Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00570
eh( DEVELOPMENT SERVICES DATE ISSUED: 10/10/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1 S135DB 05400
SITE ADDRESS: 11390 SW 94TH AVE ZONING: R -4.5
SUBDIVISION: MILLER LOT : 001 JURISDICTION: TIG
Project Description: 2 branch circuits. Jaccuzi tub and lights.
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:
BALES, MARY ELIZABETH + BRIDGETOWN ELECTRIC
TERRY VERN 22732 NW GILLIHAN ROAD
11390 SW 94TH AVE PORTLAND, OR 97231
TIGARD, OR 97223
Phone: 503 - 819 -4316 Contact #: PRI 503 - 621 -7122
FAX 621 -7123
FEES
Description Date Amount Reg #: ELE 26 -887C
[ELPRMT] ELC Permit 10/10/2001 $52.45 LIC 103824
[TAX] 8% State Surcharge 10/10/2001 $4.20 SUP 41775
Total $56.65 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- 6693,or
1- 800 - 332 -2344.
Issued By: � i �.���� Permittee Signature: x t `" ° r�J`�t�
OWNER INSTALLATION ONLY _ 1
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.
, - IL. 11 ( #
0 t' 10 2006 9:09RM Bridgetown Electric _ 5 621 ` P.2
C tif
. El ectrical Permit Application (� a i l�
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t: thgioJLCounly. 1 S5 N, r AV, Suite 350, MS 12, Hillsboro, OR 97124, Project and�Use approval "` . e :503- 846 -3470, Fax: 503 - 846.3993 # -
Ins action Re ueats 503 846.3699 L I- �p Iran
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lacement ' I -1" ! •, ....:,13
❑ New construction ❑ Addition/alteration/re
P 0 • Please check all that apply:
��
6 �� , ❑ Service or feeder 400 amps ❑ Hazardous locations
it r r'• tr It , l7 i � ?Ri tt i icb:.. , ,, ' �, it �_ y r,„ 5 i; J,1 `r ` i' r or more where the available
= "^ ' 9418, . 4'1i)il i' l iiirli r I 11 (till current exceeds ❑ Service over three amps ories
❑ 1 - and 2 - family dwelling ❑ Commercial/industrial e
l/industrial ❑ Accessory building 10,000 amps at 150 volts or ❑ Building ove three d ories
ID Multi-family ❑ Master builder [ ] Other Tess to ground, or exceeds ❑ in and boatyards
is = ' a K 14.000 amps for all other
E] Floating buildings
r s r. , s' Hlii o-.sia, y �, P
- .n --, . c , i t : Is 11 + ?� �, f , 3N ,, ..'i�- i ti 5 ll ' i ire pump ❑Commercial -use agricultural
❑ Fire um buildings
Job no.: lob address:
��,3 $" 6 4' f ❑ Emergency system ❑ Irstallation of 75 KVA or larger
City /State/ZIP: '�G,A,4 r ❑ ' ice. „ 1.2 �'2 , er, q.72 ❑ Addition of new motor i , ” ivedsystem 3„ load of 100HP Or more . °u cY
Suite/bldg./apt. no.: I Project namer ❑ Recreational vehicle ar
/0.s, ❑ Six or m ote res units P ks
Cross street/directions to job site: ❑ Health -care facilities ❑ Supply voltage for morn than
600 volts nominal
i 1J,h -4!"" 1 -r c3it r : '�. � t" .. M , lY.¢ fi tt rc�m ar i l t,11, �"'?.;
t, Ali tdg 9Wz gtr t , ai
: . t .F, s t }z
Deacri trop Q ty.
Subdivision: I Lot no.: n s+s s 4 e ,� r i ' �. 3 Fee Total IMO
r
Tax map /parcel no.: + % ! 1(� 04, h " r less 1 O fi,et t. tt . ,} >,y 0, rt -st" xdli:''141I. :?�t
y 1,000 sq. R or less
"dr x t , A it l i. -t S Pts ' ' r r ', , , i . v r rr
'
150 DO
;�:5 ,.T y'9.. za ,tee �ct ., uid;. : s ., + m.. ja _., ... „, .x,. 11w ! t.' ,..�, ¢ � a,n r 131 .it,lii Ea. add'1 S 42.00
��
,,� �tw� � � �
�Q`G��/_ -7 n .✓ _. __ Limiter energy, residential
Le+ ./ ���e N' (with above sq. ft.) 60,00
, • /ten r '�,/ Limitedenerg multi-family
f residential with above s ft.
T }F
; ;r , r :iF. ,: a t I 2 ^;' xr,111t(, , ti Y Ili'' - t r - rsr " � , t � t tt c
. _.. ,..,. i... k� _,,l, IN „n�: «„ur, .. ...r,.Jla,n^,i,r,ii,liiYl�Llnd =' "'•= ^'a - .1•.3, -,:< rt ... l?-! _ y ' s:.
