Permit CITY TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00613
514! DEVELOPMENT SERVICES'' DATE ISSUED: 8/22/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S104CC - 01900
SITE ADDRESS: 13899 SW HILLSHIRE DR ZONING: R - 7
SUBDIVISION: HILLSHIRE ESTATES NO. 2 LOT : 125 JURISDICTION: TIG
Project Description: Change out service, add (8) 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: 8 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:
BAY, MARK R + AUDREY L MICHAEL RAFFAELL CONSTR
13899 SW H ILLSHIRE DR 15170 SW KIRK RD
TIGARD, OR 97224 OREGON CITY, OR 97045
Phone: Phone: 503 - 632 - 6720
FEES Reg #: LIC 00058422
tion Date Amount SUP
Description 3
p ELE 3 -299C
[ELPRMT] ELC Permit 8/22/2005 $133.50
[TAX] 8% State Surcharge ' 8/22/2005 $10.68 REQUIRED ITEMS AND REPORTS
Total $144.18
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speaalty 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 Ore!. tility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these . e • • • estions to OUNC at
503 - 246 -6699 or 1 -800 -3 344.
Issued By: � 1'1 Permittee Signature r
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.
r , F OR`OFFICE USE ONLY` :: .
4 Electrical Permit Application Received Electrical f
Date/By: Y �r� (� -{ `, Permit No.: �c�G� p f5
City of Tigard Planning Approval Sign
i % Date,: Permit No.:
13125 SW Hall Blvd. I ' �� Plan Review Other
Date/By: Permit No.:
Tigard, Oregon 97223 y
Phone: 503- 639 -4171 Fax: 503-4149a)2 2 ■,I Post- Review Land Use
.4 ,;m; dl� ;u I 't Date/By: Case No.:
Internet: www.ci.tigard.or.us e Juri .:
I Contact ® Sec Page -2 for
24 -h Inspection Request: 503- f3K41.1. TIG 7 - a Name/Method: / /(F Supplemental Information.
BUILDING DIVISION
-
9GF:. - ,z,, °..£tcec`"'. ..._ .k".ep,a,�=+°wR : ' } , °`t;,ili'<a. _. "F,. ._�,.: :.':. +,s_x.a.e 3, ., �a.
�.;�;:���:�. �'�z:��,�:��.��.�T1'PEOFvWORK�° _� ��....si °� .x`t�: ;. .�~, >;`wa �_ �.r��PLAN�REVIE,W::" .le p1Y)k� �,.�
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
�dd1t1011 /alterat1011/replacement' Ill Other: . ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
i , � A Nt CONSTR QN:z
UCTI; _ #';^ I & 2 family dwellings four or more residential units in
� � a � � 4f
& 2-Family dwelling Commercial /Industrial ❑ System over 600 volts nominal one structure
y we g ❑ ❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
Master Builder 111 Other: plan Other:
❑ aster u
❑ Egress/lighting p ❑
,, ; ' JOB § - SI TE - INFORMATION a : - � nd °L OCAT•ION� ; ' ' Submit sets of plans with any of the above.
"
The above are not applicable to temporary construction service
Job site address: 1 RQ q s IA, 1+, 1) S 1,, r eLe_ 10 fc, I .s> . ,u. § k ; f :,= FLE* SCI3EpULE`l,;, `; MAW .
Suite #: I Bldg. /Apt #: . Number of inspections per permit allowed
Project Name: /Li 4. a t 8 Al Description Qty Fee (ea.) , Total
( New residential - single or multi - family per T
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
a • x7 ; ,; 1 ' „ in " ° Z , : service and/or feeder 90.90 2
,rDESCRIPT101®FVYORK�...,� �. Services or feeders - installation,
alteration or relocation: 4 0
200 amps or less f 80.30 WO _' 2
201 amps to 400 amps 106.85. 2
401 amps to 600 amps 160.60 2
240.60 2
:RO p,ER ° ,TAY O� „ „_ ER , ; s , r „ w= LT *ENo T , k , ' ```�„ . 1i 601 amps to 1000 amps 454.65 2
a WN Over 1000 amps or volts
Name: f-/ 0-2 Y rA A-' ( Reconnect only 66.85 2
Address: / !R a 9.9 s c,.i /4, 1 j s 1. , A—e p k Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 7 - 1 6.s t o 0,2_oi 9 7 7- 23 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
<r r $APPLICANT x l ,S. -4 ,CONTACT PERSON alteration, or
133.75 2
401 to 600 amps
s a .r a � € :s w • r r• - Ar - - -- -- _—' �' Branch circuits - new, a n, o
Name: . •
. extension per panel:
A. Fee for branch circuits with purchase of 1-e
Address: service or feeder fee, each branch circuit 6.65 _53 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
E-mail: Misc.(Service or feeder not included):
- - -. Each pump or irrigation circle 53.40 2
, � too 'TRACTOR . ;
- Each sign or outline lighting 53.40 2
Job No: R / / Signal circuit(s) or a limited energy panel,
A alteration, or extension Pa e 2 2
Business Name fy C, � 1 C- [„ ' -P / Fri p /I C,j dilIscription:
Address: /5 / -7 o s 1.c. t cia t` p2 4
CRC Each additional inspection over the allowable in any of the above:
City /State /Zip: 176- 176-04-R D CRC 5 i 7 2-23 Per inspection per hour (min. 1 hour) 62.50
Phone: 67 A. -6 7 Fax: 6 3 2. - G 7 3 2_ Investigation fee:
CCB Lie. #: Lic. #: Other
"'� 9 i Y.r.I CM : g„ElectricalPerm'i'tFe "e
Supervising electrician , Subtotal $ ) 3 3
signature required:�')'L ,., Plan Review (25% of Permit Fee) $
Print Namp9 ( r 1",,(1„z_ / Lie. #: .2_5 G a S State Surchar e 8% of Permit Fee $
/- j/ TOTAL PERMIT FEE $ pi y -
Authorized Notice: This permit application expires if a permit is not obtaided within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set.by Tri- County Building Industry Service Board.
