Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2007 -00568
COMMUNITY DEVELOPMENT DATE ISSUED: 8/15/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 102DC -01601
SITE ADDRESS: 09100 SW EDGEWOOD ST ZONING: R -4.5
SUBDIVISION: GERTZ HOMES AT EDGEWOOD LOT : 014 JURISDICTION: TIG
PROJECT: GERTZ HOMES AT EDGEWOOD
Project Description: Service for (2) private street 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: 1 W /SERVICE OR FEEDER: 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:
KEN GERTZ NORTHSTAR ELECTRICAL CONTRACTORS
19200 SW 46TH AVE 19450 SW CIPOLE RD SUITE 107
TUALATIN, OR 97062 TUALATIN, OR 97062
Phone: Contact #: PR1 503 - 612 -0840
FAX 503 - 612 -0891
FEES
Description Date Amount Reg #: ELE 34 -359C
[ELPRMT] ELC Permit 8/15/2007 $80.30 LIC 90454
[TAX] 8% State Surcharge 8/15/2007 $6.42 SUP 661S
Total $86.72 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
suspende more- an 180 days ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center
Those es are set forth •. o • R • 52 -801 -0010 through OAR 952 -001 -0100 You may obtain copi- .. -se rules or direct questions to OUNC at
503 6.6699 or 1.800 3 +344 �`
Issu d By: / I ii / / Permittee Signatu'� ' ��
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:
- NTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: .e - ,DIa( • . DATE: , 5 Q 7
LICENSE NO: I •
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.
Eiectrical Permit Application- FOR c)[ trrc`F; 11SE (11vr,v
k e�e ;ve a -,.
::y of iigurci p �
! i DaaR � Permit No,: 2 I l
I.3125 SW Hall Blvd„ , Tigard, OR 97223 Pta Review __
Phone: 503.630,4171 nix: 503 598,1960 f r iiI Date/nv: Other Permit. Inspection Line: 503.639.4175 AUG 6 - i . Date Ready /ny: lurtr 6'J Sec Page Z fur
Internet: www,ci tigard,ar.us ® L` Notified/Medwa II or
[nl'urm trios
ti'G �'i!� X11([ ru,q,t
.. ; r' fir¢;., xs;: � 1'• T . •: , ' `p
' a v ,� . •�,rf,�+ � � �� :a ... .- , • •"•:: •PL �VI)�y,
I ew construction ❑ Addl S ti1M al. FIAll • `Ant Please check all that apply.
• Demolition ❑ Other: ['Service over 225 amps, comm'l ❑i Iazardous locution
,• r . i • ❑Service over 320 amps - rating []13uildng over 10,000 sq. tt.,
` ; r,� „i, , ” ' ' i ' +'ii ..4%'' ili - V,9a
.C9N.yST'„ •h(`' •. of 1- and 2- family dwellings 4 or more new residential
❑ 1 - and 2- thinly dwelling "! Commercial/industrial ❑ Accessory building • ['System over 600 volts nominal units in one structure
❑ Multi- family • Master builder ❑ Other ❑Building over three stories ❑Feeders, 400 amps or more
q at � ;, t v' R iM. � 1 ['Occupant load over 99 persons ❑Manufactured structures or
i "fi:l r 1+�• 'itN, „ ,Ia s�i ; ti L' Ub l9 !X't,ir't '�a : 4.Ii1 . � �. ;, 1 . ! II • 2)I`t71 . �_. :�i .;L
❑ " Egrest/li g hrin g plan RV park
Job no.: Job site address: /A� - , ' //1.4a ❑Health -care facility ❑Other:
Submit j., sets of plans with any of the above.
City/State/ZIP: d, The above are not applicable to temporary construction service,
Suite/bldg. /apt. no.: Project mime {i yj,' 1Ar� , •,t�F,:,) ?.= ":`a4,,,,. ,,. ',? , !•I ' ''S.r�` )�T?fl . ,,.;� '
bascrlption Qty. Fta. Total Mil
Cross stree directions to job site: New residential single- or multi - family dwelling unit.
15W _ V r_r Includes attached garage.
