Permit `" A . CITY OF TIGARD ELECTRICAL PERMIT
00496
A114'1 DEVELOPMENT SERVICES DATE ISSUED: 8/9/ 004
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' �� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171
PARCEL: 1S125DD-09200
SITE ADDRESS: 09670 SW VENTURA CT
SUBDIVISION: WASHINGTON SQUARE ESTATES NO.3 ZONING: R-4.5
BLOCK: LOT : 100 JURISDICTION: TIG
Project Description: Installation of (2) branch circuits for NC & GFI.
Job No. 3028
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:
JEFF STONE HILLSBORO ELECTRIC
9670 SW VENTURA CT 21185 NW EVERGREEN PARKWAY
TIGARD, OR 97223 HILLSBORO, OR 97124
Phone: 541- 579 -3737 Phone: 503 - 439 -9666
Reg #: ELF 34 -4399C
LIC 134481
FEES SUP 4941S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/9/2004 $53.50
[TAX] 8% State Surcharge 8/9/2004 $4 Rough -
Elect'I Final
Total $57.78
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 f r more than 180 days. ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules a set forth in • • e 952 - 001 -0010 through OAR 952 - 001 -0100 You may obtain copies of these rules or direct questions to OUNC at (503)
246-6 99 o r 1 -800- 332 -23 • • .
Issu By: • �± ' . is Permit 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: ' iiii%, - /e_c__ DATE:
LICENSE NO: 1W /
Call 639 -4175 by 7:00pm for an inspection the next business day
Fr om : H I LLSBORO ELECTRIC LLC. 5036013680 08/06/2004 15:25 #652 P.002 /002
Electrical Permit A l',..,.! 1 ? _ FOR OFFICE Lis ; ONLY
= i EIV �
Receive f o
City of Tigard Re c e ive g p / Permit No.: f��?DO — 4O 1 ,
13125 SW Hall Blvd, Tigard, OR 972223 Plan Review
Phone. 503.639.4171 Fax; 503 598.1960 `p „!, n 6 I " " " x i 'i1. s, Date/By: Other Penns;
Inspection Line, 503,639.4175 Fr� n e' Date ReadyJBy ®See Page; for
Internet: www.ci.tipard.or,us CITY OF TIGARD Notified/Method: � - Supplemental Information
TY, DIVISI®r' ' . ' PLAN REVIEW .
❑ New construction Addition/alteration/replacement Please check all that apply;
❑ Demolition ❑Other: Eisen/ice over 225 amps, comer ['Hazardous location
['Service
CATEGORY OF CONSTRUCTION • of 1 and 2 320 amps rating ❑Bulldog over 10,000 se, ft.,
family dwelll ings 4 or more new residential
Iff 1- and 2- family dwelling 0 Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi- family [] Master builder ❑Other, ['Building over three stories ['Feeders, 400 amps or more
' . , ['Occupant load over 99 persons ❑ structures or
JOB SITE INFORMATION AND LOCATION ..
❑Egress/lighting plan P
Job no.: "30713 Job site address: 1(1)-10 iA) 1/6 1 h)r? C—, ❑Health -care facility ❑Other,
Submit 2 sets of plans with any of the above.
City /Stale/Z1,` /� A i'1j3 The above are not applicable to temporary construction service.
i
�� 1+ ����LLLVVVV "'���� 111► U � 1 9(11t4.....) FEE ". SCHEDULE =
Suite/bldgJapt, no.: Project name:
Description J Qty. I Fee. i Total I ..
Cross street/directions Mk* site: New residential single- or multi - family dwelling unit.
Includes attached garage.
00 se,. f1 or legs I 145.15 ( 4
Subdivision: 1 Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel n0.: Limited energy, non - residential 75.00 3
' DESCRIPTION OR WORK _ ''
' Each manufactured or modular
hat' • t qn . 71/1/141 - / 1,1: i ( dwelling, service and/or feeder _ 90.90 2
J f Y/ V / (/t 1 �� Services or feeders installation, alteration. and/or relocation
200 amps or less 80.30 2
PROPERTY OWNER ' "'. . .. • •:::; ' ' . EN
❑'TANT':• :'': 201 amps to 400 amps 106.85 I 2
-�� •'^AJ � I " 401 amps to 600 amps 160.60 2
J
Name: t( 5 U 1 �- 601 amps to 1,000 amps 240.60 2
Address: S IT AS ) Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/Stat Temporary services or feeders Installation, alteration, and/or
t � relocation
Phone: e' 1/ ,/ ` 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 1 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
' ❑ APPLI 'NT•, ` - I, ❑ CONTACT PERSON' - ' ;*•'` _ A. Fee for branch circuits with
service or feeder fee, each 6.653
Business name: branch circuit
Contact name: B. Fee for branch circuits
without service or feeder fee, 1 46,85 1
Address: each branch circuit
Each add'1 branch circuit 1 1 6.65 (/ • V f 2
City /State/ZiP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( )
n or outline lighting 53,40 2
E -mail: Signal circuit(s) or limited-
.
' ' .: CONTRACTOR '• - • "'• energy panel, alteration, or
extension. Describe: Page 2 2
Businessneme:Hillsboro Electric I.L.C.
Address: 21185 NW Evergreen PKWY Ste #110
Each additional inspection over allowable in any of the above
Per inspection 7 62,50 a
City/State/ZIP: Hi llsboro , OR. 97124 Investigation per hour(t hr min) 62.50
Phone: (503) 439-9666 I Fax: (503 )6 0 1- 3 6 8 0 Industrial plant per hour , 73.75
ELECTRICAL PERMIT FEES" ' •
Cea Lic.:1 3 4 4 81 I Electrical u..:34-499C I Satprv, Lic.: 4941 S Subtotal 5 -3 .5r
Suprv. Electrician signature, required: Plan review (25 % of permit fee)
Printname: Joey Vitacco Dote; cj f a State surcharge (8 °ioof permit fee)
Authorized signature: a W TOTAL PERMIT FEE ? .1S
g This permit application expires If a permit Is not obtained within ISO
days after it bas been accepted as complete
Print name: Date: • Fee methodology set by Tn-County Building industry Service Board
•• Number of inspuctions per permit allowed.
i.\ Rwldingwern PamitApp.dee Ia/co 4404615T /I0W2/COM/wsn
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
g BUP
Received Date Rev ested ` - 2 3 AM PM BUP
Location 6 (Or l Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR •
BUILDING Tenant/Owner �_ % . -r ����' ELC aq�
Footing I ELC
Foundation Access: r,
Ftg Drain 4 3V ELR
Crawl Drain
Slab Inspection Notes: SIT
•
Post & Beam A,
Shear Anchors lw
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation 4111S
• Drywall Nailing ' ' a'
Firewall - V ' � , _ � /+ I
Fire Sprinkler / `/
Fire Alarm
Susp'd Ceiling
Roof f - v, 1 GVYS /ver p T of 77-
Other:
Final P -/ . 73 Y Ori1 e i
PASS PART FAIL
PLUMBING [ .7- 27- oy
Post & Beam l
Under Slab
Rough -In j %";,‘
Water Water Service
Sanitary Sewer P/1- ,1/ $ G� FP-1L ,'41iL
Rain Drains / 7 v�
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line •
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm _
41 7- ` 'AR Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
�� '
Please call for reinspection RE: Unable to inspect - no access
Fire Supply Lin
&3 ADA ✓ l �
/ [61141 � 1 6 /�-(
Approach/Sidewalk Date I nspector Ext •
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
M �L 20o(( -0o 5-3o