(Please print name) •
is \Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Y
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
n Audio and Stereo Systems
n Burglar Alarm
n Garage Door Opener
n Heating, Ventilation and Air Conditioning System
Vacuum Systems
Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
F Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
•
n HVAC
instrumentation.
F - 7 Intercom and Paging Systems
n Landscape Irrigation Control
n Medical
D Nurse Calls
n Outdoor Landscape Lighting
Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03
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CITY OF TIGARD ' . . 4: ,6..
BUILDING DIVISION PERMIT #: ELC200.5 -00613
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/2 12005 : r
Phone: (503) 639 -4171 . �l
Inspection Requests (24 Hrs.): (503) 639 -4175 _. . _- •,
INSPECTION WORKSHEET FOR DATE: 12/19/2005 TIME: 7:01AM PAGE: 12
SITE ADDRESS: 13899 SW HILLSHIRE DR CLASS OF WORK:
SUBDIVISION: HILLSHIRE ESTATES NO. 2 LOT #: 125 TYPE OF USE: ,
PROJECT NAME: BAY
DESCRIPTION: Change out service, add (8) circuits.
OWNER: SAY, MARK R + AUDREY L, PHONE #:
•
CONTRACTOR: MICHAEL RAFFAELL CONSTR PHONE #: 503.632 -6720
Inspection Request Scheduled For: Date: 12119/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
•
105 Underground/slab cover 023701 -01 503.632 -6720 Y
Corrections /Comments/ Instructions:
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iv .u t
1
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eall94go �.7 AL , • "NWAIIIP ❑ CANCEL fl NO ACCESS
I FAIL \ CALL FOR IN ' • ' ON El ADDITIONAL FEES ASSESSED
Inspector: Date: l�l� ac Phone #: (503) 718- 2111 , . .
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2006-00613
I 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 0/22/200L
Phone: (503) 639-4171 400 410lA
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 4/12/2006 TIME: 7:04Aivi PAGE: 58
SITE ADDRESS: 13899 SW HILLSHIRE DR CLASS OF WORK:
SUBDIVISION: HILLSHIRE ESTATES NO. 2 LOT #: 125
PROJECT NAME: BAY
DESCRIPTION: Change out service, add (8) circuits.
.s---- 52:-/--33s14
OWNER: BAY, MARK R + AUDREY L, PHONE #:
CONTRACTOR: MICHAEL RAFFAELL CONSTR PHONE #: 503-632-6720
InspeCtion Request Scheduled For: Date: 4/17J2006 Pour i .
Code # 7 6 70
Inspection Description Confirm # ontact # Message .
109 Electrical final
1
027836-01 503-781-9857
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Correc ons/Comments/Instructions: ---------- .
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I FAIL CALL FOR INSPECTION 0 ADDITION • L FEES ASSESSED
Pi& _
Inspector: I Date: I / / 0 5'hone #: (503) 7 2f)
CITY OF TIGARD
BUILDING DIVISION
• ,I.: "� ='
PERMIT # � � -D 0 to J
! 2
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 i
Inspection Requests (24 Hrs.): (503) 639 - 4175` =- �
INSPECTION WORKSHEET FOR DATE: ` ' PAGE:
SITE ADDRESS: / 3'9 i f i l (s L ✓ e_ ,i)-( ` CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: �/ P : GJ"- -662—_,3 r,�
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CONTRACTOR: 1V I HONE C PHONE #:
Inspection ' qu st Scfjedul -d For: Date: if — 3 .----- 0 Pour Time:
POO Code # I • - - • To escription Confirm # Contact # Message
Corrections /Comments /Instructions:
P0()1-- LI9 06 .
