ Other: over three stories OF eders, 400 amps or more (]Occupant load over 99 persons ❑ anufactured structures or • • • .. JOB SiTE 1N.FORMATION AND LOCATION :. :.` ::.• • . ['Egress/lighting plan RV park 1 ,lob no.: '3 ' . Job site address: 1 iS 5 r ' 01,01, C c'"�' ❑Health-care facility ❑Other: , Submit 2 sets of Is with any of the above - � City /State/ZIP: `, 7, 4 V The above are not applicable to temporary construction service. zili ( 7- F.EE''. SCHEDC)ILE ' • Suite/bldg. /apt_ no.: oject name: 6 g ��y " �( l Description 4 Qty, I Fee. 1 Taal 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: Lot no.: Ea, edd'l 500 sq. ft. or portion " 33.40 I Limited energy, residential 75.00 2 Tax map/parcel no.: _ Limited energy, non - residential 75.00 2 •.•,',••• ,•,•••• .!• DESCRIPTION OF WORK ;:.::,•::':',: <;,;! ?I' Each manufactured or modular . „ . Ea 0. ] /+ ,6Y� - r dwelling, service and /or feeder 90.90 2 � Services or feeders Installation, alteration, and /or relocation 200 amps or less 80.30 • 2 - — 1 � �� � , � ' 401 amps to 600 amps S 60.60 2 201 amps to 400 amps 106.85 ROP R ” Nante: /ill I(I 601 amps to 1,000 amps 240.60 2 Address: 91144. j C6 q ye. , Over 1,000 amps or volts 454.65 2 iJ Reconnect only 66.85 _ 2 City / State/ZIP: Temporary services or feeders installation, alteration, and /or Phone: D' 7u -- " top Fax: ( ) relocation `� _ 200 amps or less 66.85 I 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 600 amps • 133,75 2 Owner signature: Date: Branch circuits — new, alteration, or extension, per panel . ❑ ••APPi.tCANT :' _ :j]. CONTACT' PERSON = • !':�; "' ": '•, A. Fee for branch circuits wish — • service or feeder fee, each 6.65 • 2 Business name: _ `/ branch circuit ^'�' B. Fee for branch circuits Contact name: wiihovl service or feeder fee, I 46.85 2 Address: each branch circuit Each add'! branch circuit 6.65 _ 2 City /State/ZIP: Miscellaneous (service or feeder not Included) Pump or irrigation circle 53.40 2 Phone: ( ) I Fax: : ( ) - - Sign or outline lighting 53,40 2 E -mail: Signal circuit(s) or limited- ' i '•::. .- : ' CONTRACTOR ::..':`.?:: •::'.: ..:•••.•... 71: •• :•.•' ;: •.::'.:• ..:,.:: energy panel, alteration, or extension. Describe: Pa 2 2 Business name: Hillsboro Electric L.L.C. Address: 21 185 NW Evergreen PKWY .Ste #110 Per i additional inspection over allowable in any of the above Per inspection 62.50 City/State/ZIP: Hillsboro, OR. 97124 Investigation per hour (1 hr min) - 62.50 Phone :(503) 439 -9666 Fax :(503 )601-3680 Industrial plant per hour 73 "75 . . - -. ELECTRICAL PERMiT F:es?* :" CCB Lic.:1 3 E le ctrical Lic.:34 -499C Suprv Lic.: 4941 S � Subtotal 4( n •'S S ttprv. Electrician signature, required: , Plan review (25% of permit fee) _ Print name: Joey V itacco • Date: ri t7/ State surcharge (8% of permit fee) TOTAL PERMIT FEE 50• • Authorized signature: \t i * Tuts permit application expires ifu permit is not obtained within ISO any* after it has bean accepted an complete Print name: D ate: a Fee methodology set by Tri- County Buiidin Indcutry Service Board " Number of inspections per permit snowed, is \Buildin \Pcrtmte\ELC- Permit... ,on 12/0 440.46 15T( t0 /02/COM/WEB CITY OF TIGARD 5' f 5,04,0tit-pd . BUILDING DIVISION PERMIT #: ELC2005.00285 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 4/28/2005 Phone: (503) 639 -4171 ./�mAilu 1 Inspection Requests (24 Hrs.): (503) 639 -4175 ...,._.,W INSPECTION WORKSHEET FOR DATE: 5/2/2005 TIME: 7:10AM PAGE: 77 SITE ADDRESS: 15715 SW HIGHLAND CT CLASS OF WORK: SUBDIVISION: SUMMERFIELD NO.6 LOT #: 318 TYPE OF USE: PROJECT NAME: BERTRAND DESCRIPTION: ( branch circuit for furnace reconnect. Job No. 3723 OWNER: BERTRAND, RALPH R, PHONE #: 503 -639 -3076 CONTRACTOR: HILLSBORO ELECTRIC ,PHONE #: 503 -439 -9666 ( Inspection Request Scheduled For: Date: 5/2/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 005737 -02 503 - 538-2953 f� ©��1'‘ Corrections /Comments /Instructions: CZ P► PASS _ PARTIAL APPROVAL El CANCEL n NO ACCESS n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED � 1 I �"Z -_vim Inspector: , Date: Phone #: (503) 718-