Permit 14 CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00722
COMMUNITY DEVELOPMENT DATE ISSUED: 12/21/2006
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 110DD - 11200
SITE ADDRESS: 15550 SW 109TH AVE ZONING: R -
SUBDIVISION: SUMMERFIELD NO.13 LOT : 682 JURISDICTION: TIG
Project Description: Branch circuit for 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: 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:
BENNETH, JOHN AND BETTIANA HILLSBORO ELECTRIC
15550 SW 109TH AVENUE 21185 NW EVERGREEN PKWY #110
TIGARD, OR 97224 HILLSBORO, OR 97124
Phone: 503 - 620 -9113 Contact #: PRI 503 - 439 -9666
FAX 503 - 601 -3680
FEES
Description Date Amount Reg #: ELE 34 -4399C
[ELPRMT] ELC Permit 12/21/2001 $46.85 LIC 134481
[TAX] 8% State Surcharge 12/21/2001 $3.75 SUP 49415
Total $50.60 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: 'Di 690/21„4: &a l 0-y.... 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.
12- 21 -'06 17:46 FROM- Hillsboro Electric 503 -601 -3680 T -454 P002/002 F -987
- alacvilceszali r erlului txppiication I C1R OhI I('1 -. l tit; O \1.1
• City Tigard Received
13125 SW !tall Blvd., Tigard, OR 9'i��fti.. ' Plate/By: t'o1 1
2/G� 66 Permit No �a1� 0oi2
Phone: 503.639.4171 Pax: 503.59 ? 1 e bn9 t �' I D an R /
�'` Other Permit:
Inspection Line: 503.639.4175 . !l
Int met: www.ci.tigard.or.us DEC 2 1 2006 �"""' --a, 1 Notified/Method: d/tviethod; rurie: 1 El See i ti l f or
I Supplemental nrarmnfion
:
❑ New construction • lACemen[ apply:
'�1e�tto p Please check all tha a e -
❑ Demolition El Other: over 225 amps, comm ❑Hazardous location
,... --4 —" ['Service ❑Build rvice over 320 amps - rating ng over 10,000 sq. ft.,
� .,., .: ;�
: :. , .. :: - .. :.. .. . 'GATE
:.::.;: 9'OF'CON Q Accessory buil • .... ..:: RY Accesso . ........ : ,.'.' :, : of 1 -and 2 -family dwellings 4 or more new residential
[il - and 2- family dwelling 0 Commercial /industrial ding USystem over 600 volts nominal Units in one structure
❑ Multi family ❑ Master builder ❑Other: ❑Building over three stories ❑Feeders, 400 amps or more
, ....:
- �. ,: ,,..;,.,:.�, : • .,.,:.�;:
DOccupant over 99 persons DManufactured structures or
• .....: �: ;:: ... ...;..,::.., ...,..,;..::,..�.., � , �:.,;�..., . �..:::,:,.:,:,,.,,.: ,:.... .., .. .. .,.. ,., gressAightingplan park
Job no.: ,, Yob site address:( "t �� 0 ' ❑Health -care facility CjOthe
^'� / � 1 � Submit 2 sets of plants with any of the above.
City /State /ZIP: 1 i u�� I The above are not applica mporary construction service.
