Permit v.t.P' ELECTRICAL PERMIT
v . CITY OF TIGARD
71 PERMIT #: ELC2008-00312
COMMUNITY DEVELOPMENT DATE ISSUED: 6/3/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1 S125DD 09000
SITE ADDRESS: 09678 SW VENTURA CT ZONING: R - 4.5
SUBDIVISION: WASHINGTON SQUARE ESTATES NO.3 LOT : 098 JURISDICTION: TIG
PROJECT: BERGLUND
Project Description: (5) branch circuits for kitchen remodel.
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:
JOHN & JUD ITH BERGLUND MT HOOD ELECTRIC INC
9678 SW VENTURA CT PO BOX 1270
TIGARD, OR 97223 WELCHES, OR 97067 -1270
Phone: Contact #: PRI 503 - 622 - 1305
FAX 503 - 925 -3525
FEES
Description Date Amount Reg #: ELE 3 -517C
[ELPRMT] ELC Permit 6/3/2008 $73.45 LIC 147640
[TAX] 12% State 6/3/2008 $8.81 SUP 4828S
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
suspend- - or more tha 180 -= ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center
Those ules are set forth i •AR . 5 .01 -0010 through OAR 952 -001 -0100 You may obtain cop)esp these rules or direct questions to OUNC at
503. '46 6699 or 1.800.3 -3•/ ,
Iss , ed By: i b.. L l/ /,At Permittee Signatu �i, ()::_/
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:
ONTRACTOR INSTALLATION ONLY
— 4
SIGNATURE OF SUPR. ELEC'N: 4 .4 �/ L� 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.
,' p.1
Electrical Permit Application FOR OFFICE USE ON L1 1
City of Tigard � � � Rcceised 2 p I ''! (.,., °f,�i ;'�(•„
u 13125 S W Hall Blvd . Tigard. OR $, - Date B e7 Op ! Permit No �����L ere)
Phone 503 639.417 I Fax 503 598 1960 Plcn Rcvle "
InspectionLtne. 503.6394175 SUN 0 3 200 Date /By
Other Permit.
.4RD
Internet Date Ready/By fur El See P.tge2for
u•ww.ligard - gov GARY Notified/Method. l(
PV d �tt Supplemenmllnformati
TIG on
p rf TYPE OF Nirra 01(�, DIN PLAN REVIEW
��}hc Please check all that appl■ (submit 2 sets of pla is v./items checked below)
El New construction ®Addition /al��tjQ
❑ Service or fceder400 amps or more 0 Building over three etones.
❑ Demolition D Other
vtere the available fa.dt current ❑ Marinas ar.d boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps al 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
® 1 and 2 family dwelling ❑ Commercial/industrial
❑ Accessory building amps for all Omer installations. buildmms
❑ Multi - family ❑ Master builder
❑ Other: 0 Fire pump ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system larger separately deiivcd syucm
❑ Addition of nen, motor load of ❑ "A" L° l 2' • 12"
Job no : Job site address 9678 SW Ventura Ct IOOHP or store, occupancy
• ❑ Six or more residential un.ts ❑ Recreational vehicle parks
City / State /ZIP• Tigard OR 97223 - ❑ i lcal,h -race facilities ❑ Supply soilage for more than
❑ Hazardous locations 003 volts noinitis'-
Suite /bldg./apt. no.: Project name: t n w t AA �,� _0Scrvieeor feedar630ampsormore
Cross street /directions to job site: IL/ FEE SCHEDULE
_- - DC3C ripiio I Qty, I Fec. Total I • --
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 145 15 4
Tax map/parcel no- Ea add'I 500 sq ft or portion 33.40 I
DESCRIPTION OF WORK Limited energy, residential T_ OD 2
(with above sq. A)
Kitchen remodel add 3 ckts, alt 2 ckt. Limited energy_ multi- family
residential (vita above sq. ft.) 75 00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less I 80 -30 2
- PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106 85
Name: 11 2
0 "7-6t n , � 401 amps to 600 amps 160.60
Address, N rc-l0 601 amps to 1,000 amps 240.60
Over 1,000 amps or solts 454.65 2
City /StatclLIP: Temporary services or feeders installation, alteration, and /or
I relocation
Phone: i ) fax: ( ) 200 amps or less 66 85
I
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
Owner signature: Date: ,. [ branch circuits- new, alteration. or extension, per panel L
A. Fee for branch circuits with
® APPLICANT I ❑ CONTACT PERSON above service or feeder fee.
Business name: Mt Hood Electric Inc each branch circuit 6 GS
B Fee for branch circuits
Contact name: Vitali without servicc or feeder fee, 1 46 85
first branch circuit 46 80 2
Address: P.O. Box 1270 Each add'I branch circuit 4 6.65 26.6 i 2
City/Slate/ZIP: Welshes OR 97067 Miscellaneous (service or feeder not included)
Each manufactured or modular
Phone: (503} 622 - 1305 dwelling" service and/or feeder 90,90 I 2
F ax:. ( 925 -3525 - Jl
Reconnect only 66 gs 2
E - mail: vitaliy�@mthoodelecrric.com
Pump or irrigation circle 53 4 - 2
CONTRACTOR Sign or outline lighting 53 40 2 -
-
Business name: Mt. Hood Electric Inc Signal circuit(s) or limned -
energy panel. alteration, or
Address. P.O. Box 1270 extension Describe Page 2 2
City /State /ZIP: Welshes OR 97067 Each additional inspection over allowable in any of the ahove
Phone. (503) 622-2305 Fax: (503) 925 - 3525 Per inspection 62.50
Investigation per hour (I Lr min) 62 50
CCB Lie : 147640 612I° Electrical Lie.. 3 -517c Suprv. Lie : 4828s - Industrial plant per hour 73.75
Suprv. Electrician signature, requirer: f /O / ///D ELECTRICAL PERVIJT FEES
�
Subtotal 73 45
Print name d Majerp I Date: 003/08 Plan review (251 of permit fcc):
: \uthorize sig ;
St surcharge (12% of permit fee)' 8 81
82.26
TOTAL FEE Print name: n Date 06(03 /O$
This permit application expines i a pe is not obtained mithin ISO
_� da tes after it ha been acc epted ns com plete.
