Permit r.4
CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00484 •
1 I � DEVELOPMENT SERVICES DATE ISSUED: 8/28/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S133DD-05600
SITE ADDRESS: 12753 SW WINTER LAKE DR ZONING: R -4.5
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 3 LOT : 095 JURISDICTION: TIG
Project Description: (3) branch circuits for NC, condensate pump & GFI. Job # 4809.
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: 2 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:
MIKE ISSACS . - HILLSBORO ELECTRIC
12753 SW WiNTERLAKE DR . 21185 NW EVERGREEN PKWY #110
TIGARD, OR 97223 HILLSBORO, OR 97124
Phone: Contact #: PRl 503- 439 -9666
FAX 503- 601 -3680
FEES
Description Date Amount Reg #: ELE 34 -4399C
[ELPRMT] ELC Permit 8/28/2006 $60.15 LIC 134481
[TAX] 8% State Surcharge 8/28/2006 $4.81 SUP 4941S
Total $64.96 • REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699 or
1- 800 - 332 -2344.
Issued By: Permittee Signature: R
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
08- 25 -'06 15:39 FROM- Hillsboro Electric 503 - 601 -3680 T -018 P002/002 F -147
L ctrical Permit Application - l O li Orr 1( i : t s i ()NIA
Ci�y of Tigard �1, �- i l�f �I ; Receivd _�_ , v P ! l . " di ,
�Y g e
permit No.
•
13125 SW Nall Blvd., Tigard, OK 1223
' ' ��
Rev
Phone: 503.639.4171 Fax; 503.598.1960 , , 1•}' ,r. P ta /By. Other Permit;
w
•
Inspection Line: 503.639.4175 AUG 2 ' �oo� i y � iii J . � lla
, t
w Notified/Method: cc . ent r
Internet: ww. ti g ar d.or,us �.Re � I 6upplem!a See penta l lfooformation
;..
• ..: • ......: • • : • . , : � , • i ) ,;.0$k •. ' • • ' : .. : ' :... ; : • :. ' N4AAP1 REVIEW
❑ New construction ) #611/a7teiit15946116ment Please check all that apply:
❑ Service over 225 amps, comet location
❑ Demolition 12 Other:
. ❑Service over 320 amps - rating Buildng over 10000
.. ' : .: ; . CAT EGORYi•OP CONSTRUCTION ` sti
� • � ' � ..: •• • • � .... , •, ... • • • •• • of 1 -and 2- f am il y d wellings 4 or more new residential
Imo+ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi- family 0 Master builder 0 Other:
, O ❑Occupant load over 99 persons (]Manufactured structures or
:.I !JOR : `1 :. R1NATI :4 f81� I CATI0N:.` : :. ❑Egess/lighting plan 1W park
Job no.: �-�'�b i Job site a dd r ess :��� f I `,r f� ) UV , ❑B�th- facility ❑Other:
,5 v) V ` .11 , Submit 2 sets of plans with any of the above.
City/State/ZIP; TI /f �jJ 01-- .z, The above are not applicable to temporary consauction service.
SuiteJbldg. /apt. no. : "( "r Project name: 11.A ® :FED : "S (pt
i L . Dmcriptlw, I Qr' I Bea I •rot l i ••
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. add'l 500 sq. ft, or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
75.00 2
... • . .. . . :.. _ D 1'lO1N: OF :Wt? •
. Limited energy, non - residential
:• . . .. :' :...:.._ : . , ..... Rea manufactured or modular
dwelling, service and/or feeder 90.90 2
if -' el A A.. ' II ' f ' A /At ; : i t Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 ' 2
. i , :PRO)E yri;;OWNER 'i 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: \ \c -Q J j ®c.3 601 amps to 1.000 amps 240.60 2
Address; Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) I Fax: ( ) relocation
200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 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
- ' ; ti :AA1'! : - - - A Fee far branch circuits with - -
,..,., � 'A ..._.....,. . .:: : 1: �:::. I•::::; 1 :.;:: .; , .,....: �.:: � :• � �:: �SQ1�I 'ARC'1'RERSOUI;��i� : : :i : : :i!;;
service or feeder fee, each
Business name: 1 l„ branch circuit 6.65 2
^'�'� B. Fee for branch circuits 1
Contact name: without service or feeder fee, 2
Address:
first branch circuit 46.85 1p
Each add'l branch circuit _ J 6.65 %• 3.7 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone; ( ) I Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuits) or limited -
.;:'-:.''•Pi :; :. ^. :'; :CONTRACTO *, , _ . _ • • . energy panel, alteration, or
� n � ext ension. Describe: Page 2 2
Business name• II.ISbt, 1�c►�C L 1 Yi '
Address Z„� Y ,�� / IA `1 u _Each additional inspection over allowable in any of the above
, Per inspection 62.50
Ciry /State/ZIP: Tl\u Aclop , I � , Investigation per hour (t hr min) 62.50
Phone: (S) ^ iut t�.0 Fax: ) ( . 0X0 Industrial plant per hour 73.75
:•ELEC itAL'•'ziam1Tr S4
CCB Lic.: \L q Electrical Lic.: 31 ,k,(CeiL I Suprv. Lic.: VAU 14 Subtotal i IS
Suprv. Electrician signature, required: . Plan review (25% of permit fee)
Print name: / �, ` . LC bate: - <4.76161.0 State surcharge (8% of permit fee) , 1 I
V `mot TOTAL PERMIT PEE I C . 1L- e
Authorized Signature; This permit application expires Ira permit is sot obtained within 150
Pint name; days after it has been accepted as complete
Date: • Pee methodology set by Tri- County Building Industry Service Board
•e Number of inspections per permit allowed.
1 130ildinePermits\ELGrermitApp .doe 12/03 440 46iiT(10/m:/COM/Wl;a
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2006- 00484
I 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/28/2006
Phone: (503) 639 -4171 r +�
Inspection Requests (24 Hrs.): (503) 639 -4175 s ' ^ ''I..
INSPECTION WORKSHEET FOR DATE: 9/21/2006 TIME: 7 :02AM PAGE: 43 '
SITE ADDRESS: 12753 SW WINTER LAKE DR CLASS OF WORK:
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 3 LOT #: 095 TYPE OF USE:
PROJECT NAME: ISAACS
DESCRIPTION: (3) branch circuits for NC, condensate pump & GFI. Job #4809.
OWNER: ISSACS, MIKE PHONE #:
CONTRACTOR: HILLSBORO ELECTRIC PHONE #: 503-439-9666
Inspection Request Scheduled For: Date: 8!2.112006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 036960 -01 503 - 538 -2953 Y
Corrections/Comments/Instructions:
(' P del__. Lk 04.iti f
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41
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: `-Lie Date: 92/ -0 Phone #: (503) 718- Z4”