. A pp 0-mi4f .
•
•
%PASS 1 1 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: 9 V v`v c3 Date: 1 4 6k Phone #: (503) 718- 2.411/1=)
CITY OF TIGARD
DIVISION PERMIT #:E14Zo 06",• oaI 4601"r.
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 l `! It t
Inspection Requests (24 Hrs.): (503) 639 -4175 A . L
INSPECTION WORKSHEET FOR DATE: Li •t2,'Ql TIME: PAGE:
SITE ADDRESS: 13 U 1 q s W W 1 O %R'i • CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: 1 A�
DESCRIPTION: sE RV y ,& Q CA F'S
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments/ Instructions:
•
PASS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: tN C3 Date: e'1 Phone #: (503) 718 - 6
CITY OF TIGARD
,
BUILDING DIVISION PERMIT #: ELC2005-00613
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8122/2005
Phone: (503) 639-4171 ,il
Inspection Requests (24 Hrs.): (503) 639-4175 „.„,...„ -....
INSPECTION WORKSHEET FOR DATE: 4/13/2006 TIME: 7:00AM PAGE: 9
SITE ADDRESS: 13899 SW HILLSHIRE DR CLASS OF WORK:
SUBDIVISION: HILLSHIRE ESTATES NO. 2 LOT #: 125 TYPE OF USE:
PROJECT NAME: BAY
DESCRIPTION: Change out service, add (8) circuits for in-gound pool.
OWNER: BAY, MARK R + AUDREY L, PHONE #:
CONTRACTOR: MICHAEL RAFFAELL CONSTR PHONE #: 503-632-6720
,
Inspection Request Scheduled For: Date: 4/13/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 027987-01 50718-2426 N
Corrections/Comments/Instructions:
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on this eport shall be corrected and
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calendar days per OAR 918-271-0030
0 PASS fl PARTIAL APPROVAL 0 CANCEL 1111 NO ACCESS
‘41 FAIL ;4 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: likt.., f408 LE" Date: Al I yO6 Phone #: (503) 718- 2
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CITY OF TIGARD
BUILDING DIVISION a PERMIT #: ELC2005- 00613
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/22/2005
Phone: (503) 639 -4171 slily lip 1 i t'1
Inspection Requests (24 Hrs.): (503) 639 -4175 ..,_111- ' 111.
INSPECTION WORKSHEET FOR DATE: 10/20/2005 TIME: 7:09AM PAGE: 20
SITE ADDRESS: 13899 SW HILLSHIRE DR CLASS OF WORK:
SUBDIVISION: HILLSHIRE ESTATES NO. 2 LOT #: 125 TYPE OF USE:
PROJECT NAME: BAY
DESCRIPTION: Change out service, add (8) circuits.
OWNER: BAY, MARK R + AUDREY L, PHONE #:
CONTRACTOR: MICHAEL RAFFAELL CONSTR PHONE #: 503- 632-6720
Inspection Request Scheduled For: Date: 10/20/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
105 Underground/slab cover 018848 -01 503-781-9857 Y
Corrections /Comments /Instructions:
z - 5 .------ SS I I PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Date: / a' d Phone #: (503) 718-
—0477---
CITY -OF TIGARD - 1 ' a „. BUILDING DIVISION i PERMIT #: ELC200€ -00613
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/22/2005
Phone: (503) 639 -4171 / iu tilli All'I
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/14/2005 TIME: 7 :09AM PAGE: 80
SITE ADDRESS: 13899 SW HILLSHIRE DR CLASS OF WORK:
SUBDIVISION: HILLSHIRE ESTATES NO. 2 LOT #: 126 TYPE OF USE:
PROJECT NAME: BAY
DESCRIPTION: Change out service, add (8) circuits.
OWNER: BAY, MARK R + AUDREY L, PHONE #:
CONTRACTOR: MICHAEL RAFFAELL CONSTR PHONE #: 503- 632 -6720
Inspection Request Scheduled For: . Date: 9/14/2005 Pour Time:
C de # Inspection Description Confirm # Contact # Message
150 Hot tubtspa/pool
015603-01
503-781-9857 Y
Corrections/Comments/Instructions: r , X
0' \N 1\ V D L, C6A1r0 g‘1•11 $ se lQ 11 o j 0 rf u0 4 G 13 Jo (,.1� l
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PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: (�,., J �� , Date: -- /X - Phone #: (503) 718 -