Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2008 -00433
: COMMUNITY DEVELOPMENT DATE ISSUED: 7/25/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S134CA-09200
SITE ADDRESS: 11218 SW 118TH TER ZONING: R - 4.5
SUBDIVISION: FEHRENBACHER NO. 2 LOT : 011 JURISDICTION: TIG
PROJECT: HOFF
Project Description: Circuit for heat pump.
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:
MUSTAPHA HOFF STAR ELECTRICAL SERVICE
11218 SW 118TH TERR PO BOX 1784
TIGARD, OR 97223 BEAVERTON, OR 97075
Phone: 503 - 579 - 9215 Contact #: PRI 503 - 579 - 9201
14Y 503 -s79 - 451/
FEES
Description Date Amount Reg #: ELE 26 -963C
[ELPRMT] ELC Permit 7/25/2008 $46.85 LIC 153627
[TAX] 12% State Surchar 7/25/2008 $5.62 SUP 4313S
Total $52.47 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 -0s 8 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OU .t 5. 24 or 1.800.332.2344.
Issued By:
0 I ■
, i'I 2 J Permittee Signature: V , � /�n
OWNER INSTALLATION ONLY 'i / I
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION 0 LY
SIGNATURE OF SUPR. ELEC'N: 11180 ,I ,',� 7 4 •. / l • DATE:
LICENSE NO: I!
I
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.
Elec tr Permit Application FOR :OFFIC USE ONLY
Received ? Pc t i e)e do y33
- City of Tigard Date/By:
Permit No : E .+
lig
q 13125 SW Hall Blvd., Tigard, OR 97223 y
g Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date /By:
Other Permit:
T I G A KD Inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for
Internet: www.tigard or. Notified/Method. "/ (Gi Supplemental Information
. • TYPE' OF WORK - • PLAN ,REVIEW .
['New construction El Addition /alteration /replacement
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION . exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION 'AND. LOCATION
0 Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ",
100HP or more. occupancy.
Job no.: Job site addrss: ; .) j SLV 1, 16 ^ 0 or more residential units. ❑ • Recreational vehicle parks.
1
City /State /ZIP: I �/1��N I D / ` ❑ Health -care facilities. ❑ Supply voltage for more than
M J «<ii{ 7 V ❑Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: lib F F ❑ Service or feeder 600 amps or more.
It ' FEE SCHEDULE _
Cross street/directions to job site: Description l Qty. I Fee. I Total I "
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145 15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
' . DESCRIPTION. OF WORK ' . (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
r e , ' ii. .4 r
S , -// residential (with above sq. ft.)
ii' .1 Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
",PROPERTY OWNER • . a ❑ :TEN_ A_ N T,' , 201 amps to 400 amps 106.85 2
Name: �� ,:: 401 amps to 600 amps 160.60 2
/ amps to 1,000 amps 240.60 2
Address: / /O` / 0 J Ail) l/8 /r 7 Over 1,000 amps or volts 454.65 2
City/State /ZIP: / 1 5 / ) j ez � Temporary services or feeders installation, alteration, and/or
' w relocation
Phone: Fax: 200 amps or less 66.85 1
(] ) ��� Z! ( ) 201 amps to 400 amps 100.30 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT a ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits G
Contact name: without service or feeder fee, 46.85 4-K 2
first branch circuit
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
' - CONTRACTOR .. Sign or outline lighting 53.40 2
.e, , t Signal circuit(s) or limited -
Business name: ,." IL . C l l� „r12 - l c-- O ` KtJ t C G L panel, energy panel, alteration, or
• �� I: Address:
8 111 extension. Describe: Page 2 2
City/State /ZIP: Sp J —p ,2 r 9 q 7 Each additional inspection over allowable in any of the above
� /{� Per inspection 62.50
't
Phone: 5, 5,)9 �. y'Ap / Fax: (51)5) 579 — ` / 7 O / Investigation per hour (1 hr min) 62.50
CCB Lie.: l �!?� / .A- trical Lie.: air'iz Suprv. Lie.: iy5, 3 5 Industrial plant per hour 73.75
J _t� '` r ELECTRICAL PERMIT FEES - /
Suprv. Electrician signature, required: Subtotal: Y � .g
Print name: Date: Plan review (25% of permit fee): .6^
/ St surcharge (12% of permit fee): S', co `�
Authorized signature: i ,,, i TOTAL PERMIT FEE: 7p t T
'- -' fto This permit application expires if a permit is not obta within 1
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I \Building\Permits\ELC- PermitApp doe 05/23/06 440 - 46151(1 I /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
`RESIDEIVTIAIWORK ONLI'; : ?.` _ "" :
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:.
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \Building\Permits \ELC- PermitApp doc 03/23/06
CITY OF TIGARD
COMMUNITY DEVELOPMENT
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
Electrical Signature Form
IMPORTANT PERMIT NOTICE
STAR ELECTRICAL SERVICE
PO BOX 1784
BEAVERTON, OR 97075
Permit #: ELC2008 -00433
Date Issued: 7/25/2008
Parcel: 1 S134CA -09200
Site Address: 11218 SW 118TH TER
Subdivision: FEHRENBACHER NO. 2
Lot: 011
Jurisdiction: TIG
Zoning: R-4.5
Project Name: HOFF
Description: Circuit for heat pump.
Your company has been indicated as the electrical contractor for the permit referenced above. In order for the electrical
permit to be valid, the.lignature of the supervising electrician is required. Please have the appropriate individual from
your company sign below and return this Electrical Signature Form prior to the start of the work. Please mail the form to:
City of Tigard, Building Division, 13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624.3651.
If you have any questions please call 503.718.2433.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
MUSTAPHA HOFF STAR ELECTRICAL SERVICE
11218 SW 118TH TERR PO BOX 1784
TIGARD, OR 97223 BEAVERTON, OR 97075
Phone #: 503- 579_9215 Phone #: 503-579-9201
Reg #: ELE 26 - 9630
LIC 153627
SUP 4313S
AN INK SIGN • RE IS REQUIRED ON THIS FORM
1 5,K PO4k4 I / 3
Signs - of Superv'ti0• a , NfW SUP LIC #
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2008 -00433
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: , 7/25,1200£3
Phone: (503) 639 -4171 �0��iigll
Inspection Requests (24 Hrs.): (503) 639 -4175 s
INSPECTION WORKSHEET FOR DATE: 8J6/200t3 TIME 7 :03APA PAGE 37
SITE ADDRESS: 11218 SW 118TH TER CLASS OF WORK:
SUBDIVISION: FEHRENI3ACHER No 2 LOT #: 011 TYPE OF USE:
PROJECT NAME: HOFF
DESCRIPTION: Circuit for heat pump.
OWNER: HOFF , MUSTAPHA PHONE #: 503 - 579 -921V
CONTRACTOR: STAR ELECTRICAL SERVICE PHONE #: 503,579.9201
Inspection Request Scheduled For: Date: 816/2000 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 073778 -01 503-624-2704 Y PM
Corrections /Comments /Instructions:
, (i
PASS n PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS ,
FAIL ❑ CA L FOR INSPECTION n ADDITIONAL FEES ASSESSED
I
Inspector: , Date: q b Phone #: (503) 718-WO