J� 1,000 sq ft. or less MI 145.15 4
Subdivision; 0 • / / Q 1L iL Lot no.: Ea. add'l 500 sq. it or portion IIIII 33.40 Q
Tax trap /parcel no.: Limited energy, residential il 75,00 H
0 `` '" . ; t t a�'i 1" ` '1;14. `ai' 1 t f ti Limited energy, non - residential 75,00
'" { �' j,, 'Pk. , Ql ." . .7-:1 i�: r'^ i
,,•c +•«s5 ' ar... I b }
r d• ',, A Each manufactured or modular
� � � / /�� � ��' dwl, SiCc and /or fee
! r!ion,inor 2
' location
i f 200 amps or less 80.30 `�/ ��
201 amps to 400 amps 10[5.85
i - 'f$'i ,;� ,.�I >4 ' �1 , If q7 1 "0." '"- WANE WANE !r t as 1 �`., 1,..
i " :,'l!+(,t F. . - . �r �.,
401 amps to 600 amps 160,60
III
Name: °
601 amps to 1,000 amps ill 240.60
Address: Over 1,000 amps or volts II 45b6 $4.65 5
Reconnect only
City /State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone. ( )
200 amps or less 66,8:5 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100,30 ____
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133,75
Owner signature: Date. itranch circuits - new, alteration, or extension, per panel
' F '{I �ti� ' 113'4 "0∎''V'l "';;, ..1. t;, ' '1 :❑ u►7 PERSQIY:c ?'.'' ! � A Fee for branch circuits with
service or (ceder fee, cash
Business name: branch circuit 6 65 2
B. Fee for brunch circuits
Contact name: wtthour service or feeder fec,
each branch circuit 46 85 2
Address: _ Each add'I branch circuit 6.65 2
City /State /ZIP Miscellaneous (service or feeder but included)
Pump or irrigation circle 53.40 2
Phone: ( ) __ �T Fax:: ( ) Sign or outline lighting 53,40 2
E - mail: Signal circuit(s) or limited-
''';,,,,),Ir. �• • . -' energy panel, alteration or
,, •i( ah,=p }i',r' "i „'+ `;c0�'.rkfAC " I ?' f' ''l •• . - , gY p +
" ,"'' extension, Describe: Page 2 2
Business name:
Address. North e
star Electrical Contractors "J" - Each additional inspection over allowable in any of the abov
19450 SW Opole Rd, #107 Per inspection 1111 62.50
/ State /ZIP : Tualatin, Ok 97062
Cit
Y (503) 612 -0840 Fax (503 ) 612 -0891 g � , Investigation per hour (1 hr nun) 62.50
Phone: ( ) Lic # 34 -3590 CCB #90454 Metro N1911 / f .' V Industrial plant per hour um 73,75 M
'' E It l'l7,XGekT,''PF�B_ 3 'X T YEk`S*
CCB Lic.: Electrical Lic.: Sup . Lic.: _ Subtotal
Suprv. Electrician signature, required: 'Airy- ' Plan review (25% of permit fee)
State surcharge (8% of permit fee) � 'I `
r •
Print name: ,, Date: fri
�Yi'y •. _ TOTAL PERMIT FEE
Authorized signature I ' T his permit amine:seen expires if a permit is not obtain; I .i 1:0
days after It has been accepted as coiaplet
Print name: Date: • Fee methodology set by Tn- County Buildins Industry Service board
" Number of mapecuoas per permit allowed,
11 euildllIO'ernIts\L'LC•IbtmltApp tat 1 2rvJ . ,o.�atsrtloJo2,coruw6B
Id Nd6z :170 LODE SO ' • '0N Xdd : N0a1d
FROM : FAX NO. : Aug. 08 2007 04:30PM P3
r �
•
.� i -- . F ? i i co
T; �1 I }
'a- `. SW 7 kh" - Ave •
ki
'''„ {., 4 ,
r. �a... ............. . . '4 . . : . S\ 1 I 1
R ' '':.,1,,,,,:.:=9'' ,,
4... , ‘•, ,;"'2--- ---i - j g
1 , , I. „ ,, 1, 1 LI
, and. A��;, ° TA
-v # 1
C ' ' )
P/r' ( I
" s,, ,
( ; - 1 : — .:6 ••••••: • : --„.-„, i ,6-\1,.. t .lkitt.. 1 " 'S Ti
'� ' 't'i: - - - -- ic i i
i , ` ' S . - -.. 'fi H 1 3....,, �I II 8
r .
.,0 i iI s j Ea •
/ I 1 i ! # H
. , st7P1l$M MS, and/. 4 ,t... - ,,M ,i
"'"" -.''' !
S ' � 1 ; GO,1,' = S a 2
'AS .i i , :45 .
i , 1 1: ' . .: , , . 4--
,, <
..,„.,,„„,„„, , • , ; . ,,, i pw- 11 -51I' Ave - - -- -- - _.... 1 I ' I "tY N &7i
,., k I '
1 1 , ; r sc•-•,
•
l'fl
ri
CP'0
I
101
table, P0 MS
,0
L't
LCD
..{
lanunrwm/
IbMS pa.a.va Ms
4,1
X14
bky
(11.t1
ed41o1 o3
Wq71
mIll'Imd POOP a IlItyroJc1
km.r.mulIS 01,4044
„,, • iwni SM ,/rmsayS, 'SAN
1I.rIqp•4S p■exiom-zn
i•
1 ow) r■i, ',./(). P.M. '5•In
144Am% 6 u11 , 9t3 - 1 d 1
I
01114144.0
1.
