Permit i " ?` CITY OF �TOGARD ELECTRICAL PERMIT
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1. " ' � I PERMIT #: ELC2008 -00172
`° COMMUNITY DEVELOPMENT DATE ISSUED: 3/26/2008
T I GA RD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 134DD -01500
SITE ADDRESS: 11777 SW TIEDEMAN AVE ZONING: R -4.5
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: VAN DOORNINCK
Project Description: Fire repair: reconnect service, repair bedroom and bathroom 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/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: 2 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
WOLTER VAN DOORNINCK BRIDGETOWN ELECTRIC
6555 SW DALE AVE 22732 NW GILLIHAN ROAD
BEAVERTON, OR 97005 PORTLAND, OR 97231
Phone: Contact #: PRI 503- 621 -7122
FAX 503 - 621 -7123
FEES
Description Date Amount Reg #: ELE 26 -887C
(EI.PRMTI 1 Permit 3/26/2008 $93.60 LIC 103824
I "FAX 1 12% State Surchar 3/26/2008 $11.23 SUP 4177S
Total $104.83 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 ma obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: — ,�si� _ Permittee Signature: —� g 'C_„.-- ] '---,,---/../
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.
Mar 25 2008 9:30AM Bridgetown Electric 503 - 621 -7123 p.1
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E ctrical Permit A><lplicati x h t t 1. (l l l I t l �l ti l tl) • l a
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i. City of Tig ard Received Date/B : 1 _,1
., r S J l .'
Tigard, OR 97223 v P n R
l °"� + 13125 SW Hall Blvd Ti Oth Permit:
1. -- Phan: 503.639A171 Fax 503.598.1960 Date/By:
+ inspedian Line: 503.639.4115 CITY ®F . i r `S11 Date Ready/By June I 0 See Page 2 for
h 1 ' Notified/Method: Supplemental information
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■ New constriction • dditionlalteration /replacement Please check all that app y (submit a sets of plans wfttems checked below):
❑ Service or feeder 400 amps or more 0 Building over three stones.
❑ Demolition ❑ Other: where the available fault current 0 Madras and boatyards.
;,; . ... ` e.... , { . 3,; --. exceeds 10,000 amps at (SO volts or ['Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -tae agricultural
74 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multifamily ❑ Master builder ❑ Other: ❑ Ftre PUmP. 0 Installation of 75 KVA or
{ , ❑ Emergency system. larger separately derived system.
'. ❑ roe of new molar bad of ❑ "A" 'E" "1 - 2" $
Job site --i- r? W Iced ems- ix or 4r moot. Recreational P ar.
Job no.: g�� Jb it address: I � ❑ or more residential units. ❑ Reaeatieoal vehicle ks.
v rf ❑ Heath -care facilities. 0 Supply voltage for more than
City/State/ZIP: ''re,,,,,-di l V —
❑Hazardous locations 600 volts momma!
Suite/bldg.apt no.: Project name: 0 Service or feeder 600 amps or more
Cross streetJdiretxions to job site: Detc City. Fee. Teat •
New residential single or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential —
75 00 2
:y N . above sq. ft u
� ' J (- Li emrgy, !ti- family
1� , - sI r4-4-4 .- , Co f�,,n,e (,1' e-- residential (with above sq. a.) 75.00 2
i a� I � -t/'t, r' C1V Services or f eeders installation, alteration, and/or relocation
G� -V' lam' `i �"' z oo amp or I rs s / 80.30 go .gyp 2
. ....r P l = :: . 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP: /State/ZIP: Temporary services or feeders lastallatIon, alteration, and/or
relocation - __ _
Phone: ( ) 1 Fax: ( ) 200 amps or Tess 66.85 1
Owner installation: This installation is being made on property that 1 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 599 amps 133.75 2
Owner Sj afire: Date: Branch circuits— new, alteration, or extension, . r panel
A. Fee for branch circuits with
i = , . rs1 above service or feeder fee, 2 6.65 13,E 0 2
... each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee,
Contact name 46.85 2
first branch circuit
Address: _ Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured m module 90,90 2
dwelling, service and/or feeder _
Phone: ( ) I Fax: : ( ) Reconnect only 66.85 (_ , t 2
E - mail: Pump or irrigation circle 53.40 2
,r : , , r °r r .. ` Sign or outline lighting 53.40 2 •
: Bridgetown Electric Signal circuit(s) er limited-
Business name: energy panel, alteration, or
Address: 22732 NW Gillihan Road extension. Describe: Page 2 2
City/State(Z1P: Portland, Oregon 97231 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 621 -7122 ! Fax: (503) 621 -7123 Investigation per hour (1 hr min) 62.50
CCB Lic,: 103824 Electrical Lic.: -887c Suprv. Lic.: 4177s Industrial plant hour 73.75
Suprv. Electrician signature, requi Subtotal: 00
Print name: Keith Steenslid Date: 3- .25 -Q Plan review (25% of permit fee):
State surcharge (12% of permit flee): r( , 23
Authorized signature: TOTAL PERMIT FEE: /0 T, 83
This permf application expires if a permit is not obtained within 180
Print name: Date: days after 11 has been accepted as complete.
Number of inspections allowed per permit.
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P r OF TIGARD
- BUILDING DIVISION - ,, ' PERMIT #: EI_C2008-00172
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 312612008 --
Phone: (503) 639 -4171 1 .
Inspection Requests (24 Hrs.): (503) 639 -4175 .�, __.,
INSPECTION WORKSHEET FOR DATE: 3127/2000 TIME: 7:O3AM PAGE: 33
SITE ADDRESS: 11777 SW TIEDEMAN AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: VAN DOORNINCK
DESCRIPTION: Fire repair: r €?c:onnect. service, repair bedroom and bathroom circuits.
OWNER: VAN DOORNINCK, WOLI"ER PHONE #:
CONTRACTOR: BRIDGETOWN EI.,EC,,TIRIC PHONE #: 603-621-7122
Inspection Request Scheduled For: Date: 3/27/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
_ -._ Ell, 'cal service 067418-01 603-621-7122 N
1 e \ C I F'►NN�
Corrections /Comments /Instr tions:
k) PO 9 ,r1,--(A,,,,,k,_ n-44, i: 6- L- -
- 6 9 1 ( A C7- i?
11 ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
• - " • ❑ ADDITIONAL FEES ASSESSED ci› 1 *.)1/0
Inspector: n' ' Date: Phone #: (503) 718-