Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00186
,, . DEVELOPMENT SERVICES DATE ISSUED: 3/28/2005
'I 13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171
PARCEL: 2S111 DB -14800
SITE ADDRESS: 09303 SW HOME ST ZONING: R -4.5
SUBDIVISION: KESSLER ESTATES LOT : 005 JURISDICTION: TIG
Project Description: Hook up AC and add 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:
FROOM, ROB HILLSBORO ELECTRIC
9303 SW HOME ST. 21185 NW EVERGREEN PARKWAY
TIGARD, OR 97224 HILLSBORO, OR 97124
Phone: 503 - 525 -3615 Phone: 503 - 439 -9666
FEES Reg #: ELE 34 -4399C
Description Date Amount L[C 134481
SUP 4941S
[ELPRMT] ELC Permit 3/28/2005 $53.50
[TAX] 8% State Surcharge 3/28/2005 $4.28 REQUIRED ITEMS AND REPORTS
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 - 332 -2344.
Issued By: Permittee Signature: A DT
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.
From:HILLSBORO ELECTRIC LLC. 5036013680 03/25/2005 17:11 #237 P.002
,. ..
i , . .. ...... . ,. . -•.• . _ _____... ..
.
FrENED
EiectrIcal Permit Alllawt.oh FOR 011:1(:E USE ON IN . •
City of Tigard r\iiii:. 0
25 2045 Received -
Permit N C
Date/Eivi ...2 - ctrz•S
/ D) Z , A..X.., ../:- A ..) 0 l y‘•
......_ ,.
13125
$W Hall Blvd., Tigard, OR 97223 1 . Plan Review
Phone: 503.639,4171 Fax: 503.5 s dr TiGpiiiii" Date/By: Other Permit: .
Inspection Line: 503,639.4175
s.,. - 1,
C I l OF
,4 Date Ready/By: latis: .... fee Page; 11r
BUILDING DIV
Internet: www,ei.tigard.or.us Not/Method: 1 V.,/' Suppientental Information
. .
. ... . . TYPE OF WORK . • • 1 •. : • .., • ' . .. : • • , •• . ...., • •• • ' PLAN REVIEW : " • .••• • '
.
•
0 New construction eAddition/altcratiOn/replacement . Please check all that apply:
El
OService over 225 amps, comm'l 1DHazardous location
Demolition Other: 0
• OService over 320 amps - rating 17Buildng over 10,000 sq. ft., -
. - . CATEGORY OF CONSTRUCTION••• • . '. • ' :..• . . • • : : of 1 - and 2-family dwellings 4 or more new residential
[kf: and 2 dwelling 0 Commercial/industrial 0 Accessory building 0Systern over 600 volts nominal units in one structure
El Building over three stories 0 Feeders, 400 amps or more
0 Multi-family D Master builder El Other: ElOccupant load over 99 persons avlanufactured structures or
. • ' . • : - .. JOB SITE INFORMATION AND LOCATION • • ::' ; •: ::.. :, : '' .••• '. 02gress/lighting plan RV park
Job no.: ' Job site address:6r 'QV filr WA,. .." Cie ['Health facility ElOther:
Submit 2_ sets of plans with any of the above, •
City/State/ZIP:111104 On/ 9:1724 The above are not applicable to temporary construction service.
Suite/bldg./apt. no.: Project name:t/MO/1 .. ,',... • . .;: .... - :FEE* SCIIEDULE •.:.-' :::•::•••'..; ''' : •.:•:"'• ••;.. ::.
Description I Qty. I Res. I Total [ '.
Cross street/directions to job site: New residential single- or multi-family dwelling unit.
• Includes attacheige.
