Permit , .,, 12. 2007 10 58AV1 ^:- .. a � e � I t 4i- 3 No. 30 P. 1 ( t ,0.� r
Electrical Permit Application ��� "r''i """ „' k u '
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� + City of Tigard
OCT 1 2 2007 DatelB l�. I Permit N om/!.roa7�
n 13125 SW Hall Blvd., Tigard, O12 2�"` Plan Review /
i t I1
41, Phonc: 503.639.4171 . Fax: 503 51Ott I oj , Date/By: Other Permit:
dsrt;:' fdtgt Inspection - , ' ' "LISA y y: See Pa
iTt I C ; A k 17 � ction Line: 503639 � �i e �� i Ua l e R ea d B 7uris ® � 2 for
'`.9c!NMlrer" 1 =,dh(K1r Internet: www tigard-orgov s_-' I� G D 4 . ° 1lo Method: J Supplemental Information
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p i ll '21.} ! 11. �� } { } I f { {1i.I(S ;p.1 }pR}}i } }.Si p! 1 ��• a ,;;,1 1 1+1 1 +4r� a ?�} : 5 ,1jI.1a1.f).jjj 1I F }�1�i, i6.f {I1,fl,ll.�l{i}.1[tfr tai 111 Jll�t1l ,4�.{,{.�til} { t I.;•>r .a. y as .1,, 1 11 1lf1/i11 ]11 iL!'{�#]� f'
71 tU kiEf1' n '.'..1 .111311i1�i +f:�{I14t tilt. • if ,i I i :tf :pna,a lid:, Wt:S , 11Wi, dill.! - :�Ilt}till!ki� • F N[I�ul#Irf,� 'ItiN.{St.1�14171` t171 }I ht �lm,'r�;t n Saa::.t{{�a :,v,� l�.tn[ 1¢yr Sljfill)1 1[ t l t . �tlttit l::idlnlifliA
❑ New construction C Add ition /alteration/rep Please check all that apply (submit 2 sets of plans w /items oheoked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other where the available fault current ❑ Marinas and boatyards
{!81['. > 111 i'Ml { t(j111 T 't } t �11t , uu,�v lLdl. ' tail fa u �[ r n+ itl a 1}ql �lrtfi t r , t 11 ) } 1 t u
f $� 1! X ?. +1 {ft. JJ I:jj, l E k�,d i t ` t [Iu"alul l b fl It 1 +min l[ a+} 3 � . � J ! l ! { p it i ai '[ 1 i i I i it t . !# }`4K ■ { il �,I, exceeds L0,000 amps o 1 S volts or ❑ Floating buildings.
,d. 'N !' lA tnr[il, f 1� !1�,�tllUi,81 l t o rou or ta0o
, 1 and 2 dwelling Commercial/industrial g ❑ Commercial - use agricultural
L
y g ❑ ❑ Accessory building amps for alI other installations. buildings,
❑ Multi - family ❑ Master builder ❑ Other f In Fire pump. ❑ Installation of 75 KVA or
t , ': }'t!d P `{ rl ...'I }� { Sl(�J� ` t [ }�� {j L "t'I21 + {{ n�i,1 {lt §f, �J :141j1 c 3 ?Gt ritr jryp t 1 i } ' 4 ( }gil 1 } 1 I I[1 } i , ! ;' Ill[ li ynvrIN ; l ; l ❑ Emergency system. larger separately &lived system.
++ ►1 � I' .. iitJ4 �l:tt3.4.. llti�[(1ti:;t,,Y,, ,b,1,S„ r.: f 1112llil+ 41.,,..t MIlr ■ flan :Nt i >i I� tiliiiU �l N 1 l! i 1 ' 1 ❑ Addition of new motor load of ❑
Job no.: Sur r , G Job site address: t • ' '7 v 5 W 'fly h A ,� six or chore. occupancy.
❑Six or more residential units. ❑ Recreational vehicle parks.
City /State /z1P: pp`� Q ❑ Health -care facilities. ❑ Supply voltage for more than
( C Ct r t V ' ` / 1 �-Z3 ❑ Hazardous locations, 600 volts nominal
Suite/bldg. /apt. no.: v Project name: i (--.e .. _ s y ❑ Service or feeder tt600 ampss or more
i iiti it li. r ��'j I' { }1!' )7f1f 1 i{i9'v "`t'1l {'{t { , +j S}l �j�tl3 f,� liiiSd! 1 , ,` ja r
1 •#> iEilil iSite{ 3: 111�1��{{1 tl1' etansd!{ uCU. m,,", Le. �i�..v,tfuulllttfH ���l�tl11111f� #i
Cross street/directions to job site: SW fSI n ` ) uacriptim, Qty- Fee, Total 1 ,
7 \ 1 v ` v P New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
l lu.± ' '?C}}a11 + ", t 111 t ,l Ib }T t' 1 r d ttS{ ?l1 ;' Y>r:}3e u + i"i I }: +1 a1ayUllt;t[it 1'f ?'iif!'f + + }' ++j ? 1 Ili f f {, { ,Ills • Limited energy, residential
[[�'', }, l lFi ! I ] ,' l� ` }1f i } r ' . { r d f p di i: T (i ' l t) d ° I_t 7�3P4 7l ` l ( s9 ) 75 -00 2
� . bdt.t,lt ,. 'i.Ylai: 1s t+i,Ft#!, f1 1 111; { +' mil - 1I U ':' l un Air ALINil all :tS:eSlrJ,.tl .
