Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 - 00967
i DEVELOPMENT SERVICES DATE ISSUED: 12/19/2005
I
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S134BD-01400
SITE ADDRESS: 11665 SW HAZELWOOD LP ZONING: R -4.5
SUBDIVISION: ENGLEWOOD NO. 2 LOT: 102 JURISDICTION: TIG
Project Description: (1) 200 amp panel, (1) branch circuit for microwave.
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: 1 W /SERVICE OR FEEDER: 1 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
WENDY HOFFMANN T & T ELECTRIC
11665 SW HAZELWOOD LP 4120 SE INTERNATIONAL WAY
TIGARD, OR 97223 SUITE A -105
MILWAUKIE, OR 97222
Phone: 503 - 590 - 8278 Contact #: PRI 503 - 652 -7610
FAX 503- 652 -7612
FEES
Description Date Amount Reg #: LIC 150973
[ELPRMT] ELC Permit 12/19/200' $86.95 ELE 26-1105C
[TAX] 8% State Surcharge 12/19/200` $6.95 SUP 2184S
Total $93.90 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: __Le Q, etc
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.
03); 3/2014 17:29 FAX la 001 /002
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Electrical Permit A lication FOR OFFICE ILltir, ONLY
`` Ci}� of Ti Ord �� - )
City g permit Ne. G it -67
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
L e"° , Y s
Phone; 503,639,4171 Fax: 503,598.1960 DEC 1 9 1 � � ,� D ate / ]]yI Oth P
Inspection Line. 503.639,4175 •.' Date Ready /By, Juri: 0 Scc Page 2 for
Internet; www,ei,tigard,orus I Notified/Method ller Supplemental information
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❑ New construction f N'Addili on/al teration repiaccmcnt Please check all that apply:
171 Demolition ❑Other: ['Service over 225 amps, comml ['Hazardous location
,,t %'! i ,;. ;u• t ; I ,. 1 i G1`I ; i ,, •, ,,, . , ti
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft
;;1,.i ,l ! it , ,; ; •'`;'l;'-�,It il�'', I s. , G 4ty;sl i CT4 ;3 r ,,i.l;l•rii' ;; of I- and 2 - fanuly dwellings 4 or more new residential
R'7 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
EBuilding over three stories ❑Feeders, 400 amps or more
❑ Multi - family ❑ MaStCf builder ❑ Other:
�:• ; v1,10.;,-,,,,;,,.:: +r�, , , ['Occupant load over 99 persons ❑Manufactured structures or
n" iIc ,3 f;'r r , i + 'I : I ' ,lm r gli� *t, ri ' 7,4 ;K'''.D, ;On' T N,' „ '. ' , i , , , ' ❑Egress /lightin plan RV park
Job no. ❑Health -care facility ['Other,
” Job site address: pe 5 � .2 .e� y
!� 6t�. S u b m i t 2 sees o plaits with any of the above.
City /State /ZIP: _41r ! 0 a 97,9.23 The above are not applicable to temporary construction service,
Suite/bldg./apt. no.: _._ TFEE'''Scoll 01:4, '
Project name; ' '" "
Dracriptlon r Q. I V. Tom!
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.: Ea. add'I 500 sq. ft. or portion 33,40 1
•
Tax map /parcel no.: Limited energy, residential 75,00 2
I ;,.. r l pIn u Limited energy, non - residential 75.00
',i ,:Z II n d; Mfr, ), dl d.J al , ;i ,:: M ' n i , i
'
ts,,,, vl,t ..'tit t1i.t�hit,r: ;lrtl,t,� t •,��,;; t, ,,,ai; tPt�; , i',,, t , 6 �' i'4 ,� � , e „ , t'I �I,In ,pl�'� ,'tiS,( I' ; i; ' { 1 Each n
• t aP � manufactured or modular
dwelling, service and/or feeder 90.90 2
r9O A prn ( 56 1" ` C t' v_e Services or feeders installation, alteration, and /or relocation
6.-i'rr 200 amps or less / 80.30 gp 30 2
oil 'lEat l '
r ; i i l �s l # , ;'l
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<< :,: 'o; ., ;, '` , ' ' ' 6'1 , 2r PEP.i Tiia4 ,,,, , , 201 amps to 4()() 106,85 2
amps _
401 amps to 600 amps 160.60 2
Name: ' — ill. r ,. ..1. 601 amps to 1.000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
A`! _ Reconnect only 66.85 2
City/Blatt /ZIP Temporary services or feeders installation, alteration, and /or
relocation
Phone: (
503) s - Sa g Fax: ( ) 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, lettse, rent, or exchange, according to ORS 447, 449, 670, and 701. _ 401 amps to 600 amps 133.75 2
Own s siignature: Date: �{ i B ranch circuits - new, alteration, or extension, per panel
i " , �iU {ik1II rn g y , ` r, ti , .f, ` i ' l 1 ; '{ ; ii t e :: A. Fee for branch ',i "' 1 'd, ,rl; �gtl,tc,a�a'. �, �'' b ch cirt:uits wuh
service or feeder fee, each
Business name: branch circuit 6.65 2
B. Pee for branch circuits
na
Contact ie: without service or feeder fee,
Address:
each branch circuit 46.85 2
Each add'I branch circuit ___ 6,65 rQ Gl 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax: : ( )
Pump or irrigation circle 53.40 2
Sign or outline lighting 53,40 2
E -mail:
Signal circuit(') or limited-
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1 r ''''VJJ i �'bh) , { 1 i t , i I�ti `!1 t l D'yy� t it +i,f' w � r �+��Jt�.�, s � r �ibp� ^, ,',d'i'f , ' eu 1!