AID
91'(d ITV 1.0-
INflP .
IWILTAIS
CE-ow. /
__.
7
clasodaw-zal . L.,
,....._=.7r - r r, _,..x."...e.e 1.4 7-e e •41 , V7L - - t ."---r 7V■V...ci" -r r . F r . 2II 7 r .. . 'v - •r 'e V 4 G -- :: •rrrt IP r
Fr r err. rrrrr rrarrrrrr.„:rrre'rrereerrere'rcrrrosr.00.0
r_s• r r r r. - r r r r I V- r-c.--s--r1-r -0-r-r- th. ,.. L r-r1-•,---,- r• ■,. -- r - ri - i-sr 1 r
r r rOiDirE r r r -. r .7 r cOP4te c• r r V re r V Vrrer 7'? r''errerrrrerrr
F Ir. /77 . r r c r: err rrr V v ve r v -v -r• rr- - r -- 7 - r 11 . T . '2 . 1 .- V 7 7 r 7 r ri c'
- - '' --• rrrree
\ rrrr
✓ V V r .7
r
. r • ee• err
✓ V V V
✓ r r
r 7 7
r : r r r r ,
e rer r.--c—
\ _ _
13,:1
FROM :
r
INOrlindls
cir.Ntead-t41
C 310d
,
r
1'2
FAX NO. :
. • r
lr r r
r
r
r
iicruZias
C3504:110
S TOO
✓ r
✓ r r I e
e rrir
• r err e
rrrr
- r_
r
LC
r r e r
e
\ I I
, I
Rug. 08 2007 04 : 30PM P4
NV DO VI. 41 1UuC./ L V v., fl55S r - - — .
'1 e 0J 1
r
.-- :: .", ", , , -.: •
.„ .
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ac2007..00668
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/15/2007
Phone: (503) 639-4171 4 47490ii /i
Inspection Requests (24 Hrs.): (503) 639-4175
'' •
INSPECTION WORKSHEET FOR DATE: 1W11/2007 TIME: 7 PAGE: 85
SITE ADDRESS: 09100 SW EDGEWOOD ST CLASS OF WORK:
SUBDIVISION: GERT7 HOMES AT EDGEWOOD LOT #: 014 TYPE OF USE:
PROJECT NAME: GERTZ HOMES AT EDGEWOOD
DESCRIPTION: service for (2) private street lights.
OWNER: PHONE #:
CONTRACTOR: NORTHSTAR ELECTRICAL CONTRACTORS PHONE #: 503-612-0840
Inspection Request Scheduled For: Date: 10/11/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
— - 7--
115 Electrical service 057353-Of , - 503-612-0840 V
Y
1 CI 1 F ; aq AL-- ,
Corrections/Comments/ Instructions:
. -
)
' )
i .
do PASS I I PARTIAL APPROVAL n CANCEL fl NO ACCESS
El FAIL CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: .. / Date: 1 40 7 Phone #: (503) 718-
. .
CITY OF TIGARD `„ ,
BUILDING DIVISION PERMIT #: ELC2007- 00668
13125 SW Hall Blvd., Tigard, OR 97223 -, DATE ISSUED: 18/16/2007
Phone: (503) 639 -4171 _ 1141��' `
Inspection Requests (24 Hrs.): (503) 639 -4175 - i '
INSPECTION WORKSHEET FOR DATE: 8/17/2007 TIME: 7 :01AM PAGE: 47
SITE ADDRESS: 09100 SW EDGEWOOD ST CLASS OF WORK:
SUBDIVISION: GERTZ HOMES AT EDGEWOOD LOT #: 014 TYPE OF USE:
PROJECT NAME: GERTZ HOMES AT EDGEWOOD
DESCRIPTION: Service for (2) private street lights.
OWNER: PHONE #:
CONTRACTOR: NORTHSTAR ELECTRICAL CONTRACTORS PHONE #: 503 - 612.0840
Inspection Request Scheduled For: Date: 8/17/2007 Pour Time:
Code # Inspection Description on irm ° • Contact # Message
06421e.-01 503 -612 -0840 N
\ 0,5' 0 0 Pa424 (2-6A) 0 f • 0 0-b
Corrections /Comments/ Instructions:
a, PASS PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
FAIL ❑ CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: 1 ` (■12i Le Date: 1111.01___ Phone #: (503) 718 -