Permit ., CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00181
DEVELOPMENT SERVICES DATE ISSUED: 3/25/2005
�,■ ; 1 1 I
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1 S134BD -07900
SITE ADDRESS: 11676 SW PENN CT ZONING: R -4.5
SUBDIVISION: PENN LAWN ESTATES LOT: 007 JURISDICTION: TIG
Project Description: Hook up NC & add plug. Job # 3629.
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:
COFFIN, ORAN C HILLSBORO ELECTRIC
11676 SW PENN CT 21185 NW EVERGREEN PARKWAY
TIGARD, OR 97223 HILLSBORO, OR 97124
Phone: 503 - 524 -7590 Phone: 503 - 439 - 9666
FEES Reg #: ELE 34 -4399C
Description Date Amount LIC 134481
SUP 4941S
[ELPRMT] ELC Permit 3/25/2005 $53.50
[TAX] 8% State Surcharge 3/25/2005 $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: -- 3): 5,L Permittee Signature: c- jfe, 9`),,
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 09:53 #228 P.002
Electrical Permit AppREieEIVED FOR OFFICE USE ONLY
City of Tigard Received _
Date./Bv: , 7) ' P N° • : 64Xe2ati) <- a1 /
13125 SW Hall Blvd., Tigard, OR 97223 i) t;., e)fin Pion Ravienv
Phone: 503.639.4171 Fax: 503.598.1960 '' .- ••• t- Luv ''''' i4 1 Date/Ei : Other Permit;
Inspection Line: 503.639.4 I 75 ,1 --- 1;:54 L. Data Ready/Ely: IM Ell See Page; for
Internet: www.ci.sigard.or.us CITY OF TIG '''"'' Notified/Method! Supplemental Information
PLAN REVIEW
- ' ' TIMPtttc2IP
. . .. . • ' ..... ... " '...• .
•
EJ New construction II.TAddition/alteration/replacement . Please check all that apply:
['Service over 225 amps, comml 0Hazardous location
[1 Demolition 0 Other:
['Service over 320 amps - rating OBuildng over 10,000 sq. R..
• . ••• • • CATEGORY OF CONSTRICTION. '. • • ::• -..: . :• of 1- and 2-family dwellings 4 or more new residential
tErl - and 2-family dwelling 0 Commercial/indUStrial 0 Accessory building OSystem over 600 volts nominal units in one structure
['Building over three stories ['Feeders, 400 amps or more
0 Multi-family 0 Master builder 0 Other: ____________ °Occupant load over 99 persons ElManufactured structures or
• • . . •••:. . • JOB SITE INFORMATION AND LOCATION : • .i ..:' : ::..'; • : '• :: • .• • ['Egress/lighting plan RV park
Job no is" ,' Job site address: , to , 0Health 11614 °Other:
..,c 94 . • Submit juts of plans with any of the above. •
City/State/zip: T j(jf:( vL___ it-tri, 1 . The above are not applicable to temporary construction service,
. '. • • .• .• ::, ••••• •••:' . • :: . FEE! SCHEDULE ...:',•::1•• . •::' .'....:. :•:. '
Suite/bldg./apt. no.: Project name: ossmarlos i Qtr. I Frx I MIII I **—
Cross street/directions to job Site: Now residential single- or multi-family dwelling unit.
Includes attached garage.
' 1,000 sq. ft. or less __ 145.15 4
Subdivision: . I Lot no.: Ea. addi 500 sq. II. or portion 33.40
----- Limited energy, residential 75.00 2 '
Tax map/parcel no.: -
Limited energy, non-residential 75.00 2
,•'•': : ; •:•:••K;:" • : '.:•...:•.•.*:....:: ,..: ": DESCRIPTION OF WORK::::(-: .,:.!..:;,:::::::;:.;; ;i::::iil Each manufactured or modular
fl lc 1, tiezt AAA !AUG) dwelling. service ancVor feeder _ 90.90
Services or feeders installation. alteratio n. and/or relocation 2
200 amps or less 80.30 2
201 amps to400 amps 106.85 2
. —.-. 401 amps to 600 amps 160.60 3
Name: 0 y- N,, (_, _ 601 amps to 1,000 amps 240.60 2
Address: W ' it .,. < Ved 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
Phone:))) rt • 1 I FAX: ( ) relocation
1 00 amps or less 66.85 . t -
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
:f ;••••:' .:':'•-'•:'...::::' 0 Pl.:16:NT:''''';::•:.••••a•:••••'••••.1::::*::::,•4!::;i;•:::1:1.:CONTACT 'PERSON 1;; r..:::!;:,:i'..:':;:. A . Fee for branch circuits with
service or feeder fee, each 665 2
Business name: branch circuit ,
' -
B. Fee for branch circuits
Contact name: withouI service or feeder fee, 1 46.85 g5. 2
each branch circuit
Address: Each add'I branch circuit 1 6.65 4 t 61 -4 2
-----
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) • I Fax: : ( 1
Sign or outline lighting 53.40 _ 2
E-mail: ' Signal circuit(s) or limited-
. -;.::•,:....;;;...:...... •..,....... . . ..:: :: .4 .. % CONTRACTOR ..., :" :f...... 7:: ..' .;:::...„.•;•.:•.;,:.::::.,::..:: energy panel, altellition, Or
..-
- extension. Describe: Page 2 2
BUSineSS narne: Hillsboro Electric L.L.C. — '
Each additional Inspection over allowable In any of the above
Address: 21185 NW Evergreen PKWY Ste. #11_Q_ -
Per inspection 62.50
City/State/ZIP: Hillsboro, OR. 97124 Investigation per hour (i hr min) 62.50
.
73.75
Phonc:(503) 439-9666 Fax: (503)60'1_3680 Industrial plant per hour PERMIT FEES.
—3680 • — •
. - •.. • ".. .: RLEcrRicAL * ' ': • :. • .
CCB Lic.:1344 81 1 Electrical Lic.:34-499C I Suprv. Lic.: 4941S Subtotal . 5°
. •
Suprv. Electrician signature, required: . Plan review (25% or permit fee)
State surcharge (8% of permit fee)
Print name: Joey k itacco / Date: 317,31K '. _ITIT
/ .,, TOTAL PERMIT FEE :76 -
Authorized signature:1 1 i A a : a This want application expires If a permit is not obtained within 180
days after it has been accepted as complete
Print name: . Date: • Fee methodology set by Tri-Counly Building Industry Service Board
•• Number or inspections per permit allowed.
iminitaingwonniuhELC-Permitapp. 12/03 4404613Ti I wol-comAYEA3
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005 -00161
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/25/2005
Phone: (503) 639 -4171 , o r
Inspection Requests (24 Hrs.): (503) 639 -4175 `:_...
INSPECTION WORKSHEET FOR DATE: 3/30/2005 TIME: 7:11AM PAGE: 67
SITE ADDRESS: 11676 SW PENN CT CLASS OF WORK:
SUBDIVISION: PENN LAWN ESTATES LOT #: 007 TYPE OF USE:
PROJECT NAME: COFFIN
DESCRIPTION: Hook up NC & add plug. Job # 3629.
OWNER: COFFIN, ORAN C, PHONE #: 503 - 5247590
CONTRACTOR: HILLSBORO ELECTRIC PHONE #: 503 - 439-9666
Inspection Request Scheduled For: Date: 3/30/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message I I
199 Electrical final 003148 -01 503 -530 -2963 Y
Corrections/Comments/Instructions:
( ci r -" : /:
r PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
2 i
Inspector: Date: p �v s Phone #: (503) 718-