Permit CITY TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00973
DEVELOPMENT SERVICES DATE ISSUED: 12/27/2005
'--' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 104AC -01000
SITE ADDRESS: 12930 SW 132ND AVE ZONING: R - 4.5
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: Branch circuits. AC, furnace and GFI.
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:
BURL MORFORD HILLSBORO ELECTRIC
12930 SW 132ND AVE 21185 NW EVERGREEN PKWY #110
TIGARD, OR 97223 HILLSBORO, OR 97124
Phone: 503 - 590 -3611 Contact #: PRI 503 - 439 -9666
FAX 503- 601 -3680
FEES
Description Date Amount Reg #: ELE 34 -4399C
. [ELPRMT] ELC Permit 12/27/200' $60.15 LIC 134481
[TAX] 8% State Surcharge 12/27/200: $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 -80 32 44 .
Issued By: l� di Permittee Signature: j� Q� C
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- 27 -'05 08 :40 FROM- Hillsboro Electric 503 -601 -3680 T -023 PO02/002 F -479
.�; °--�--- — ---•- ^- -- ■�•�__�- • - I.
City of Tigard E C E' V ' 14' E Received
b oats /eve 06 r ' Permit No y_G ► / /
13125 SW Hall Blvd., Tigard, OR 97223 mon Review -
Phone; 503.639,4171 Fax: 503.598.1960 l/),
Inspection Line: 505.639,4175 DEC { h�I�� P Re Ot Permit:
2 7 20 I ; r 2 Pate Ready /By: RI S Page 2 for
Internet: www.ci.tigard.or.us t+ Notificd/Method: /L Supplemental InfOrmotion
1.,t.-iybf-VvoWWkRY.. '',,((���/1 , • '�.. PLAN REVIEW •
0 New construction Ei6W/ac tii2t5lSr� a �1V ent Please check all that apply:
❑ Demolition ❑Other: ['Service over 225 amps. cornm'l DHazardous location
❑Service over 320 amps - rating ❑Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION •• .. of 1- and 2 - family dwellings 4 or more new residential
E/ 1- and 2- family dwelling Q Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑Sodding over three stories ❑Feeders, 400 amps or more
IA Multi- family 0 Master builder ID Other:
JOB SITE INFORMATION' AND LOCATION ❑Occupant load over 99 persons ❑Manufactured structures or
❑Egress/Iighting plan RV park
Job no.: 4 Dk Job site address;'V7 SO) I . A ❑Health -car: facility ❑Other
Submit 2 sets of plans with any of the above.
City/ State/ZIP: 'nj�a i CV-21;3 The above are not applicable to temporary construction service.
��+ DY %. SCHEDULE ..':, ,.
Su {te/btdg, /apt. no,: Project name: .. FEE _ •
` Description Qty. Fes, TOW
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.: En. add'I 500 sq. ft. or portion 33,40 I
Tax map /parcel no.:
Limited energy, residential 75.00 2
energy, non- residential 75 2
. :.: .. . DESCRIPTION OF WORtC' : : :r.. • • :
�'� " <�'' '' • � � Each manufactured or modular
dwelling, service and/or feeder 90.90 2
'
�[s�! �!'—� Services or feeders installation. alteration. And /or relocation
w
,......
PRO PERTY OWNER .. ,:.. :.: amps to 400 amps 106.86
2
. ❑'TENANT";; : :. .... :, :; :•.!.``;': 201 Ps ,
' 401 amps to 600 amps 160.60 2
,
Name: / / ill. , h et 601 amps to 1,000 amps _ 240.60 2
Address: � 6 1t S/ t A }� (,� a� /11� ,, Ovcr 1,000 amps or volts 454.65 2
r+i �/� Reconnect only 66,85 2
City / State/ZIP: Temporary services or feeders installation; Alteration, And/or
•
Phone: ( /9', i Fax ( ) relocation
O 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 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: :;'::
i: •': :i:, A. Fee for branch circuits with '
'service or feeder fee, each
Business name: f branch circuit 6,65
B, Fee for branch circuits —
Contact name: without service or feeder fee, LLe • Address:
each branch circuit 46.552
Each add'I branch circuit 6,65 1. 2 ,
City /State/ZIP: Miscellaneous (service or feeder not included)
Phone: Pump or irrigatio circl 53.40 _ 2
( ) Fax: ( ) Sign or outline lighting 53,40 2
E -mail Signal circuit(s) or limited-
- :c . .....j.q..:`... ' •: :'• ..- .•::. r '. • 'CONTRACTOR .' energy panel, alteration, or
extension. Describe: Page 2 2
Business name: Hillsboro Electric L.L.C.
Address: 21 1 8 5 NW Ever • Teen PKWY Ste ; 1 1 fi Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: Hill sboro , OR . 97124 TM Investigation per hour (I hr min) 62,5
Phone: (5 0 3) 439-9666 Fax(503)60-j Industrial plant per hour 73.75
. : .ELECTRICAL PERMIT FEES'' •
CCS Lic.:1 3 4 4 81 Electrical Lic.:3 4 4 9 9 C Suprv, Lie.; 4 941 S Subtotal p I'S
Suprv. Electrician signature, required; O Plan review (25% of permit fee) µ
Print name; Joey ^' Vitacco Date; � 7 State surcharge (8% ofpennit fee) 1,,,I • g%
: m 4o
_ TOTAL PERMIT FEE b' L-i -14,.o
Authorized signature; This permit application expires ita permit is not obtained within 1So
days after it has been accepted as complete
Print name: Date: ■ Fee methodology set by Tri- County Building Indusny Service Board
" Number er inSpeCtions per permit allowed.
i:\n.iid ins \Pcrn}ils\ELC- PonnitApp.doc I]/ir 44v- 4615T( Inm ?Icon/wea.
•
CITY OF TIGARD
BUILDING DIVISION
PERMIT #:
13125 SW Hall Blvd., Tigar . OR 97223 DATE ISSUED: 12127/2006
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): ( 639-4175
INSPECTION WORKSHEET FOR DATE: 1/11/2006 TIME: 7:81AkA PAGE: 89
SITE ADDRESS: 12S3OSVVi32NDAVE/ CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: MORFORD
DESCRIPTION: Branch circuits. AC, furnace and GFI.
OWNER: MORFORD, BURL PHONE #: 503-tao-3611
CONTRACTOR: M|LL8BQRQELECJR|C PHONE #: 503-459-9660
Inspection Request Scheduled For: [}ate: 1/11/I006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
193 Electrical final 024684O2 503-538-2963 Y
Corrections/Comments/Instructions:
- �
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/�M �� J\�� ] ����Y\ � � ,\�� «�y\��J ��mt_
- ~ `-~ ' ^' ' -'~--( �~ '`~� ° -'� ' �' ~
I | PASS | | PARTIAL APPROVAL CANCEL El NO ACCESS
FAIL n CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Aei
/ .
Inspector: � Oa�au''�/ t7 Phone #: (503) 718' *'