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Permit 41111, CITY OF TIGARD ELECTRICAL PERMIT • t' PERMIT #: ELC2005 -00431 DEVELOPMENT SERVICES DATE ISSUED: 6/20/2005 `l^'` °�J I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171 PARCEL: 2S110BD -04400 SITE ADDRESS: 11938 SW ELEMAR CT ZONING: R -4.5 SUBDIVISION: ASPEN RIDGE LOT : 009 JURISDICTION: TIG Project Description: A/C, furnace & 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: OSBORNE, DONALD L + HILLSBORO ELECTRIC 11938 SW ELEMAR CT 21185 NW EVERGREEN PARKWAY TIGARD, OR 97224 HILLSBORO, OR 97124 Phone: 503 -639 -4234 Phone: 503 - 439 -9666 FEES Reg #: ELE 34 -4399C Description Date Amount LIC 134481 SUP 4941S [ELPRMT] ELC Permit 6/20/2005 $60.15 [TAX] 8% State Surcharge 6/20/2005 $4.81 REQUIRED ITEMS AND REPORTS Total $64.96 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: .i: .� pu+„ n OWNER INSTALLATION ONLY 8 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. Fr ELECTRIC LLC. 5036013680 06/17/2005 18:22 #869 P.002 Electrical Permit Applit a t p , a n WED FOR OFFICE 'LSE ONLY u d t u 1..„ Received / City of Tigard Date/Bv: ■ ®o t Permit No.: Gex 0 v f 13125 SW Hall Blvd., Tigard, OR 97223 III i 2 G 2005 flan Revi Phone: 503,639,4171 FaK: 503.598,1960 "" o il jr All DatcfBv: Other Permit; • Inspection Line: 503,639.4175 Dais Ready /By 11501 0 see Page 2 for Internet: www,ci.tigard.or,us CITY OF TIGAFin Notified/Method: S information r. svgs ffilvti><i'trISION PLAN REVIEW ❑ New construction E/ Addition /alteration/replacement Please check all that apply: OService over 225 amps. comm'I ❑Hazardous location ❑ Demolition • 17 Other: O Er I EService over 3.. 0 amps - rating []Bulldog over 10,000 sq. ft., • CATEGORY OF CONSTRUCTION • of 1- and 2- family dwellings 4 or more new residential IF, 1 and 2 family dwelling C] Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure ❑Building over three stories ❑ Feeders, 400 amps or more ❑ Multi- family ❑Master builder ❑Other: ❑Occupant load ovcr99 persons DManufactured structures or JOB SITE 1N.FORMATION .AND LOCATION .' .'. .. :..• :, ` RV park (]Egr'c99 /Ilghting plan Job site address: ©Healthcare facility ❑Other; lob no.: k ?■ t i ' f� 1.L i • Submit 2 sets of plans with any of the above. City /State/Z1P: I 1 / / The above are not applicable to temporary construction service. FEE,' SCHEDULE: •' .. '- Suite/bldg./apt. no.: Project name: C /6 L.` nesertn +Ian ED I P.m I Total , •• Cross street directions to job site: New residential single or multl- 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 • Limited energy, residential 75.00 2 Tax map/parcel no.: Limited energy, non - residential ry 75.00 2 ... . ,,... DESCRI OF WO1RK:c, ... .,.:::: . _ ... .:.: .......;,::�':':,•.::. ' Bach manufactured or modular n / , -. dwelling, service and/or feeder 90,90 2 �� J �Q r f 1 , � ; 1k Services or feeders installation, alterntinn, and /or re(oce - - 200 amps or less 80.30 2 . ..:: .•:,. , ..;.::: 201 amps o amps - ' ' . ' t ..PROPERTY OWNER ...... : ,,,, , .. • .:': :- i . ..._ ❑ TENANT'::..., a • �� �• �Oi a t 400 a 106.85 ? j� • 401 amps to 600 amps 160,60 2 Name: )01 1 ?�, t�l� /L 601 amps to 1,000 amps , 240.60 2_ Address: 5.(A / (S tlI j Over 1,000 amps or volts _ 454.65 2 Reconnect only 66.85 City /State /ZIP: Temporary services or feeders installation, alteration, and/or Phone: �) • � (' Fax: ( ) relocation 200 amps or lass 66.85 1 Owner installation: This installation is being tirade on property that l 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 13335 2 Owner signature: Date: Branch circuits- new, alteration, or extension, per panel ; , .. ` branch circuits with ❑ APP ICANTt: ':::.::..,.; , -' �'i,:r:;;•. ❑.•CONTACT P)rR50N';;;.; ^;ii,.: , A Fee for b service or feeder fee, each 6,65 2 Business name: iSe branch circuit B. Fee for branch circuits Q� ,.r Contact name: without service or feeder fee, 48.85 )14' S 2 each branch circuit Address: Each add'I branch circuit l' 6.65 1'3, 40 2 City /State/Z1P: Miscellaneous (service or feeder not included) 1 • Pump or irrigation circle 53, 2 _ Phone: ( ) Fax: : ( ) Sign or outline lighting 53.40 2 E - mail: Signal circuit(s) or limited CONTRACTOR.: �_:..:. ::_: •.... • . ; _..:: energy pane , alteration, or .:. • • . ... .. . extension, Describe: Page 2 2 Business name: Hillsboro Electric L_L,C. Each additional inspection over allowable in any of the above Address: 21185 NW Ever •reen PKWY St- ; • Per inspection 62.50 City/StatealP: Hillsboro, OR. 97124 Investigation per hour (i hr min) 62,50 phone: (5 0 3) 439-9666 Fax: (503 )6 01- 3 6 8 0 Industrial plant per hour . 73.75 ELECTRICAL PERMIT FEES* ' .. . CCB Lic. :1 3 4 4 81 Electrical Lic. :3 4 - 4 9 9C Suprv. Lic.: 4941s Subtotal �R U ( S Suprv. Electrician signature, required: Plan review (25% of permit fee) I Stale surcharge (8% of permit fee) Print name: Joey Vitacco Date: Q f'"I � E �— TOTAL PERMIT FEE / - q 1 Authorized signature: This permh application aspire, if. permit is not obtained wiit,in I81) daya after it hni been accepted ae complete Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board " Numtur of inspections per permit allowed. I:\ P +dldinu\Pcnnitn\ELC- PeontiAppaec IVO 4411.4(, TII:vcs,COM/Wfia CITY OF TIGARD , C O G BUILDING DIVISION PERMIT #: ELC2005 -00431 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/20/2005 Phone: (503) 639 -4171 :irill Inspection Requests (24 Hrs.): (503) 639 -4175 „''� INSPECTION WORKSHEET FOR DATE: 7/5/2005 TIME: 7:12AM PAGE: 70 SITE ADDRESS: 11938 SW ELEMAR CT CLASS OF WORK: SUBDIVISION: ASPEN RIDGE LOT #: 009 TYPE OF USE: PROJECT NAME: OSBORNE DESCRIPTION: A/C, furnace & GFI. OWNER: OSBORNE, DONALD L +, PHONE #: 503 - 639 -4234 CONTRACTOR: HILLSBORO ELECTRIC PHONE #: 503.439 -9666 Inspection Request Scheduled For: Date: 7/5/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 010555 -02 503 - 538-2953 Y Corrections /Comments /Instructions: MI V\ V` L i' j &V\ qRRift'lk ) - \A,c %S L� it v _s L\cf ,1 1-3 1 m\ ) r c)k c70 ii Fv)“ . X \ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 7 � - Date: Phone #: (503) 718-