i}l,iindlll i t�llli , sl 1st °;! with abovo - ft.
Limited energy, multi - family 75..00 2
2 CL- 1 ( LS 1 _ - 0 L.... t ri AO C& S y r o residential (with above aq. A.)
J
Services or feeders installation and/or relocatio
vv. f ! rar # g , , i =' , i + R +ai} rag i+ u u i4,,fyrl su, l d til [ {}fit t ( u,< y; * 200 amps Of 1035 80.30 2
i�lJ Vilil. ill iti,tln,.m,ia1C: chi [!` ;ul l t.v ltl.,I l + l i4itf :� {t.'fi l l•}lllldl:1lHk�t1�„f t?i >in,r�j" �kt.', .ullft l�{ !l^ I }lilir{ �} 201 amps to 400 amps 106.85 2 th:
Name: P-. r c ( .42 .O p 401 amps to 600 amps 160.60 2
t 601 amps to 1.000 amps 240.60 2
Address: I'' c S F Sin Pi U t Over 1,000 amps or volts _ 454.65 2
City/State/ZIP: r pv q — �Z'� Temporary services or feeders installation, alteration, and/or
i i rG� sa "I relocation
Phonc: (303) y Li c .. • s j Fax: ( ) 200 amps or less 66.85 1
Owner installation: r is in- allation is bcing trade on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, 1 t.e r or exchange, accorrj+ 0 ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
id�� Branch circuits - new, alteration, or extension, per panel
Owner signature: - bate
t # / �y { 1 t� ' �: liJ A. Fee for branch circuits with
.1 1}1 f I1 11 ` 6u '.z l ;fi �I1 i /ligkili illill s 3 1 1 1 d r dat +A � L t f,�;, , �!sj and 4 u llill 1 about service or feeder £cc. 6.65 2
each branch b branch circuit
Business name: / ui
I
B. Fee for branch circts
with service or feeder fee.
Contact name: r
ach circuit 46.85 ills, 2/ 2
first ban 2
Address: Each add'! branch circu 6.65 4 , (b 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90,90 2
Phone; ( ) I FaX:: ( ) Reconnect only 66,85 2
E -mail: Pump or irrigation circle 53,40 2
�{,fi t l " 1 t +'i �"- {, . }v r Mnu urn_ wycuuu ' �;{1k, i .. , , r 4�' , 1-' I���
�'"if#;l 1 4r1 ' t a it iif3l�:illfl l , i l ERTI", lUPita: Mir { l t1t }il![l�{ II Il'.Lii� 11 itli il{l{t ll1 Sign or outline lighting 53.40 2
Signal ciroult(s) or limited -
Business name: Peal, /C3-rl c s 12,1 Qj �. c a.A C..Ci rt_DA •ppl --S, energy panel, alteration, or
H extension. Describe: Page 2 2
Address: (14 3 (so Nw z_o-k Ave, 1714,7_ -3f a �.
�
City /State /ZIP: UCjric Uhl tl42..r w G P (6Ce iv' Each additional inspection over allowable in any of the above
Phone: ( ) 51 (-1 _--1.2.6 V -, : ( O) 5(.4 to _ Z 1 58 Per inspection 62.50
Investigation per hour (t hr men) 62.50
CCB Lie,: Electrical Suprv. Lie.: IS40.S Industrial plant per hour 73 75
/ 'T Il 1 .:i li�ll % t[il h '�u' tt f rl itf� �ni �i s aC' r1 i�lMEli+�11'ii3G. i
Suprv, Electrician signature, required: / .. a uRl Subtotal: z
Print name: 3 , N . \ le., h , . • Date: 1 a _ 1 Z _ 0---/
Plan review (25% of permit fcc): . 5
[ State 9urehar � ge (8% of permit ice): �f ,�
Authorized signature: TOTAL PERMIT FEE: "_""'hhh
—
Print name: Date: This p ermit application expirm if a permit is not obtained within
days after it has been accepted as complet
i' Number of inspections allowed per permit. X ,/
l:\Building\Pv n t 2LC- Pum:,App,Ooc 05/27/06 440 /n5 /COM/WEB 5 7e+
7.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: FI_C2007 -00705
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/1712007
Phone: (503) 639- 4171u:,; lii
Inspection Requests (24 Hrs.): (503) 639 -4175 :_.
