Permit CITY OF TIGARD ELECTRICAL PERMIT
, PERMIT #: ELC2007 -00610
COMMUNITY DEVELOPMENT DATE ISSUED: 9/4/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25101 AB -02000
SITE ADDRESS: 07175 SW BEVELAND RD 105 ZONING: MUE
SUBDIVISION: BEVELAND LOT : 004 JURISDICTION: TIG
PROJECT: QUERIN
Project Description: (5) 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/ 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: 4 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:
BERMAN, JOHN M + LITE -RITE ELECTRICAL
SUMMERS, MICHAEL L 28820 SW BURKHALTER RD
7175 SW BEVELAND RD #210 HILLSBORO, OR 97123
TIGARD, OR 97223
Phone: Contact #: PRI 503 - 693 -9775
FAX 503- 693 -9775
FEES
Description Date Amount Reg #: ELE 34 -358C
IELPRMT] EEC Permit 9/4/2007 $73.45 LIC 89854
[TAX] 8% State Surcharge 9/4/2007 $5.88 SUP 4041S
Total $79.33 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: 4•11rAr , Permittee Signature:
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.
Electrical Permit Application , FOR OFFICE USE ONLY
IN City of Tigard Date/By: Received 1/' Permit No El�� IS 00 It 0
q 13125 SW Hall Blvd., Tigard, IV Plan Review
-
Phone: 503.639.4171 Fax: 50 1 0 Date /By: Other Per nit.
Inspection Line: 503.639.4175 Date Ready /By: Juri ' ® See Page 2 for
TIGA ItD Internet: www.tigard- or.gov AUG 2 '7 2001 Notified/Method: ln Supplemental Information
TYPE �I 1 TIGARD PLAN REVIEW
❑ New construction r Additi itiant II. VISION Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three storks.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ; 'y Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I - ",
/ 1 IOOHP or more. occupancy.
Job no.: Job site address:
„,----7 7/7 c `/ /3E1/ .8/7/0 , "" ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: / ❑ Health -care facilities. 0 Supply voltage for more than
/ / (17--
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: ' l eCt name: tr .0 ❑Service or feeder 600 amps or more.
iii arr ►�� %If - FEE SCHEDUL
Cross street/directions to job site: 62 e Description I Qty. I Fee. I Total
`��C 4--) 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] 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
s .-.--^ Limited energy, multi- family 75.00 2
-f e WAIW tir -i /1, 0 (4 7 7 residential (with above sq. ft.) (. � j Z / Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑TENANT 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: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1
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 599 amps 133.75 2
Owner signature: Date: Branch circuits new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT . I ❑ .CONTACT PERSON above service or feeder fee, 6.65 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 4. 60 2
Miscellaneous (service or feeder n included) �/Y%
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
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Lid -L./ I " , j9 / r , /' Signal circuit(s) or limited-
_ energy panel, alteration, or
Address: I , / extension. Describe: Page 2 2
City /State /ZIP: l/ 1 _ Each additional inspection over allowable in any of the
` , 6 � a i ' 9� Per inspection 62.50
Phone: ) 6,:...1//75--
E- / / 75 r Fax: IG 4) M —jf7, 3 _
`J , Investigation per hour (1 hr min) 62.50
CCB Lic.: = /.' i Electrical Lic.: Suprv. Lic.: t/ Industrial plant per hour 73.75
�� ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: J ► /!l! Subtotal: 7�j •
Print Hain ,/ J r. ; • Date: Plan review (25% u of permit fee):
� . - � State surcharge (8% of permit fee): 6 K
Authorized signatu : /�/ 4 ,W - TOTAL PERMIT FEE: 79 , � b
Print na® J � � � !/ � Date: 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 penult.
1 \ Building \ Permits \ELC- PermitApp.doc 05/23/06 440- 46t5T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard •
Page 2 - Supplemental Information
LIMTTED ENERGY PERMIT FEES:
I RESIDENTIAL WORK ONLY:
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*
n Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 260 - 260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n 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
I \ButIdmg \Permits \ELC- PermitApp.doc 03/23/06
CITY OF TIGARD
l i BUILDING DIVISION PERMIT #: ELC2007 „0ti06i0
I 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9,,,1/20O7
Phone: (503) 639 -4171 t 161
Inspection Requests (24 Hrs.): (503) 639-4175 ,„,—Mil. ''',.....
INSPECTION WORKSHEET FOR DATE: 9/27/2007 TIME: 7:00AM PAGE: 77
SITE ADDRESS: 07175 SW BEVELAND RD 105 CLASS OF WORK:
SUBDIVISION: I3EVELAND LOT #: 00,E TYPE OF USE:
PROJECT NAME: QUERIN
DESCRIPTION: ( branch circuits
OWNER: BERMAN, JOHN M +, PHONE #:
CONTRACTOR: LITE -RITE ELECTRICAL PHONE #: 5033.693 -9775
Inspection Request Scheduled For: Date: 9/27/2007 Pour Time:
Code # Inspection Description C#' Contact # Message
199 Electrical final 056425 -01 503.781 -3839 N
Corrections /Comments / Instructions:
- +5 A V61 <-11 f kjlp, MiTr ,
/ski N W R 1C.,
1
rli
A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: f N� Date: 91211n Phone #: (503) 718- Z
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007 -00610
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9
Phone: (503) 639- 4171uar
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 902007 TIME: 7:00AM PAGE: 50
SITE ADDRESS: 07175 SW BEVELAND RD 105 CLASS OF WORK:
SUBDIVISION: BEVELAND LOT #: 004 TYPE OF USE:
PROJECT NAME: QUERIN
DESCRIPTION: ( branch circuits
OWNER: BERMAN, JOHN M +, PHONE #:
CONTRACTOR: LITE -RITE ELECTRICAL PHONE #: 503 - 693 -
Inspection Request Scheduled For: Date: 9 / 7 / 2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
•- 2 61e44r44-W4 055292 -01 503- 781 -3639 N
125 WAS ( ) tiN
Corrections /Comments /Instructions: �J
AS [ I PARTIAL APPROVAL n CANCEL 1 1 NO ACCESS
FAIL (l CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: G`4 N L Date: c4 1 467 Phone #: (503) 718 - 1441,
CITY' OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007 -00610
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/412007
Phone: (503) 639 -4171 fop/ A
�
Inspection Requests (24 Hrs.): (503) 639 -4175 l
INSPECTION WORKSHEET FOR DATE: 9/5/2007 TIME: 7:00AM PAGE: 26
SITE ADDRESS: 07175 SW BEVELAND RD 105 CLASS OF WORK:
SUBDIVISION: BEVELAND LOT #: 004 TYPE OF USE:
PROJECT NAME: QUFFdIN
• DESCRIPTION: ( branch circuits
OWNER: BERMAN, JOHN M +, PHONE #:
CONTRACTOR: LITE - RITE ELECTRICAL PHONE #: 503-693
Inspection Request Scheduled For: Date: 9!512007 Pour Time:
Code # Inspection Description 7 C6irm h • Contact # Message
120 EIectric:af rough -in 1055 503- 781 -3639 N
Corrections /Comments /Instructions:
t No CN C■4tA (RfANE=
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• sys cNv C.-E1Lt , (`. 33LI , A•2- .
\ . ' 5 1 %:1 S 1" ij 1MPo ■r=�lwA ` 10 I F
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J J
n PASS 1 1 PARTIAL APPROVAL n CANCEL NO ACCESS
X FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
•
Inspector: C- _ 1A 4 LC Date: i Phone #: (503) 718- 21-10)