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Permit C ITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2005 -00757 � i DEVELOPMENT SERVICES DATE ISSUED: 10/7/2005 �' "� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 13134AC -00800 SITE ADDRESS: 11402 SW IRONWOOD LP ZONING: R -4.5 SUBDIVISION: ENGLEWOOD LOT : 036 JURISDICTION: TIG Project Description: (3) branch circuits for 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: DAVID CAMPBELL HILLSBORO ELECTRIC 11402 SW IRONWOOD LOOP 21185 NW EVERGREEN PKWY #110 TIGARD, OR 97223 HILLSBORO, OR 97124 Phone: 503 - 590 -2436 Phone: 503 - 439 -9666 FEES Reg #: ELE 34 -4399C Description Date Amount LIP 134481 SUP 4941S [ELPRMT] ELC Permit 10/7/2005 $60.15 [TAX] 8% State Surcharge 10/7/2005 $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: 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. 10-06-'05 10:14 1 '^�t) -1- 211 4 i:;� 503 -227-4634 T -669 P002/002 F -005 i I . * tt.1 14:41 . Cs 11111 -e-s, 1 t + _ it FOR ()l•I'iC:}: 1 ONL 1 O Of �rigard Raccind , G �` 7 b 4 '13125 SW Halt Blvd,, Tigard, OCT i Bard, OR 97223 6 Z00 Data/Civ: ,._ �� - © 'vex_ No.: i t�l./ r Plan Review Phone: 503.639.4171 Fax: 503.598.1960 -'� i Date/13 ; Other Permit: v� i 1Lf . Inspection Line; 503.639.4175 CITY -. . ''� Dat Ready/By: 0 see Poge2 fnr Internet: www.ci.tigard.or.us CITY Notified/Method Supplemental Information 171 1 , . 1'431 - I ' 'T ... .•', . PLAN REVIEW ❑ New construction (' Addition /alteration/replacement • - • Please check all that apply: p Demolition ❑ Other: ❑Sery ice over 225 amps, comm'l ❑Hazardous location CATEGORY OF CONSTRiICT10N ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft„ . of i- and 2-family dwellings 4 or more new residential A 1- and 2- family dwelling ❑ Commercial /industrial © Accessory building ❑System over 600 volts nominal units in One structure ❑ Multi - family ❑ Master builder ❑ Other: ❑Building over three stories ❑Feeders, 400 amps or more . Occupant load over 99 persons ❑Manufactured structures or • • .:. , .. : . . • :, :'. JOB SITE fAIFOft1t�IAT10N' AND E:OCAT[ON • • ::: : . • • : .- ' ' • . .. :. ❑Egress/lightin park . gplan RV p ❑Health -care facility ❑Other Job no.: Job Site address: I t (1> A 1/ Submit 2 sets of plans with any of the above. • City /State/ZIP: 111 a ri a it / . /101 - The above are not applicable to temporary construction service. Suite/bldg, /apL no.:111 Project name: / '. . ` : "' :; .' ': • •:, : ,: :. FEE !, SCHEDULE,: '•'•:.;'' , : :` I .: :" '' I ..:: • '. a 1 Description _ [ Qty- I Foe. Total �•• 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. 1'L or portion 33.40 _ 1 Tax map/parcel no.: --- Limited energy, residential 75.00 2 • : ..._.,.. . ....�::. .; •.::�...,.,:'. DESCRIPTION :,:;� : - .:• :- 75.00 ,. .., . :, •.,..: ...,,•r": ' • DESCR PTION O ;SVpRK'' Limited rterby, non.resl en Is ' ' � ' ' •"'� Each manufactured or modular ML- � t/I/1 _dwelling, service and/or feeder 90.90 2 � `r 4- -�` L � I Services or feelers installation, alteration, and /or relocation . 200 amps or less 80.30 2 : '� ri ' • ' .. 