• • 1,000 sq. ft. or less MS 145.15 - 4
Subdivision: Lot no.: Ea. ruin 500 sq. ft, or portion 33,40 1 ,
,„,..__________.--------- Limited energy, residential ' 75.00 2
Tax map/parcel no,: . • . Limited energy, non-residential 75.00 2
DESCR tPTION OF 'WORN :•:. '''' :.: ./. ,:.:';:.; ; ■:i l • :.: .' Each manufactured or modular
• , dwelling, service and/or feeder 90,90 2
aro t. 4 4 /t: A .4 f /.4 Services or feeders installation, alteration, and/or relocation
200 amps or l 80.30
993 2
‘:• • .:::,....:•:,... :El: rFlOPERTY• OWNER • ": ...;•:"::":::::-: 12:•TESIANT.•; "
::: ''"".":::...":.....' 201 amps to 400 amps 106.85 - I
A , 4 401 amps to 600 amps 160.60 2
Name: -111) liWiliZil , ' 4 4.4) 601 amps to 1,000 amps 240.60 -7-
Address: ‘ Ai i' 4 i .4% i . . over I .000 amps or volts 454.65 2
Reconnect only 66.85
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) - . -
200 amps or less 66.85 . 1 _
Owner installation: This installation is being made on property that [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 amp to 600 amps • 133.75 2
Owner signature: Date: Brunch circuits- ew, alteration, or extension, cr panel
7 ' . ....: : •,' .:*: •::.::;:::;::::" , 0*.APPLICANT'' ': '.. 'O.:CONTACT PERSON ';:',:';i.il ';',;.: A. Fee for bmnch cireuits with
'service or feeder fee, each 6.65 • 2
Business name: pAp, brunch circuit
B. Fee for branch circuits
Contact name: - • withota service or feeder fee, i 2
-
each branch circuit I 46.85
Address: _ Each add') branch circuit 6.65 2
City/Stateal P: Miscellaneous (service or feeder not included)
------- Pump or irrigation circle 53.40 2
Phone: ( ) , Fax: : ( ) Sign or outline lighting -
53.40 2
E • Signal circuit(s) or limited-
energy panel. alteration, or
•• 1 •• • • • •:.' ...::•.1`:•:' :•.:"... ' ' -:..... 7 ..o . • '.. . ' CONTRACTOR .'!'•.'.- •::::-•::• .••• • .::.:••• ...::.•.. ';'=!'.:.:•:.;::.::'::, :::•''
' extension. Describe: Page 2 2
Business name: Hillsboro Electric L.L.C.
_
Each additional inspection over allowable in any of the above
Address: 21 1 85 NW Evergreen PKIALY Ste #110 , Per inspection 62.50
-
City/State/ZIP: Hillsboro, O. 97124 Investi gation per hour (t hr min) 62.50
Industrial plant per hour 73.75
Phone; (503) 439-9666 I Fax: (503 /601-3680 - • •- • ELECTRICAL PERMIT FEES* : ' ••" • - '.• .
CCB Lic.:1344 81 I Electrical LiC.:3 4-4 9 9 CI Suprv. Lie.: 49 41 S Subtotal S.'S.-
Suprv. Electrician signature, required: - Plan review (25% of permit fee)
S t ate surcharge (8% of Pertnit ice)
Print name: JO cayi ta.cco / I Date: 51
TOTAL PERMIT FEE .
.•
Authorized signatn .. A • . A i g • This permit apptication aspires ir., permit is sot obtained within ISO
..414,0 A_ sf.A.AP' • days after It has been accepted at complete
Print name: t . pate: * Pee methodology sat by Tri-County Building Industry Service Board
- ** Number of inspections per permit oliciwed.
hB i(App.. 0c I 210 44 0 1 fa( ISM/COM/WEB
1
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: ELC2005-00186
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3128/2005
Phone: (503) 639 -4171 ego :
Inspection Requests (24 Hrs.): (503) 639 -4175 ; '. '' L
• INSPECTION WORKSHEET FOR DATE: c 4/2005 TIME: 7:10AM PAGE: 58
SITE ADDRESS: 09303 SW HOME ST CLASS OF WORK:
SUBDIVISION: ' ESTATES LOT #: 005 TYPE OF USE:
PROJECT NAME: FROOM
DESCRIPTION: Hookup AC and add plug.
OWNER: FROOM, ROB, PHONE #: 503.525 -3615
CONTRACTOR: HILLSBORO ELECTRIC PHONE #: 503-439'9666
Inspection Request Scheduled For: Date: 5/9/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 006364 -01 503 - 245-1717 Y
Corrections /Comments/ Instructions:
Ale/ ( PA - r.lc. -- -o P . 1 Ki(
Air P 1 14 M, A- 3 o mod" l.{'
e _h_se_ 0 A./ A.(e_ 4 Sc , "ck ti=us (_-_C
fr PASS II PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL II C, OR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: --- Date: 5‘'-- - 91e' O‘ Phone #: (503) 718-
.\