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Permit CITY OF TIGARD ELECTRICAL PERMIT • ° PERMIT #: ELC2008 -00468 COMMUNITY DEVELOPMENT DATE ISSUED: 8/13/2008 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2 S 104AA -07200 SITE ADDRESS: 12785 SW KATHERINE ST ZONING: R -4.5 SUBDIVISION: BELLWOOD NO. 2 LOT : 113 JURISDICTION: TIG PROJECT: BAKER Project Description: Installing (2) branch circuits for A/C unit and fireplace outlet. 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: BAKER, DONALD D /RENEE HILLSBORO ELECTRIC 12785 SW KATHERINE ST 21185 NW EVERGREEN PKWY #110 TIGARD, OR 97223 HILLSBORO, OR 97124 Phone: 503 - 590 -4157 Contact #: PRI 503- 439 -9666 FAX 503 - 601 -3680 FEES Description Date Amount Reg #: ELE 34 -499C [ELPRMT] ELC Permit 8/13/2008 $53.50 LIC 134481 [TAX] 12% State Surchar 8/13/2008 $6.42 SUP 4941S Total $59.92 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. Issued By: �� tea Permittee Signature: i� /! />G►/`/ 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. 08- 13 -'08 09:53 FROM- Hillsboro Electric 583- 601 3680 T -871 P002/002 F -545 'Electrical Permit Application r ( )R t q r I , I ' 0\1.1' , :a City of Tigard ,RECEIVED v � 1 ,t/ '` r • 13125 SW Hall Blvd., Tigard, OR 97 'L it a . Plan Review - Phone: 503.639.4171 Fax; 503.598.1960 Date/13 : Other Penult: = . Inspection Line; 503.639.4175 0:1,::::v "13,1) 3 200 Cate Ready/By: 6d See Page 2 for ,•- "' , •, Internet; www_tigard-or.gov Al l G 1 Notified/Method: BM Supplemental Information TYPE OF W rir . F TIC PLAN REVIEW ❑ New construction TA Addition/alte�t yi r.4,,- it 1 6. Please check all that apply (subruit 2 sets of plans w /items checked below): El Demolition Other: v,+J ❑ Service or feeder 400 amps or more q Building over three stories. where the available fault current f.] Marinas and boatyards. CATEGORY 01? CONSTRUCTION exceeds 10.000 amps at ISO volts or ❑Floating building. ij I less to ground, or exceeds 14.000 1I Commercial -use agriculture! 1- and 2- family dwelling ❑ Commercial/industrial 0 Accessory building amps for all other i nstallations. buildings. 0 Multi - family 0 Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or .1013 SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "B ", "1 -7" "I -d Job no.: • ill Yob site address , . .. r A. � C 1ooHP or more. occupancy. p �� r El Six or more residential units. ❑ Recreational vehicle parks - City /Suite /ZIP. t A /, A U �„ 2i • ❑ Health -care facilities. ❑ Supply voltage for mom than 0 Hazardous locations, 600 volts nominal, Suite/bldg. /apt. no.' Project name: Pip A , - El Service or feeder 600 amps or more. Cross street/directions to job site: !FEE SCHEDULE Otters. •.. iu, Fee. • New residential single- or multi- tlrmlly dwelling unit: - — _ Includes attached garage. Subdivision: j Lot no.: 1,000 sq. if or less 145.15 4 ~ Tax map /parcel no.: Ea- add'! 