201 amps to 400 am ps 106.85 2 PRO .. . :OWNER ' 401 amps 10 600 amps 160.60 3 Name: ., >V 1 f 601 amps to 1,000 amps 340.60 2 - Address: : 4 / "0.1 , ' ��, te _ Over 1,000 amps or volts 454.65 2 Reconnect only • 66.85 2 City/State/ZIP: ' Temporary services or feeders installation, alteration, and /or Phon ae_ Fax: ( ) relocation _ E' _ 00 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 zs ' 1 .: * ,, ;. A. Fee • _ ©'. APPLICA`NT ?" ❑.'CONTACT lyER50 �� for bran ciYtiurrs with • Business name: service er feedor foe, each 6,65 • 2 isk brunch circuit Contact name: B. Foe for branch circuits wi/hnra service or feeder fee, Address: each blanch circuit 46,85 - 2 Each add'I branch cltcu 6.65 2 City /Statc/ZIP: Miscellaneous (service or feeder not included) Phone: ( ) IFax :: ( ) _Pump or irrigation circle 53.40 2 Sig i or outline lighting 53.40 • 2 E -mail: • :.:...' CONT ; Signal circuit(s) or limited. .. 12ACTOR ';,, ' .::'; ,;; • a ::...;:':`•; *;':• ?` •, energy panel, alteration or extension. Describe: Page 2 2 Businessname:Hillgboro Electric L.L.C. Each additional inspection over allowable in any of the above Address: 21185 NW Evergreen PKWY Ste #110 Per inspection 62.50 City/State/ZiP: Hillsboro, OR. 971 24 Investigation per hour (I hr min) 62.50 • Phone; (503) 439 -9666 Fax: (503 ) 601 -36$0 Industrial plant per hour 73,75 ELECTRICAL PERMIT FEES *' CCB Lic. :1 3 4 4 $1 , Electrical Lic.:3 4- 4 9 9 C i Suprv. Lie.: 494 1 S S ubtotal �'� Suprv. Electrician signature, required: , Print - Plan review (25% of permit fee) I ' ^ 1 Slate surc harge (8% ofp ermit fee r i n name: Joey Vi tat Date: v ls� . TOTAL PERMIT F1EE Ott , Authorized signature: This permit application expires ifs permit is not obtained within 1$0 Print name: Date: d ays after it has been accepted as complete Fe e methodology set by Tri- County Building Industry Service Board " Number of inspections per permit allowed i:\ Buiidinb'PmnileELC.PvmitApp.doc IJII? 440 -14 DTI I0A)JCOM/WEB CITY OF TIGARD . _ / „. BUILDING DIVISION PERMIT #: ELC2005-00757 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/7/2005 Phone: (503) 639-4171 311)!Pe Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 10/26/2005 TIME: 7:07AM PAGE: 3 SITE ADDRESS: 11402 SW IRONWOOD LP CLASS OF WORK: SUBDIVISION: ENGLEWOOD . LOT #: 036 TYPE OF USE: PROJECT NAME: CAMPBELL DESCRIPTION: (3) branch circuits for NC, furnace & GFI. OWNER: CAMPBELL, DAVID PHONE #: 603-590-2436 CONTRACTOR: HILLSBORO ELECTRIC PHONE #: 503-439-9666 Inspection Request Scheduled For: Date: 10126/2005 Pour Time: Code # Inspection Description / Confirm # Contact # Message 199 Electrical final 019419-02 503-538-2953 Y 4/ 2 0 4 Alt- 0 ° Corrections/Comments/Instructions: • fri lardrir 1./ - ° ( - # - ( 1 4 fr P Rir A ,/',/,__,/. .■" , ', it; -:—... _ /...!/..14 /,./ ir. , ...•,eP . !,,:4/4., ... I hp' ,'1 - ... —..f...3.■ZI10. —.:c".. - • . r 7 JA /.. S qe., 6;.) ,„,. ... . „ ..A.. „ .11 „ • i • ■ ( C PASS n PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS I I FAIL n CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED / Inspector: I Date: ID ll.) UCPhone #: (503) 718-