I . 3ua u,
d; 1.0 -Pe mdApp doe 092 23 `rumba of insp coons allowed per p ermit 40- 4uI5T(1 1,05/C OM11/WE B
CITY. OF TIGARD
BUILDING DIVISION
• PERMIT #: ELC2008-00312
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 613 /20013
Phone: (503) 639 -4171 Via+ �
Inspection Requests (24 Hrs.): (503) 639 -4175 I �..
INSPECTION WORKSHEET FOR DATE: 602008 TIME: 7:00AM PAGE: 8
SITE ADDRESS: 09678 SW VENTURA CT CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE ESTATES NO LOT #: 098 TYPE OF USE:
PROJECT NAME: BERGLUND
DESCRIPTION: (5) branch circuits for kitchen remodel.
OWNER: BERGLUND, JOHN & JUDITH PHONE #:
CONTRACTOR. MT HOOD ELECTRIC INC PHONE #: 503G22 - 1305
Inspection Request Scheduled For: Date: 6/5/2008 Pour Time:
Code # Inspection Description 761ifirm-# Contact # Message
120 Electrical rough -in 070945 -01 503 -622 -1305 N
Corrections/Comments/Instructions:
•
•
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: - ', ��e1� Date: 6-6; Phone #: (503) 718 - mit()
1
CITY. OF TIGARD Ali
1 BUILDING DIVISION , , PERMIT #:
I 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: L'1 C200�OCI312
Phone: (503) 639 -4171 Vi 6 /3/200I3 Inspection Requests (24 Hrs.): (503) 639 -4175 __..
INSPECTION WORKSHEET FOR DATE: 7/28/2008 TIME: 7:03AM PAGE: 26
SITE ADDRESS: 09678 SW VENTURA CT CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE ESTATES NO LOT #: 098 TYPE OF USE:
PROJECT NAME: BERGLUND
DESCRIPTI (5) branch circuits for kitchen remodel.
OWNER: BERGLUND, JOHN & JUDITH PHONE #:
CONTRACTOR MT HOOD ELECTRIC INC PHONE #: 503 - 622 -1305
Inspection Request Scheduled For: Date 712W2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 073289 503.209-9346 N
Corrections /Comments /Instructions:
® p►�6/.._ C..c.c cam At 11A 1\ I5 5 NI Ol wQ6L 1 ,
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
K FAIL N CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
•
Inspector: . Nb4 LE
Date: 1 .D6 Qi Phone #: (503) 718- 1L i
CITY OF TIGARD
BUILDING DIVISION ° PERMIT #:
cLC2008-0031 a
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 513/2008
Phone: (503) 639 -4171 rl1l1.
Inspection Requests (24 Hrs.): (503) 639 -4175 �' F _
INSPECTION WORKSHEET FOR DATE: 7/29/2008 TIME: 7:01AM PAGE: 6
SITE ADDRESS: 09678 SW VENTURA CT
CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE ESTATES NO LOT #: 098 TYPE OF USE:
PROJECT NAME: BERGLUND
DESCRIPTION: (5) branch circuits for kitchen remodel.
OWNER: BERGLUND, JOHN & JUDITH PHONE #:
CONTRACTOR: MT HOOD ELECTRIC INC PHONE #: 503.622 -1305
Inspection Request Scheduled For: Date: 7/29/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
109 Electrical final 073389 -01 503.622 -1305 \ y
Corrections /Comments /Instructions: IR
\ PN \
(z Re. 1 AR.... 6 to hi517 .- v - 0
• ti Cen %.) 0 D .
11-4° . V
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL y FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Y V L Date: Phone #: (503) 718- ILO()
CITY OF TIGARD ' /,y,.
BUILDING DIVISION PERMIT #: EL C2008-00312
{7 {1312
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 613/2008
Phone: (503) 639 -4171 4i AP Requests (24 Hrs.): (503) 639 -4175 --
INSPECTION WORKSHEET FOR DATE: 730/2008 TIME: 7:01AIVl PAGE: 5
SITE ADDRESS: - CLASS OF WORK:
09678 SW VENTURA CT .
SUBDIVISION: WASHINGTON SQUARE ESTATES NO LOT # : 098 TYPE OF USE:
• PROJECT NAME: BERGLUND
DESCRIPTION: (5) branch circuits for kitchen remodel.
OWNER: BERGLUND, JOHN & JUDITH PHONE #:
CONTRACTOR: MT HOOD ELECTRIC INC PHONE #: 503 -622 -1305
Inspection Request Scheduled For: Date: 7130! X008 Pour Time:
Code # Inspection Description Confirm # Contact # sage ■
199 Elethical final 073471 -01 503 -622 -1305 Y
Corrections /Comments /Instructions: 1
3 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G- ' ► N be) LE Date: 11 101 at Phone #: (503) 718- MIA