Permit CITY OF TIGARD ELECTRICAL PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELC2008 00582
DATE ISSUED: 10/10/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S135BD-00300
SITE ADDRESS: 09735 SW SHADY LN 303 ZONING: C - G
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: DR FREEDLAND
Project Description: Relocating switches and receptacles. (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:
HAZEL INTERNATIONAL, INC AND BRIDGETOWN ELECTRIC
HIGASHIYAMA HIGHLANDS CO, LTD 22732 NW GILLIHAN ROAD
BY NORRIS + STEVENS REALTORS PORTLAND, OR 97231
PORTLAND, OR 97204
Phone: Contact #: PRI 503 - 621 - 7122
FAX 503 - 621 -7123
FEES
Description Date Amount Reg #: ELE 26 -887C
[ELPRMT] ELC Permit 10/10/2001 $73.45 LIC 103824
[TAX] 12% State Surchar 10/10/2001 $8.81 SUP 41775
Total $82.26 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 / _ Permittee Signature: Tee /jCer7/
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.
Oct 10 2008 3:56PM Bridgetown Electric 503 - 621 -7123 p.1
■
, Electrical Permit Application l (11: 01 It] : l ..I: O� 1 :,
4 , s •
City of Tigard � , . 4 . v
13125 SW Hall Blvd., Tigard, OR 97223 pan Reid Other Perm - .
_ i" ' Phone: 503.639.4171 Fax: 503.598.1960 DateB : "� OWO
r . , , ; Ir 1 , Inspection Line: 503.639.4175 Date Ready/By. WEI r. See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Intormatioa
r r r i� "'Y 7� 7, , r F i 'Z y - ';i5? iJ • - ! .. .! _.y h 1_ , !- ° i /Fi'h4_l �� . i „ t .. r
-.pi ' .. +. ell i: .! ei.4 -a 1. ? '..: _� .r. r , fi r i a ., tip
❑ New construction ❑ Addition /alteration /replacement ease c hec that app (submit j ads of plans wheals checked below):
❑ Service or feeder 400 amps or more ❑ Building over throe stories.
❑ De tttol![fon 0 Other:
where the available fault current 0 Marinas and boatyards.
:1 " ; , 11 b z ra � eacads 10,000 amps at 150 Volta or ❑ Roarin bwldin
, .: , . _. � w ->_.z X ._o..z^ai 0 ""''' ! '' less to ground, m exceeds 14,000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling 1 74 .Commercial/industrial ■ Accessory building amps for all other installations. buildings.
❑ Multi - family I\ Master builder ❑ Other: 0 Fire pump. ❑ Installation of 75 KVA or
!.4.,1k G ❑ Emergenry system. larger separately derived system.
v
.,A y... , _... . ._ _. _
.6 p t
_' . ❑ Addition of new motor load of 0 "A ","E" °1 ","1 -3 ",
Job no.: Job site address: 4 9 ' 7 3 5 " 57/4, %Ac, Aanc,
1ooH P or mot occupancy. .
ID Sac m residential unite. ❑ Recreatiomal vehicle perks
City/State/ZIP: / 1 .0 3 ❑ Health -care facilities. ❑ Supply voltage for more than
/
❑ Hazardous locations. 600 volts nominal.
Sulte/bldg. /apt. no.: Project name: )( s. 4/„..- , ❑ Service or feeder 600 amps or more
Cross street/directions to job site: Description " ` Qty. Fee. Y" Tsai �•
:
New residenlial single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax snap/parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 I
Limited energy, residential
"_.. s ..; : _. _ .:. ( .--- :? +k �;a . 1 , .'s . , T:>ti .I?t . (with above sq. ft.) 75.00 2
,.__. Limitedenetgy,multi- family 75.00 2
- i dh ti/ e . obeleO- .../n residential (with above sq. ft.)