INSPECTION WORKSHEET FOR DATE: 11/21/2007 TIME: 7 :00AM PAGE: 51
SITE ADDRESS: 13320 SW ASH AVE CLASS OF WORK:
SUBDIVISION: VILLAGE GLENN LOT #: ()01i TYPE OF USE:
PROJECT NAME: E3UI`2C;ES
DESCRIPTION: 2 branch cis cults.
OWNER: PHONE #:
CONTRACTOR: ADVANCED ELECTRICAL CONCEPTS, INC. PHONE #: M3
Inspection Request Scheduled For: Date: 11/21/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 06007401 360574 -7200 \ Y
Corrections /Comments /Instructions: 1 V 1 I
nii
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1M PASS PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
FAIL fI CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Cr • 0 S Date: `1 6 111 21101 Phone #: (503) 718- A -00
CITY OF TIGARD
BUILDING DIVISION ` PERMIT #: ELC20f7.00705
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/120007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/20/2007 TIME: 7 :00AM PAGE: 51
SITE ADDRESS: 13320 SW ASH AVE CLASS OF WORK:
SUBDIVISION: VILLAGE GLENN LOT #: 004 TYPE OF USE:
PROJECT NAME: BURGESS
DESCRIPTION: 2 branch circuits.
OWNER: PHONE #:
CONTRACTOR: ADVANCED ELECTRICAL. CONCEPTS, INC. 11( ■ Me,, C -L PHONE #: 503- 29&t36%
Inspection Request Scheduled For: Date: 11/20/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 059985.01 360-574-7200
Y
1-g6 SS
Corrections /Comments /Instructions: _
. 1
PASS 1 PARTIAL APPROVAL ►i1 CANCE 1 NO ACCESS
n FAIL CALL FOR INSPECTION I ' ITIONAL FEES ASSESSED
Inspector: & ' V � L Date: 14IQ1 Phone #: (503) 718- 1,14:
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CITY OF TIGARD •
BUILDING DIVISION PERMIT #: f_t .,cm , 00705
13125 SW Hall Blvd., Tigard, OR 97223 , r DATE ISSUED: 10/1212007
Phone: (503) 639 -4171 � , ', , „. , 1
Inspection Requests (24 Hrs.): (503) 639 -4175 '�'+` _...
INSPECTION WORKSHEET FOR DATE: 11/14/ 2007 TIME: 7:02AM PAGE: 47
SITE ADDRESS: 13:20 SW ASH AVE CLASS OF WORK:
SUBDIVISION: VILLAGE GLENN LOT #: (K)4 TYPE OF USE:
PROJECT NAME: 13tJR ESF.
DESCRIPTION: 2 branch circuits.
OWNER: PHONE #:
CONTRACTOR: ADVANCED ELECTRICAL_ CONCEPTS, INC. PHONE #: 503 - 2960655
Inspection Request Scheduled For: Date: 11/14/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
i
1 99 Electrical final 0'959 01 36&574- 72.00 \ f
Corrections /Comments /Instructions; ' �)e' electricaf installation defects noted
_ / on this report1shall be corrected and
Co P RQN 1®c 30 c.•1 (.. WO(LII i ACS anillipectioniieiluest made within 20
calendar damper OAR 918- 271 -0030
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n PASS ❑ PARTIAL APPROVAL ❑ CANCEL 7 NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
�, w` 1 , �(
Inspector: C N 6(6 Date: 011 �t (71 Phone #: (503) 718- 2-'18 io I
i
CITY OF .TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2007 -00705
COMMUNITY DEVELOPMENT DATE ISSUED: 10/12/2007
TIGARD! 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 102CA - 00904
SITE ADDRESS: 13320 SW ASH AVE ZONING: R - 4.5
SUBDIVISION: VILLAGE GLENN LOT : 004 JURISDICTION: TIG
PROJECT: BURGESS
Project Description: 2 branch circuits.
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/ SVCI 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:
BURGESS ADVANCED ELECTRICAL CONCEPTS, INC.
13320 SW ASH AVE A.K.A MR. ELECTRIC
TIGARD, OR 97223 14300 NE 20TH AVE. D102 -313
VANCOUVER, WA 98686
Phone: Contact #: PRI 503 - 296 - 8555
FAX 360 - 546 -2158
FEES
Description Date Amount Reg #: ELE C136
[ELPRMT] ELC Permit 10/12/200' $53.50 LIC 168324
[TAX] 8% State Surcharge 10/12/200' $4.28 SUP 4588S
Total $57.78 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: `. � i�,- �/ Permittee Signature: ery7 a/ d rak
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.