ble to to
Suite/bldg./apt. no.: Project r "'S ��._
P J t name: Eg::. .... 01r4r,::i' . :',: :.;::':! :::: ::;:: ,.ii '
1 Y DOetibtlOn I Qty, I Fee. I Tettil ••
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: I Lot no.: Ea. add'l 500 sq. ft. or portion 33,40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
,:.:::.,!da' ; :�;� Limited
r: :..,.:,: ergy.n residential 75.00 2
:DESCR]PTIQI'!T' OF WORT :
; , :.....:: " "'' ......:........ Each manufactured or modular
I,, ^ " ,� dwelling, service and/or feeder 90.90 2
1 V i Pri e, _ Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
.i : :...:,,.::..: CA r: t*k to 400 amps' 106 2
.85
.,.,:, Et.�'Y t�W�Ic' :! ::' :I;;: am P
.: 40I amps to 600 amps 160.60 2
Name:
1011 ( D // , V 601 amps to 1,000 amps 240.60 2
Address: ( n A Q , Oi ( &1 1� \A _Over 1,000 amps or volts 454,65 2
City/ State/ZlP: "` `1 J Reconnect only 66.85 2
Temporary services or feeders installation, alteration, and/or
Phone: l� L? -. i 1 5 Fax: ( ) relocation
_200 amps or less 66.85 1
i
OWuer 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, rant, or exchange, according to ORS 447, 449, 670, and 701. 401 a pp s to 600 amps 133.75 2
Owner signature. Da _
,:.:. .. ,... : ..,;.,�. alteration, or care
........ ,.,,.:....:: RLIG A. Fee f c
............:.. ,., 1.. �,.„.._......... ...:,..,..�°::.:::�.....:,.,' � -.RE circui With
h o
' n
n o ex c per panel
or branch
'' n " ' ` service or feeder fee, each
Business name; .� V'c branch circuit 6,65 2
Contact name: B, Pee for branch circuits ' r't !
f rst without service or feeder fee, 46.85 [� 2
Address: first branch circuit
Each add'l branch circuit 6.65 ] 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ) I Fax::
( ) Pump or irrigation circle I 53,40 j 2
E -mail:
Sign or outline lighting 53.40 2
..... t rcui
la " ; ;- � •' FOR energy anal, al
.................,. � ...:: :.:..::,..:...:,, ...:......... ,iV'J;1Z�A, .. [erasion, or
•
Business name: r U ,1 L` , t .,
extension. Describe:
Page 2 2
Address: _ t L / , /
.A 1 ' Each additional inspection over allowable in any of the above
Per inspection I 62,50 [ .
' City /State/ZIP: 1
- L .f .. • Investigation per hour (1 hr min) 62.50
Phone: St y4 (4 j(( Fax: ( $ ' n rti 1 , „ Industrial plant per hour 73.75
>
CCB Lic.: 1 Electrical Lie,: Suprv. Lic.: �i 1 " : : :: lEGTRICAX ` titM T; FEES !::' , . •r'a:; ,. ,• ,• „
3 J t.1 Su P 1"1
�!. lc
Subtotal IIE
Suprv. Ele signature, required: i , _. Plan review (25% of permit fee)
Print name: \D i vt I , v 11�CL + J Date: 1— ,1 1 - State surcharge (8% of permit f e e ) - 7 )
` � 1 TOTAL PERMIT FEE WI (OD
Authorized signatu This permit application expires if a permit is not obtained .within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
" Number of inspections per permit allowed.
i:U Building \Pcnninaic- permitApp.dee 12/03 440 - 46 1sT(1No2/CbMJWEB
CITY OF ��mm m n�`w nu����mm��
BUILDING DIVISION ~�~~"~~~~""°~= ~~"°"~~.~~.° .`�• PERMIT #: ELC2006-O0722
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/21/2006
Phone: (503) 639-4171 /004044 II'
Inspection Requests (24 Hrs.): (503) 639-4175 All 1.1-
INSPECTION WORKSHEET FOR DATE: 1/5/2007 TIME: 7:00AK4 PAGE: 8
SITE ADDRESS: 15G6gSWjU9THAVE CLASS OF WORK:
SUBDIVISION: SUMNIERFIELD NO 3 LOT #: 682 TYPE OF USE:
PROJECT NAME: BENNETH
DESCRIPTION: Branch circu
OWNER: BENNETH, JOHN AND BE|!|ANA. PHONE #: 503-620-9113
CONTRACTOR: HILLSBORO ELECTRIC PHONE #: 5O3
Inspection Request Scheduled For: Date: 1/612007 Pour Time:
Code # Inspection Description . Confirm # Contact # Mes
//_�o
199 Electrical �Dna| 041855-01 5O�'53�2353 . ((- �
Corrections/Comments/Instructions:
.
.
�� PASS | I PARTIAL �� NO ACCESS CANCEL ' �l
- . . �� . .
n FAIL CALL FOR INSPECTION r i ADDITIONAL FEES ASSESSED
��
�u�
|Inspector: �~«�/ ' Date: / �� y�J � Phone #: (503) 718-
. / / ' r__
_' .