Permit - CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00407
DEVELOPMENT SERVICES DATE ISSUED: 7/7/2004
..��1 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S103BD -07200
SITE ADDRESS: 12517 SW 115TH AVE
SUBDIVISION: HUNTERS GLEN ZONING: R-4.5
BLOCK: LOT : 028 JURISDICTION: TIG
Project Description: 2 branch circuits. AC and plug.
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:
BAYLEY, GLEN M + LAURIE M HILLSBORO ELECTRIC
12517 SW 115TH AVE 21185 NW EVERGREEN PARKWAY
TIGARD, OR 97223 HILLSBORO, OR 97124
Phone: 503 - 579 -6112 Phone: 503 - 439 -9666
Reg #: ELE 34 -4399C
LIC 134481
FEES SUP 4941S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 7/7/2004 $53.50
[TAX] 8% State Surcharge 7/7/2004 $4.28 Rough -
Elect'I Final
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 -3 -2344.
Issued By: , f,t_) Permit Signature: 6 f.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: 4 .7Lq ij-
Call 639 -4175 by 7:00pm for an inspection the next business day
F rom : HILLSBORO ELECTRIC LLC. c 5036013680 07/06/2004 10:33 #303 P.002
i tlectrical Permit ,A npl at IVC D FOR OFFICE, USE oN'I.l'
CI- of Tigard JUL 2004 Received
Date/Bv: /T0 46 permit No.: / Asp 13125 SW Hall Blvd., Tigard, OR 97223 _ _.. —t �
Phone: 503.639,4171 Fax: 503,598.1960 •; '1 Plpn co
� .�1M� 1 ' Date /8v. Rev Other Pettit!
Inspection Line: 503,639.4175 CITY OF TIGAR': 62 J Date Ready /By; Z Sec Page 7. for
}ntemet: www.ci.tigard.or,us BUILDING DIVISION Notified/Method: 111M Suppienteptul lnfornmtion
TYPE OP WORK r •
•
- PLAN REVIEW
❑ New construction V4 Addition/alteration/replacement Please check all that apply:
❑Service over 225 amps, comm'I ❑Hazardous location
El Demolition ❑Other;
Service over 320 amps - rating ❑13uildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
�i -and 2- family dwelling El ComtttereiaUindustriDil ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi [7] Master builder El Other:
. - - rsons
Occupant load over 99 persons ❑Manufaetu red structures or
JOB SITE INFORMATION' AND LOCATION "': .: ❑Egress/lighting plan RV park
Job no -:7 Job site address: 1Z Sul lei � . ❑Health -care facility ❑Other:
Submit 2 sets of plans with any of the above,
City/State/2i P:'(�i/1 VA ` � j - Z The above are not applicable to temporary construction service,
Suite/bldg./apt. no.: Project name: l SCHEDULE ".
Description I Qty, j Fee. J Toni f "
Cross street/directions • New residential single- or multi- family dwelling unit.
Includes attached gars
1,000 sq. ft, or less 145.15 4
•
Subdivision: Lot no.: Ea. add'I 500 sq. ft or porti 33.40 1
Tax map/parcel no.: Limited energy. residential 75.00 2
Limited energy, non - residential 75.00 2
:':..:•:•• ' : '..' :, . DESCRIPTION O OF WORK:.::- ;" . ,. ,� ,.
' " Each manufactured or modular
�� 1 I 1 dwelling, service and/or feeder _ 90,90 2
Services or feeders installation, alteration, and /or relocation
amps 80.30 200 m or less . 2
PROPERTY OWNER 201 am to 400 am 2
�:: -.:�. ,......., .... ❑''.TENANT' =;;;, :..;., = '::.' ;:: amps amps .85
Name: f ' G , 4 /sl� j (ti i 601 amps to 1,000 0 0mps 140.60 2
601 amps to ],000 amps _ 240.60 2
Address: 52 t" 1 1f' 7 A V : . td� 4� i Over 1,000 amps or volts 454.65 2
oi Reconnect only 66.85 3
City/State2IP: _ Temporary services or feeders iastaltation, alteration, and/or
Phone: 116 ) C ( / 0 1 I Fax: ( ) relocation
300 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 600 amps • _ 133.75 2
Owner signature: _ - Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT', ": ❑. CONTACT PERSON'! A. Fee for branch circuits with
service or feeder fee, each
Business name: is branch circuit 6.65 2
B. Fee for branch circuits
Contact name: wil/wul service or feeder fee, • (
_
Address: .
each branch circuit 46.85 ��� 2
__ _ Each add'I branch circuit _ i 6.65 Le , U4 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( ) Sign or outline lighting 53.40 2
E-mail: Signal circuits) or limited-
CONTRACTOR " :; :; energy panel, alteration, or
. extension, Describe: Page 2 2
Business name: Hillsboro Electric L.L.C.
Address: Each additional inspection over allowable In any_of the above
21185 NW EVeregreen PKWY Ste #110 Per inspection 62,50
City/State/ZIP: Hillsboro , OR. 97124 Investigation per hour (t hr min) 62.50
Phone; { 5 0 3) 439-9666 I Fax: (503 0 3) 6 01- 3 6 8 0 industrial p lant p er hour 73,75
ELECTRICAL PERMIT FEES?
CCB Lic.:1 3 4 4 81 I Electrical Lic. :3 4- 4 9 9 C Suprv. Lic.: 4 9 41 S Subtotal ,?
Suprv. Electrician signature, required: ZS� I/ - .....e.21 Plan review (25% of permit fee)
t + � State surcharge o
Print name: t70ey Vitacco Date: �!� !
V " I 6 e (8% f permit fee)
•
TOTAL PERMIT FEE 3.
Authorized signature: This permit application aspires ifa permit is not obtained within ISO
days char it has been accepted us complete
Print name: Date: • Fat methodology sat by Tri- County Building Industry Service Board
t " Number of inspyruons per permit allowed.
I:\ Bulldinu \Pcrmits\ELC- PermitAppeoe i /tO 44(4 46 )FTtittn0t't)MIWEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Live: 003) 639 -4171 MST
BUP
Received Date Requested ! J AM PM BUP
Location 1 - 5 I �- t O "(1—<- Suite MEC
Contact Person KGB Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/tar - JL i �' ELC c2uu 7 — QO £d 7
Footing 5 7 - / /
ELC
Foundation
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors . 71
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
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
C,
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA Date Inspector Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL