Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00396
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/15/2011
Parcel: 2S 108AB04200
Jurisdiction: TIGARD
Site address: 14148 SW 155TH TER
Project: Brentwood Estates Subdivision: BRENTWOOD ESTATES Lot: 4
Project Description: (1) 201 amp service upgrade, (8) branch circuits and (1) limited energy panel for spa, car charger, barbecue, media
room and sauna.
•
Contractor: LANTIL LLC DBA THREE PHASE ELECTRIC Owner: BRENTWOOD HOMES
493 NE 3RD AVE SUITE B200 15170 SW FINIS LN
CANBY, OR 97013 TIGARD, OR 97224
PHONE: 503 - 889 -6615 PHONE: 503 -407 -1101
FAX: 503 - 651 -3540
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 201 to 07/15/2011 $133.56
Specifics: 400 amps
8 crt Branch Circuits w /Purchase 07/15/2011 $59.36
Type of Use: SF Service or Feeder
'Class of Work: NEW 1 ea Signal circuit or Limited 07/15/2011 $75.00
Energy Panel
Type of Const:
1 ea 12% State Surcharge - 07/15/2011 $32.15
Occupancy Grp: Electrical
Total $300.07
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952- n -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: CJAr / ,1 7 ° / ° ' - ' / Ce5 2- 7 -7 r2
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' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
2011 -07 -14 13:50 503 -651- .1 , r., cc pr, c c.c.- u . ,
Electrical Permit Application OFFICE I Si: OM.\
Received City of Tigard PKnirit r1,,,;
25 SW Ha1183vd,, Tigard, OR 97 17ate/ny; 7
131 �S �/ CGS �/� -49a 59. 7 Cj '\ Datc/By: Other Permt
Phone: 503.718,2439 Fax; 503.5', . i � `�� DatclBy: �STA�O O y 6e/f�f
T 1(, A t: I ) inspection Line; 503,039.4175 `\ •, ate Ready/By: gwis: See Page ?tar
Internet: www.tigard<rr.gov V� t r :004tilied/MeOuxl: •7 (S Supplemental Information
�� �, +, / n 4 l f p ' '" �" i k Y,. V i i' 'I ' ' '' j ' fit ,hp !I �.. p
1 }'t t ,1l 11 b - ramp n av x e! ru cpfc tt>� 1 t, � r, rl 1 t , ! �, r t n GY1�• - .
t,�J tit i#i ar " ar71i A ,� ,�y{ ':�, .. , �. c +�n ,arail�tAxlG�rtttr4i#�•dt ' � . 114 0� „ + , - �„ t+'�j',. }nt�x,n� rtUilflf�l���`.�A''� %icer ��, i � .,+ �,d��"!��id r1v,3�P�9�?N44 rft�'�!��
❑ New construction ► • ddition /alteratiot t} 3, ••‘'• Please check all that apply (submit 2 sere of plans wlitcros checked below):
❑ Demolition ..`` ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ q O AT 1.\ ) where the available fault current 12 Marinas and boat ants,
�8R ! l i n `€'C + �?l rt au , . t 11�1+ 1 t t lt'� r 4' �1 'sr t f,, ,, Er fi exceeds 10.000 amps at 150 v ur ❑ P lowing buildings.
1
d n ,,, ' t 'rs n oAY .c c ttxzdtm h. it: ttltro ittla inI '°1444444 A 16 u o F ' f�c.. d - ' • , , •
less to ground• or exceeds 14.0 ❑ C: ommerc ia l -use a
El- and 2- family dwelling QCornrnercial /industrial Accessory building amps fur all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fro pump. ❑ Installation of 75 KVA or
t, � I i ft u yk{w to �rata ltal,llrcuctugg4 ! (u(t u t - tt �ttrl t I , r 1] Fatlergency system. larger Separately derived system.
uc 1-r' rY' : �: {rkc I1').'ryj ti 1•i -1/ tt b G a ;:; a
M. A. . ,.4R s ly �[ S
r r n. l<n+ star/ t! rtnircat{ mt: hr $w�>saz.tlilctrunna r 1 ,,, ,1, . /
t ' . ❑Addition of new motor load of ❑ "A”, „E...1 - �„ .<
Job no.; 15) �-.1� GU Job site address; M c^ IOOHP or mire, occupancy.
4 t � t?� ❑ Six or more residential units. I.] Recreational vehicle parks.