500 sq. ft. or portion 33.40 _ 1 Limited energy, residential DESCRWTION OF WORK (with above sq. ft.) 75.00 2 — Limited energy, multi- family 75.00 residential (with above sq. L) 2 Services or feeders installation, alterati, , and/or relocatio 200 amps or less 80.30 2 ❑ PROPERTY OWNER © TENANT • 201 amps to 400 amps 106.85 2 Name: 401 amps to 600 amps _ 160.60 2 Address: — 601 amps to 1,000 amps 240.60 2 Over 1,000 amps or volts 454.65 2 ' City/State/ZIP: • Temporary services or feeders installation, alteration, and/or • relocation Phone: ( ) Fax: ( ) 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 Owner signature: Date: Branch circuits new, alteration, or extension, eE panel sP " © AILiCAN I 0 CONTACT PERSON A. Fee for branch circuits with T SON above service or feeder fee, 6.65 2 Business name: each branch circuit - E. Fee for branch circuits - Contact name: without service or feeder fec, ( 46.85 ti)tt . gC 2 first branch circuit Address: Each add'l branch circuit I 6.65 .AP's 2 City/State/ZIP: ,. • Miscellaneous (service or fetter not included) Each manufactured or modular 80,90 2 Phone: - dwelling, service and/or fader ( ) Fax:: ( ) - - Reconneot only 66.85 2 E-mail: _ Pump or irrigation circle 53.40 2 CON'T'RACTOR Sign or outline lighting 53.40 2 13usincss name: H I I,�,S BORO ELF }r}7 Signal circuits) or limited- ,�T1? IC, LT,C energy panel, alteration. or Address: 21185 NW EVERGREEN PKWY #110 extension. Describe: Page 2 2 City/Suite /ZIP: H I LLS BORO , OR 97124 Each additional inspection over allowable in any of the above Phone: Per inspection 62.50 ( 5 0 3) 439 1 Fax: (5 0 3 investigation per hour (1 hr min) 62.50 CCB Lic.: 134481 Electrical Lic.: 34_499c ' Suprv. Lie.: 4 9 41 s Industrial plant per hour 73.75 - Suprv. Electrician signature, requires; ELECTRICAL PERMIT FEES Subtotal; -. Print name: JOEY VITACCO Date: ■ Plan review (25%of permit fie): Authorized signature: A 8/ r- p 1 StaOc surcharge (12 °r6 of permit fee): w.. mil . • -- �.0rr _ TOTAL PERMIT FEE: q t' Print name; D ate: �" This permit appuw es tion expire) if a permit is not obtained ` i hla 1110 - days after it has been accepted as complete. 1 : 1 BuitdingW�milsll ;t,GParm,iApp.doc 05l23/06 • Number of inspections allowed per permit. 440.46I 57(11 /05/COM/ W BSI „_ ... • , _ ._ ., CITY OF TIGARD A .• BUILDING DIVISION PERMIT #: ELC2008-00468 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: empoot3 Phone: (503) 639-4171 40 4110 0, Inspection Requests (24 Hrs.): (503) 639-4175 4 ,4191. - 111, INSPECTION WORKSHEET FOR DATE: 8/19/2008 TIME. • 7:00AM PAGE: 9 SITE ADDRESS: 12785 SW KATHERINE ST CLASS OF WORK: SUBDIVISION: BELLWOOD NO 2 LOT #: 113 TYPE OF USE: PROJECT NAME: BAKER DESCRIPTION: Installing (2) branch circuits for NC unit and fireplace outlet. OWNER: BAKER, DONALD D/RENEE, PHONE #: 503-590-4157 CONTRACTOR: HILLSBORO ELECTRIC PHONE #: 503-439-9666 Inspection Request Scheduled For: Date: WM008 Pour Time: Code # Inspection Description Confirm # Contact # Message •---..,, 199 Electrical final 074348-01 503-538-2953 V ..e...... Corrections/Comments/Instructions: Q( 3% ° PAN a.wr.ro gt” INSIP A dm A Cto 5ixT . Rz 4-o1ll 6 6W 4 PoL E . J N N N N \\ \ \N\ IN v i AS El PARTIAL APPROVAL 0 CANCEL _ ri NO ACCESS I I FAIL pi CALL FOR INSPECTION pi ADDITIONAL FEES ASSESSED Inspector: % NO43 i_.) Date: t. 19 . A Phone #: (503) 718- 1-f LAO