Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00430
�,� DEVELOPMENT SERVICES DATE ISSUED: 6/20/2005
4 I� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S133DA -07600
SITE ADDRESS: 12612 SW SNOW BRUSH CT ZONING: R -7
SUBDIVISION: AMART SUMMERLAKE NO. 2 LOT : 136 JURISDICTION: TIG
Project Description: A/C & furnace.
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:
KRUGER, DENNIS A + WENDY L HILLSBORO ELECTRIC
12612 SW SNOW BRUSH CT 21185 NW EVERGREEN PARKWAY
TIGARD, OR 97223 HILLSBORO, OR 97124
•
Phone: 503 - 524 -9029 Phone: 503 - 439 -9666
FEES Reg #: ELE 34 -4399C
LIC 134481
Description Date Amount SUP 4941S
[ELPRMT] ELC Permit 6/20/2005 $53.50
[TAX] 8% State Surcharge 6/20/2005 $4.28 REQUIRED ITEMS AND REPORTS
Total $57,78
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: -- -7 Permittee Signature: ��
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.
Fr om : H I LLSBORO ELECTRIC LLC. 5036013680 06/17/2005 18:25 #870 P.002/002
0 .
Electrical Permit Application . Folt orFLC_E tls1t: ONLY •
`�' >� Received City of Tigard FIE CEI 1 � R e • ��/ I Permit N°.: Q if
13125 SW Hall Blvd., Tigard, OR 9722 \ Rco
Plan Review
Phone: 503.639.4171 Far: 503.598.1960 4 '''", +rl (1 ` • DaroBV Other Permit:
Pea
Inspection Line: 503.639.4175 A� t- n.� Date Ready /By: MI E7 See Pose? for
Internet: www.ci,tiprd.or.us Notified/method; Supplemental Information •
TYPE 0tt4'Qr •7iCIAR®• • . ' . . . • • •• PLAN REVIEW
• ❑ New construction [ Additiot> lj ' Unepttt liN Please check all that apply;
❑Service over 225 amps, comm'I 0 Hazardous location
El Demolition El Other;
❑Service over 320 amps— rating ❑ Buildng over 10,000 sci. R.,
4 CATEGORY OF CONSTRUCTION • '. of I- and 2- family dwellings 4 or more new residential
1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Mhlti- family El Master builder ❑ Other: ❑Building ever three stories ❑Feeders, 400 amps or more
00ecupant load over 99 persons ❑Manufactured structures or
. JOB SITE INFORMATION AND LOCATION : . ❑Egress/lighting plan RV park
Job no.: - Job site address: \ ` 5W & 1
UC.L A) •' •• `, •� ❑Health -care facility ['Other - • J Submit 2 sets of plans with any of the above.
City /State/ZIP: S l mai ( a /I- , The above are not applicable to temporary construction service.
r V t i Project name: � i � ; ;::. PCE" SCIiEDULt•: _: ;......_
Suite/bldg. /apt. no.
Description j Orr. I Pee. j Tai j ..
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sg, ft. or Tess 143.13 - 4
Subdivision: I Lot no.: Ea. addl 500 sq. R. 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 ;:4-?:.:;: . .> . ; ;: •.:,:::,:..:::: � _ : -. .. Each manufactured or modular
M,1' - dwelling, service and/or feeder __ 90,90 2
'� `� I f NJ1F•e� pI Services or feeders installation, alteration. and/or relocation
200 amps o l ets 80.30 2
•
u ... , • ` .. . • 201 amps to 400 amply • _ 106.85 2
PROPERTY OWNER "' .:.. .. - . 401 amps to 600 amps 160.60 2
Name: Q(v1n 4 M N . 601 amps to 1,000 amps —
240.60 2
�,y,,
Address: A jjl� vr� Over 1,000 amps or volts 454.65 2
Reconnect only 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: (r ' — 1 r�?.1 Fax: ( ) relocation
y v7 v 200 amps or less 66.85 I
Owner instal atlon: This installation is being made on property that l 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— now, alteration, or extension, per panel
••:.:-,;:::,..;,•,:: ❑ •APPLICANT.'':' : %:` ::::, .',f ::';:- ::❑. CORrACT PERSON;:• - A. Fee for branch circuits wide
'service or feeder fee, each 6,65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: wi hiul service or feeder fee, 1
46.85 2
each branch circuit 1
Address: • Each add'I branch circuit _ r 6.65 Lei . 2
City /State/ZIP: • Miscellaneous (service or feeder not included)
Pumper irrigation circle 53.40 2
Phone: ( ) . Fax: : ( ) I Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
. CONTRACTOR ,'' .. .. , I':.....
or
i-.:'• energy panel, alteration o
extension. Describe; Page 2 2
Business name: Hillsboro Electric L.L.
Each additional inspection over allowable in any of the above
Address:
21 185 NW Evergreen PKWY Ste #a 10 Per inspection 62.30
City/State/ZIP: Hills boro, OR. 97124 Investigation per hour (I hr rain) ' 62.50 •
Phone: (5 0 3) 439-9666 Fax: (503 ) 6 01- 3 6 8 0 • . Industrial plant per hour 73.75
_ ELECTRICAL PERMIT FEES* '
CCB Lic.:1 3 4 4 81 I Electrical Lic.:3 4 4 9 9 C Suprv. Lie.: 4941 S Subtotal
Suprv. Electrician signature, required: • Plan review (25% of permit fee)
Date: I 1 State surch o(pet fee)
D
Print name: Joey Vi cc0 t,Q I
TOTAL. PERMIT FEE • -- if • Authorized signature: • This permit application expires if a permit is not obtained within 180
dogs after It has been .ctepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
-• Numher of inapeclione per permit allowed.
.• ma .■leim rerfaitAOP• 12/(0 44ndr,IJrt11012/C0MIw8B
re-
CITY OF TIGARD /Y ,/ -5 ,4r►,l- X1'`"'4
BUILDING DIVISION PERMIT #: ELC200S-00430
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/20/2005
Phone: (503) 639 -4171 l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/11/2005 TIME: 7:07AM PAGE: 87
SITE ADDRESS: 12612 SW SNOW BRUSH CT CLASS OF WORK:
SUBDIVISION: AMART SUMMERLAKE NO. 2 LOT #: 136 TYPE OF USE:
PROJECT NAME: KRUGER
DESCRIPTION: A/C & furnace.
OWNER: KRUGER, DENNIS A + WENDY L, PHONE #: 503- 5249029
CONTRACTOR: HILLSBORO ELECTRIC PHONE #: 503 - 439.9666
Inspection Request Scheduled For: Date: 7/11/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 011070 -02 503 -53B -2953 Y
Corrections /Comments /Instructions: 9 1 g62q
'./(-----,----..-.-' 7 ----- '---
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 7-11-65 Phone #: (503) 718-