City /State/ZIP: - R A -�.�� (] �� 1 2.- -i ❑ Health -care facilities, ❑ Supply voltage for morc than
4'�"' ❑hazardous locations. 600 volts nominal,
Suite/bldg./apt, no.: Project name: ❑ Scrvicc or feeder 600 am re
� .E_7� � s or mo
p
i d s.i fa A? k H",u1 i l A, lrt+ t V>r {awl V , r r IT
Cross street/directions tojoh site: S
J ll f l 4�C d 'iA( narroi af1M111YA111nrt 'u,'3. ''i �!I 1,M {1!!t`. ;'
j (Z.CE � 6 � ��1�-�"� S' Description' c2ty, F. Tnror •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq, it. or less 168.54 4
Eu. add') 500 sq. ft. nr portion 33.92 1
Tax map /parcel no.: Limited energy, residential
j 1. ! � r A.1. r ? t�f , (t ;'ll Ir�A '44".1u1Lu t T1'111 n ,1 @4 t t:� { 1 { )j1 �,'
lJ � ai lll�i i t malt i1�?ii�S((`'lt �,u#+ u Atig dl „utr,till+i tai f � {%1 �E11 1 t1 4^t - gat i {.i 1 r ! ;. f Jl _ (we en rgy, „i 75.00 2
75
�, ` . ( Limited energy, multi - family (10 2
. V ( [ . 1 A (1 •.0 f' _,L C - i.(( • ,r, � 1 f a . c residential (with above sq. n,)
( " Services or feeders installation, alteration, and/or relocation
r > 1'r R 200 amps or less t 00.70 12
i ;I r rt l = , ! I ntro p ry gw xt. z y� (c !r ) i c ' u i i l t G I l ti `l `i` M cl if f s , '' facet ( ui t 201 —
• 11>`i ! A i s �l i o 1 f [( 1 t`� itlr i } ` a te lid, c n , / i y ,- t1l i,jil' 01 amps In it 13 3.5ti 2
,l, ),, dl 'w A, nV 'an ch,4.4r:. t tial W ai , AO..Y 4 .Y r i r..' i•buoilii 4 '� i n " A.AIIII .Y . tY- t I � � ,� •
401 amps to ti00 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
r Temporary services or feeders installation, alteration, and/o
City /State/ZIP; relocation
Phone: ( ) r F ax; ( ) 200 amps or less 59.36 l
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701, 401 amps to 599 amps 168.54 2
Branch circuits — new alteration, or extension, er panel
Owner signature: Date: A. Fee for brunch circuits with
" `� 1 i i r, 1 A , rip r r itoE? f l{ f t (olt fsrv,r t s i •Yr 1 d a4 n }4 tr 1 A vivyx r r :z
u` 1 , + J ' (( st ? �l Y,� w+' i i R 3 ! l {l! ,yAr tr{b" '�i, YY l A 1t ef p Y/rc mt 1 } I t 1 ,1: above service or feeder fee, <,
1: • 1,N zl.,ci ;t1,,... tst,YM,,,r(ut.6,1. ? u , ^i, k v. .dS ,Atal .cur, ,,. .a4ra.)41a t o s a rAI t „AS.nr each brunch cinmit 7 .42 r � .� b 2
Business name: B. Fec for branch circuits without
service or feeder fee, first
56.16 2
Contact flame: branch circuit _
Each add') branch circuit 7.42 2
Address: _.. Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67 84 2
dwelling, service and/or feeder
Reconnect only 67.84 2
Phone: ( ) Fax: : ( )
E -mail:
– Pump or irrigation circle 67.84 2
;+, `tr+( „ 1(+'t Sign or outline lighting 67.84
Yt 2 ff/ VI'i;l.l` F *l .k=u�lfldl�E p �e�A�Adt(tuknG+�P.{tias auul... {u+ C+�. i)r + + fi r. fm's {13 fl r . .. g 2
1.�. rte.?, �
. �/ �r% r+ �A( AAr {: %i"r:F,r�p�tAil(I�,r. tS i tJ!a¢Sw�� Signal circuit(S) or limited-energy
Business name; LA T1. L- . t� c . i � I I.&' k i G ' parcel, a or extension. I Page 2 15. 2
e p Each additional inspection over allowable in any of the abov
Address: j;.,+ 3 ' Ni1/4.5c ? A a•J ¶J 1 e • ' 0 Additional inspection (1 hr min) – 66.25/ hr
City /State/ZIP: g` 1 � hUV t. ' Investigation (1 hr min) 6625/ hr
r, l t ' t U � L– Industrial plant (I hr min) 78,18 / hr
Phone: j) D _ a.- ,,irt ; U9 5 `- 3_5 1 o Inspections for which no fee is
s etficall listed 'h hr ruin 90.00/ hr
`6,9/ CCB Lie... i vex ectrical L ic.: - t (' . S u p rv. Lic.: 3't u �, t ;,,Illi El _ * 111'x'; !' , -? r �Ii � x:Y° ,, /ii z d vy tl �'s 1 �,, lr 1 . A :•
"tt , ;,,1w; A, �,..,° ;
Suprv. Electrician signature, required: Coft..-:, el 6-1/ii lo' f i3 Subtotal: aiwl n 7
Plan review (25% of permit fee):
Print name: N 1 `a LA.) L `....e. "r Date: 1 L A. , I , I State surcharge (12% of permit fee); 1 rj
TOTAL PERMIT FEE; ` Cj, r -"t V
Authorized signaAuthorized rhi, permit application expires If a permit Is not ohtnieed within 180
days after it has been accepted as complete.
