Permit CITY OF TIGARD • ELECTRICAL PERMIT
PERMIT #: ELC2005 -00331
DEVELOPMENT SERVICES DATE ISSUED: 5/18/2005
I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 25111 DB -15100
SITE ADDRESS: 09337 SW HOME ST ZONING: R -4.5
SUBDIVISION: KESSLER ESTATES LOT : 008 JURISDICTION: TIG
Project Description: Installation of NC unit (1) branch circuit.
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:
MARTINEZ, ROBERT HILLSBORO ELECTRIC
9337 SW HOME ST. 21185 NW EVERGREEN PARKWAY
TIGARD, OR 97224 HILLSBORO, OR 97124
Phone: 503 - 620 -1611 Phone: 503 - 439 - 9666
FEES Reg #: ELE 34 -4399C
LIC 134481
Description Date Amount
SUP 4941S
[ELPRMT] ELC Permit 5/18/2005 $46.85
[TAX] 8% State Surcharge 5/18/2005 $3.75 REQUIRED ITEMS AND REPORTS
Total $50.60
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: jor Permittee Signature: R,1vi
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.
• 4 1 ° F rom:HILLSBORO ELECTRIC LLC. 5036013680 05/18/2005 10:06 #660 P.002
Electrical Permit Applic9
i FOR OFFICE USE ONi:Y
•
City of Tigard rd Rat clued
`J MAY 18 20 e ve — S J��J�- Perm i t No , el`..p 2 ! /Uf /
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ►
e
Phone: 503.639,41 71 Fat: 503.598,1960 CITY OF TI `' ' ' g:� I�1 Date/13v: Other Permit:
Inspection Line: 503,639.4175 BUILDING D'- ° Dale Ready /By: H See Page far
Internet: www,ci,tigard.or.us - Notified /Method; Supplemental Information • PE OF WORK .• ... PLAN REVIEW. .. .. .
C] New construction Addition /alteration/replacement Please check all that apply:
❑ Demolition ❑Service over 225 amps, comm'l OHazardous location
_ (] Other: QService over 320 amps- rating QBuildng over 10,000 sq. ft„
CATEGORY OF CONSTRUCTION ; . of) - and 2- family dwellings 4 or more new residential
El 1 and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
El Building over three stories ❑Feeders, 400 amps or more
❑ Multi family ❑ Master builder El Other: ❑Occupant load over 99 persons ❑Manufactured structures or
. .JOB SiTE ,IN FORMATION' AND LOCATION : .. . ❑Egress /lighting plan RV park
J []Health -care facility DOther:
Job no.: 1 Job site address: 1' 1- l�' ] ' Submit 2 sets of plans with any of the above.
City/State/ZIP: " The above are not applicable to temporary construction service.
, � • . FGE!!, SCHEDULE ._ - . ' : ' ..
Suite/bldg /apt. no.: Project na nme: Y t e s t soft
1 s� ��/�t��y,',a,�J p I Qly, I Fee. I Total I '
Cross street/directions to job site: Ncw residential single- or multi- family dwelling unit.
Includes attached garage.
• 1,000 sq, ft. or less 145.15 4
Subdivision: 1 Lot no.: Ea. add'l 500 sq. if or portion 33.40 I
Limited energy, residential 75,00 2
Tax map/parcel no.: Limited enera, non residential 75.00 2
,,..::.. ;.. DESCRIPTION OF WORRK °:.a >. ; ; :,:,: , °..
• .. ... ''::" .:;:•:, " ' . Each manufactured or modular
dwcllin .- service-and /or feeder 90.90- -2 -
�(! - Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
... ° :: -❑ .PROPERTY OWNER ' ....::.:: :.. .:..::..
20! amps to 400 am 106 ,
401 amps to 600 amps 160.60
Name: r , 6.4 . a AL!la 601 amps to 1,000 amps 240,60
Address: 1'i/ AS A /A y • _ • Over 1,000 amps or volts 454.65
Reconnect only 66.85 2
City /Statc/ZIP: Temporary services or feeders installation, alteration, and /or
0 • l I relocation
Phone: 6V2) lY Fes ) 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, least, 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
.
' A Fee for branch circuits with
,.•,.. ❑' APP iCANT.' " . -::;� ; ":: �::: ; ., . . "'. CONTACT PEItSONi; ' >� ��.
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: _ without service or feeder fee, 6 46.85 , ' ' , 2
- each branch circuit
Address: Each add'I branch•circuit 6.65 2
City /S tate /ZI P: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) FAX :: ( ) Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
-,.:.•......:',:.....!'''...• . • :. ., . energy panel, alteration, or
•.... CONTRACTOR ; !.:: "'
extension. Describe: Page 2 2
Business name: Hi llsboro Electric L.L.C.
Each additional ins rection over allowable in an of the above
Address: 21185 NW Evergreen PKWY #110 2
Perinspeotion 6.50 ..
City/State/ZIP: Hillsboro OR. 97124 Investigation per hour () hrmin) 62.50
Industrial plant per hour
Phone: (5 0 3) 439-9666 Fax: (5 0 3 6 01 - 3 6 8 0 T=
ELECTRICAL PERMIT FEES
CCB Lic.:1 3 4 4 81 I Electrical Lic.:3 4 I Suprv. Lic,: 4 9 41 S subtotal 4C9 - 13�
Suprv. Electrician signature, required: Plan review (25% of penni( fee)
VVV ' "51 ��� State surcharge (8% of pennit fee) �lik►S
Print name: Joey Vitacoo Date:
TOTAL PERMIT PEI: II
Authorized signature: • This permit application expires Ku permit is not obtained within ISO
— days after It has been accepted as complete
Print name: Date: • Fee methodology net by Tri- County Building Industry Service Board
- •• Number of inspections per parmiha8owed.
i;\aui Iding \ParmitsdELC- rermilApp.doC 12/10 440- 16(T(111 /92/CONl/W8B
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: ELC2005.00331
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/18/2005
Phone: (503) 639 -4171 / /P i��; f I f i'
Inspection Requests (24 Hrs.): (503) 639 -4175 J,W
INSPECTION WORKSHEET FOR DATE: 5/26/2005 TIME: 9 :23AM PAGE: 11
SITE ADDRESS: 09337 SW HOME ST CLASS OF WORK: ,
SUBDIVISION: KESSLER ESTATES LOT #: 008 TYPE OF USE:
PROJECT NAME: MARTINEZ
DESCRIPTION: Installation of NC unit (1) branch circuit.
OWNER: MARTINEZ, ROBERT, PHONE #: 503 - 620 -1611
CONTRACTOR: HILLSBORO ELECTRIC PHONE #: 503.438 -9666
Inspection Request Scheduled For: Date: 5/27/2005 Pour Time:
Code # Inspection Description Cnnfirm # Contact # Message
199 Electrical final 007 47 -02 603 -538 -' 953 Y
Corre ions /Comments /Instructions:
.fin 4 f G 1 rv-4- 1,KfruCl t4,
ti. 1 1 , et-i.1 10A S S 4 GI' / 'A Al L C"4
C.-C___
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ►, NO ACCESS
` 7( FA ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
p ✓� Phone #: (503) 718 -
Inspector: 1.4.--aziP7 Date: J 7