J Services or feeders installation alteration, aad/or relocation
id
s tG i
/a/ elo . 'fl4 / .' 4ie.r.- 200 amps or less 80.30 2
... :. ' ., r:',,. _.__ _ .... , : tz . .. s t ': -r ��ti s ., :s .. i y•,.. 1 ..._. ,, .,,- 201 amps to 400 amps 106. 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: ( ) Fax: ( ) 200 amps or less 1 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 mops 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
Branch circuits - new, alteration, or extension, er panel
Owner signature: Date: A. Fee for branch circuits with
r . . ... .. _.. _ , :,..n..'...., . 2.a� ' . ..W_.:, .,.,. , `: :'k .7 �>,.. ,.`a fi above service or feeder fee, 6.65 2
each branch circuit
Business name; _ , t `L/ e V fjj� 'rieeVI t 4 _ B. Fee for branch circuits
wlthoia service or feedeee. 5 /4 os
/ 46.85 7 U 2
Contact name: r fee.
fast branch circuit
Address: Each add'I branch circuit .5Z 6.65 a4,,( 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Phone: ( ) Fax: : ( )
Reconnect only 66.85 2
E- mail: Pump or irrigation circle 53.40 2
` :` ? ? r. t _LC .�. > - �_ t S ign or outline lighting 53.40 2
Business name: Bridgeton Electric Signal circuit(s) or limited-
Brid energy panel, alteration, or
Address: 22732 NW Glllihan Road extension. Describe: Page 2 2
City /State/ZIP: Portland, Oregon 97231 Each additional inspection over allowable in an of the above
Per inspection 62.50
Phone: (503)621 -7122 Fax: (503) 621.7123 Investigation per hour (I hr rain) 62.50
CCB Lie.: 103824 Electrical Lie.: ,-887c Suprv. Lie.: 4177s Industrial • rant per hour 73.75
Suprv. Electrician signature, requi Subtotal: • Y S
Print name: Keith Steenslid Date: 10 (
, i , s Plan review (25% of permit fee):
State surcharge (12% of permit fee): g', S 1.
Authorized signature: ' TOTAL PERMIT FEE: S.2 , 4 )(4)
This permit application expires If a permit Is not obtained within ISO
Print name: Date: days after It has been accepted as complete.
• Number of inspections allowed per permit
I: 1B "iti;"gTennits1FIC•PermitApp,doe 05/2346 440.4615T(i I/05/COM/WPB
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2008- 00582
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/10/2008
Phone: (503) 639 -4171 „11 F���
Inspection Requests (24 Hrs.): (503) 639 -4175 - - !�
INSPECTION WORKSHEET FOR DATE 10/28/2008 TIME: 7:01AM PAGE: 5
SITE ADDRESS 097355 SW SHADY LN 303 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: DR FREEDLAND
DESCRIPTION: Relocating switches and receptacles. (5) branch circuits.
OWNER HAZEL INTERNATIONAL, INC AND, PHONE #:
CONTRACTOR: BRIDGETOWN ELECTRIC PHONE #: 503. 621 -7122
Inspection Request Scheduled For: Date 10/28/2008 Pour Time:
Code # Inspection Description • ' # Contact # Message
199 Electrical final 077275.01 503-621 -7122 N
Corrections/Comments/Instructions: ''
l 140 1: LE e.1 , tApoak f^(t.F42ra) iN
I MAN4 (h as ,
•
N.
0
N ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 3” N Sg Date: 1012., CI) Phone #: (503) 718- 1,1A
CITY OF TIGARD ' .
BUILDING DIVISION PERMIT #: El G20flE 0059d
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1(3/1012(10B
Phone: (503) 639 -4171 fib° . l
Inspection Requests (24 Hrs.): (503) 639 -4175 F - —
INSPECTION WORKSHEET FOR. DATE: 10/'13/200t3 TIME 7 :00AM PAGE: 18
SITE ADDRESS: A9735 SW SHADY l N 303 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: DR FREEDLAND
DESCRIPTION: Relocating switches and receptacles. (5) branch circuits.
OWNER: HAZEL INTERNATIONAL, INC AND, PHONE #:
CONTRACTOR: BRIDGETOWN ELECTRIC PHONE #: 503-621 -7122
Inspection Request Scheduled For: Date: 10/1312008 Pour Time:
Code # lnspectio • escription Confirm # Contact # Message
in Wall cover 076619 -01 503.621 -7122 N
Correcti s/ •. :- - s Instructions:
V
SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPE I TION ❑ ADDITIONAL FEES ASSESSED
Inspector: ■ 0 /6! , Date: /0 — / 3 " 4' Phone #: (503) 718-