Print name: Date: ' Number of inspections allowed per permit.
r:\ Building \Permits \P.r.C- PpmitApp,dec 07 /01 /10 44044151(l i /US /cowwbR
2011 -07 -14 13:50 503- 651 -3540 three phase electric P 2/3
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
�1 }�� �{ v { `� 1 ,�k �µ S�i•Yy i 41 1 tl ��I f 7 t tti
'f fA1x.R A�AfAAtltiINM 5l 1 t (V11.0 1 �WA A111 :. r ,:� 4 { IEI� 1 _ _ i
Fee for all residential systems combined $75.00
Check Type of Work Involved:
Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other.
al
': lldutllx [.1frrK ult].'.�.1'1 ;lfA7EfWm. tAly.(1W.WYIW t r4�'.l.l nl ill ��1 .�A_ „A {yl' .� �:�
Fee or each commercial $75.00
system.
(SEE OAR 918. 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
l\iyit ulePmmmiNE.C•PmmMypJuc m / /lu
Jul. 22. 2011 4:31PM PGE PORTLAND SERVICE CTR No, 4412 P. 1/2
Jul y , .c.: .. Jason e. rtrisLlne roint;s 503 723 8948 p. 1
Jul 22 11 11:27a Jason & Kristine Points 503 723 8948 p.2
, . Request to Energize an Electrical Installation ELCo l 1 - o 0 3 74°
.... ,... k kW ':0 b,C3
_ REQUESTING SUPERVISING ELECTRICIAN INFORMATION _
Name of supervis;ng electrician: 1 l di: `t, - G - ,
_ Date of ! / l
Supervising electrician's license number: r',';' Date installation was completed: C'. I I I 1 I
Electrical permit no,: ' J 3cj /• If a temporary perntil is posted al the job site, please include a coPy of it with this form.
FMP1-,O ELECTRICAL COTRACTOR INFORMATION -
Name of electrical contractor: 1 i - - _. 4'; Cow 1� l' t' t' w CI G Licc n _ ' � '
'�'),(�
dress: 1- -i e
• -
Business ad l • l
! � i / _ ;, t T64 ` ACC, w---
City: L L `7 y .__.. - . r St ate: i• ', �.'` zlr: t j 2 • i 7
Thole: Li :1,_-_,i=4 )s => Ha::- ?y - CAL 3•5,-Lc/G_ 1J -Bait: r c , s a �4lirc c4 L_JJL- LL k
GU INFORMATION
Customer's name: s �_ L.
C:ustetner's address: - t � -f ;; �...1 i ` 5 71 - N ""� _.
�'_tCv _ ___. .
City: .i15 ,•)(...,' ,;l _ State: _ j, Q ZIIt: el• 7_ , s __
Address of iriStallatiun it' different than customer's address: •r: J'( L I.
City: Slate: ZIP:
INSPECTING AUTHORITY INFORMATION
Authority having jurisdiction to inspe �� ` , � - y, Phone' •2 7f't .� S'7
L
Address: I' 'i - - 'L--% i-1 0,U. .R) ,'c� - -
Ciry: ---3 =i , A _ _ Stale: c j L ZIP: ` ?
RECEIVING ELECTRIC UTILITY INFORMATION
Name of electric utility receiving request: '� "L___--/ Phone: 5!. . I, :77i.. • L %751-
_
Address: - - -
i
City: State: - ZIP: __ �. _ �.�.�
REASON FOR REQUEST
A. Restoring electrical service that was interrupted or disconnected because of either a:
rvicc change or D Uncontrollable event. such as fire, flood, or severe weather:
or
13_ Electrical service at a remote location needs to be:
Q Initialized _ 0 Restored
COMPLETION INSTRUCTIONS AND SIGNATURE - — ^. _ T , _
Supervising electrician Electrical contractor
Note: Atter sending this form to the electric utility Note: By close of business on the first business day following
named above, you miry[ send a copy of this form to: energizing ofa completed installation in response to the above
(1) the electrical contractor, (7.) the customer, a nd request, yuu mast: (1) notify the authority having jurisdiction
(3) the inspecting authority, that the installation has been energized, and (2) request that the
authority inspect the completed installation.
Sopervising electrician's Date Electric utilily 1
Tr Note: Please consider notifying the inspecting authority '
({ '*••: ",,..,,,,e 1 z1 1 I identified in this request when an installation is energized
hefire inspection.
Wt fP
; E +��T
lONE q.i
&SVI�tNLn