�. a 6 � 3 1
Name: `�� � � V Q , I MF 200 amps or less 40 2
�� cc �� 201 amps to 400 ernes 8 2
Address: a 401 amps to 600 amps 10
s 18.00
2
City/State /ZIP: 601 amps to 1,000 amps 270 2
/0 e1 Over 1,000 s or volts 504.00 2
Phone: J (ry ✓ 1 7�) 0 71 l — L-/ 3 t< 4,, . l F ax ( ) tr:,� ,t� `.. d'f a t+ ^Ita"'7 ,� t r �rr �7ar f,i 1 �
�04 p � r' t lj`,E_ ii Fi r i4itdi. rtF. IIA 4 �r 1 1 q . r ii iN ^sfc tt4t1
Owner inabllatiao; This installation is being made on residential or farm property owned by me or a member of ` p �'+ 3 '
my immediate family_ This property is not intended for sale, exchange or run. (ORS 479.540(1) and 479.560(1). amps to less 78.00 or
Owner signature: Date: _ 201 amps to 400 amps. 150.00
ur d 401 amps to 599 amps 00
sue'_ y , - ;,tt 1, ii: r tt ;,. : y:., t :, ,: .s. t c
3 !2 3r s y '� r 4 r , - i
„_... mm, 1, it ib(ptlil, Fee for branch circuits with b '.. ! �� a a s A. Business name:
above service or feeder fee, 8 S
Contact name: each branch circuit 2 /
B. Fee for branch circuits L ” 5 ``)
Address: without service or feeder f 4o b
fee first branch circuit
/ r rs
City /State/ZlP: Each add I branch circuit 8 50 I 2 L `J�
f.
Phone: ( ) I Fr , ” j �,�pt 1 to ' ;Akl_
F ( ) f >x _ 't ' ''"
Each rrmnufaciured or modular
E -mail: ]02.00
dwelling, service, and/or feeder
2
a
Reconnect only 75.00 I
r 1 1 �,1 iG tau ,lii5 � R
r ?J" 6 z •' i �t1. t ''': * ; a t . :a a_ r.. '' u . j ,,M x i - 4 v - 41V! Itte'S,a x iRni"r511ii tit741 G : Egli M ` Pun or irrigation ,� P gationcircle 60.00
Business name: p ! 2
� rrt 7 �W g[ / eCYf I"! Sign or outline lighting 6 0.00
Address: �� 9 3 11#2, r r /� Signal p alter Iimited- 2
a/ f/P 609 sw ad , energy panel, alteration, or
City /State/Z1P: 1 f)y� .572_3/
extension. Describe: 6o.oa
Phone: (� 4, Z/ - 7 /2,... z.., Fax: (5 ) ,i t r r nt "r n ! 0 !r ,t, n »atr. a 2
E -mail: Per inspection 90.00
CCB lie. no.;.. -,/ g o
1 d.7 [5 r�yG Investigation fee (see ownptieaoo)
Electrical lie. no.: 0 74, , 813 - 7
Supervising elec ician 1 11 3 r ¢ t u �t� d [; t ' a s _ nicd, �r
t
signature, t' il,r :41 * ,- Ii..' , titfa, , iF ; *i, t l r.L . s:v,
maul • - ' - ,A • ��
Subtotal,
Print name: F7 � • r ns /- d Dart : �` _ /O -64. Plan review (25% of permit fee) �
Authorized ° J State surcharge (8% of permit fee) oYi
signature: TOTAL PERMIT FEE
Print slime: l Dater This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete �/ / _
° Number of inspections allowed per petrol .� t ''. Revision 06/26/06 ' s IO
P. 2
OCT -10 -2006 TUE 09:03 TEL:1 NAME:
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2006-00570
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/10/2006 A -
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 11/13/2006 TIME: 7:04AM PAGE: 80
SITE ADDRESS: 11390 SW 94TH AVE CLASS OF WORK:
• SUBDIVISION: MILLER LOT #: 001 TYPE OF USE:
PROJECT NAME: BALES
DESCRIPTION: 2 branch circuits. Jaccuzi tub arrd
OWNER: BALES, MARY ELIZABETH +, PHONE #: 503-819-4316
CONTRACTOR: BRIDGETOWN ELECTRIC PHONE #: 503,621-7122
Inspection Request Scheduled For: Date: 11/1312006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 039610-01 503-519-1206
Corrections/Comments/Instructions:
•
dt
I PARTIAL APPROVAL CANCEL I NO ACCESS
FAIL fl CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: e... Date: I o b Phone #: (503) 718- 26
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: ELC2006-00570
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/10/2006
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 11/3/27 7 116:11' TIME: 7:01AM PAGE: 78
•
eye-6-4'W
SITE ADDRESS: 11390 SW 94TH AVE CLASS OF WORK:
SUBDIVISION: MILLER LOT #: 001 TYPE OF USE:
PROJECT NAME: BALES
DESCRIPTION: 2 branch circuits. Jaccuzi tub and lights.
OWNER: BALES, MARY ELIZABETH +, PHONE #: . 503-819-4316
CONTRACTOR: BRIDGETOWN ELECTRIC PHONE #: 503-621-7122
Inspection Request Scheduled For: Date: 11/3/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough-in 039233-01 503-5'19
Corrections/Comments/Instructions:
•
0 -PASS EI PARTIAL APPROVAL fl CANCEL 7 NO ACCESS
FAIL LII CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED •
Inspector: e-Wir Date: ///5/ Phone #: (503) 718-