Il1!' I ?,;',
,I�,� elitg4rt4ifn liih>(,'t11'.a,a' it4y�i11laxlrt��ulif?ti3a' ,. 1sti`tA''17Kr,P��;r,+><,Y' °�'!?' I 1 '13' ^,,c. a �,� ,.<� „Llil� t�,�i ,I ,. energy panel, Alteration, or
a ` ;' ` ” ` " " " ' extension. Describe: Paget 2
Business name: T & T Electrical, LLC
Address; 4120 SE International Way, Suite A 105 Each additional inspection over allowable in any of the above
Per inspection 62,50
City /State /ZIP: Milwaukie, OR. 97222 Investigation per hour (i hr Irvin) 62.50
Phone (503) 652 -7610 Fax; (503) 652 -7612 Industrial plant per hour 73,75
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CCB Lie.; 161187 �c;.;l`lfti ,,� 'n'.�'��i�l�e�l.,'�, �, ����t�Fi'., � .1`�i���`J�'F+ts�',',Er. �u <,! o
it ,: to I; u
Electrical Lic.: 3 -6050 Suprv, Lic.: 5176S Subtotal �� IF
Suprv. Electrician signature, require : 7 Plan review (25% of permit fee)
Print name; — riZQti( t s"' 1 f Date:
State surcharge (8% of permit fee) ° t T
S
TOTAL P1 =ltMlT FEE 1�
Authorized signs e: ,,,__JJJ This permit application ex pi re s if n permit In nor obta ined W i thin 19D
v r day after it has been accepted as complet
Print name: � Q o 7 . I Datc: ` Fee methodology set by Tri C o un ty Pirating Industry Service Board
!, � •• Number of inspe per pcnmt allowed.
i laui!dingwenrucs\ELC•PermiIApp doe IIIW 44046151(1 0/021COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #:ELC241
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 /uuy�tlll
. Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: 6 66-6 ( \Apr CLASS OF WORK:
SUBDIVISION: LOT #: • TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: ' PHONE #:
Inspection Request Scheduled For: Date:\ Pour Time:
Code # Inspection Description Conf ` # Contact # Message
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Corrections /Comments /Instructions:
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PASS ❑ PARTIAL APPROVAL CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED
Inspector: 6 6 1.1: Date: 6 () Phone #: (503) 718- ��
f J7 ( 3
CITY OF TIGARD • ,�
BUILDING DIVISION PERMIT #: ELC2(10i t;t743; 7
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 12/191`2006
Phone: (503) 639 -4171 4 � Ipu j � i
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: //912006 TIME: 7 :01AM PAGE: 66
SITE ADDRESS: 11665 SW HAZELWOOD LP CLASS OF WORK:
SUBDIVISION: ENGLE 000 NO. 2 LOT #: 102 TYPE OF USE:
PROJECT NAME: HOFFMANN
DESCRIPTION: (1) 200 amp panel, (1) branch circuit for microwave.
OWNER: HOFFMANN, WENDY PHONE #: 503 - 690 -B2M ..
CONTRACTOR: `I & T ELECTRIC PHONE #: ,3 - 1 ,- 51 1}
Inspection Request Scheduled For: Date: 1/912006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 024542 503.652 - 7610 y
Corrections /Comments /Instructions:
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The electrical installation defects noted
on this report shall be corrected and
an inspection request made within 20
calendar days per OAR 918- 271 -0030
n PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
, FAIL X CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: .
nspector:
' 9'V rV ` Date: ! " 1 - 01 Phone #: (503) 718 -V